儿童屈光参差性弱视立体视觉中枢区激活的fMRI远期研究

目的：运用血氧水平依赖性功能核磁共振成像技术(BOLD-functional magnetic resonance imaging,BOLD-fMRI)阶段性评价屈光参差性弱视儿童在规范弱视训练后视皮质相关功能区激活情况。

方法：收集先期研究及后续收集屈光参差性弱视儿童共13例进行任务态组块模式(Blocks)的功能磁共振(fMRI)研究,采用前后对照t检验对规范弱视治疗18mo和24mo及终止治疗6mo后的脑功能激活数据进行分析。图像处理平台为Matlab 7.12.0.635的SPM8软件。

结果：各阶段功能区激活主要集中在左枕叶(Brodmann 18区)、枕中回(Brodmann 19区)、边缘叶(Brodmann 19区)、双侧顶上小叶(Brodmann 7区)、右枕叶舌回(Brodmann 17区),弱视治疗24mo激活范围无明显扩大,差异无统计学意义(mean T=1.014,P>0.01),终止治疗6mo后激活范围差异无统计学意义(mean T=0.9793,P>0.01)。

结论：屈光参差性弱视治疗2a后视中枢基本稳定,持续弱视治疗对于视中枢功能重建无显著作用。     

屈光参差性弱视患儿综合治疗效果的相关因素研究

目的：探究影响屈光参差性患儿综合治疗效果的相关因素,为临床干预提供理论依据。

方法：选取我院2013-10/2014-10间收治的100例屈光参差性弱视患儿,经过6～18mo的治疗后根据治疗效果分为A、B、C三组,A组54例,治疗效果判定为治愈; B组34例,治疗效果判定为进步; C组12例,治疗效果判定为无效。对其年龄、依从性、屈光参差程度、屈光参差类型、弱视程度、注视性质进行分析。

结果：三组患者之间屈光参差类型差异无统计学意义(P>0.05),而三组患者之间年龄、治疗依从性、屈光参差程度、弱视程度、注视性质相比差异有统计学意义(P<0.05)。通过回归方程分析各因素对综合治疗效果影响程度依次为弱视程度、屈光参差程度、注视性质、年龄、依从性。

结论：屈光参差性患儿综合治疗效果与年龄、治疗的依从性、屈光参差程度、弱视程度、注视性质密切相关,而与患儿的屈光参差类型无明显的相关性。     

The Prevalence of Anisometropia,Amblyopia and Strabismus in Schoolchildren of Shiraz,Iran

Purpose: To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran.

Materials and Methods: A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus.

Results: Mean age of 2638 schoolchildren was 12.5 years (response rate?=?86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p?=?0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively.

Conclusions: Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.     

Effect of induced anisometropia on stereopsis and surgical tasks in a simulated environment

Purpose:To quantitatively correlate the loss of stereopsis by induced anisometropia with its effect on tasks that require binocular vision and stereopsis, such as ophthalmic surgery in a simulated environment.Methods:Thirty-nine ophthalmic residents with best-corrected visual acuity of 20/20 or better OU, with normal binocular vision and stereopsis, were recruited for the study. Anisometropia was induced using spherical and cylindrical trial lenses from +1D to +5D in a trial frame. The residents performed an anterior chamber navigation exercise on the EYESi simulator and the surgical score at baseline and for each level of induced anisometropia was noted. Near stereopsis was assessed by the Randot test and TNO test at baseline and for each level of induced anisometropia.Results:Stereoacuity on the Randot test and TNO test were 30 (95% CI, 25.9–34.1) and 44.4 (95% CI, 28.5–60.3) arcseconds, respectively which reduced to 65.5 (95% CI, 48.7–82.3) and 75.9 (95% CI, 15.5–136.3) arcseconds at anisometropia of +1D Sph (P < 0.001) and 380 (95% CI, 309.9–450.1) and 1922.1 (95% CI, 1582.5–2261.7) arcseconds for +5D Sph, respectively for the two tests, (P < 0.001). The corresponding surgical score reduced from 93.8 (95% CI, 91.1–96.7) to 87.5 (95% CI, 79.2–95.8, P < 0.001) for 1 DSph and 55.97 (95% CI, 38.3–73.7, P < 0.001) for 5DSph. There was a strong negative correlation between stereopsis scores and surgical task scores (Spearman''s rho -0.86, P value <0.001) Similar changes were seen for anisometropia induced with cylindrical powers.Conclusion:Induced anisometropia is associated with a significant diminution in surgical task scores in a simulated environment and this is correlated with the deterioration in stereoacuity. Assessment of stereopsis may be included as a regular part of the screening procedure for ophthalmic trainee residents.     

An Audit of The Royal College of Ophthalmologists Strabismic Amblyopia Treatment Protocol: A Departmental Review

Introduction: Children presenting with strabismus and mixed (anisometropic/strabismic) amblyopia are managed by a local protocol as per guidelines from the Royal College of Ophthalmologists. Decisions regarding intervention for occlusion are currently delayed until a 22 week review allowing for refractive adaptation, with intermediate reviews at 6 and 14 weeks. Purpose: The purpose of this audit was to determine adherence to the protocol and the benefit of the 14 week review. Materials and Methods: We performed a prospective data collection of all children attending the orthoptic department with strabismus without pathology, both with and without unequal vision, from October 2007 to July 2008 managed using the protocol. Results: 26 patients were eligible. Mean age at presentation was 3.3 years (1.4 to 6.5). Cycloplegic spherical equivalent (SE) mean was 2.6 dioptres (?2.25 to +7.25). Five patients failed to comply with the protocol; one patient was listed surgery, four patients commenced premature occlusion. At presentation 8 patients had equal vision (defined as < 0.1 logMAR difference) between the two eyes or would only perform BEO vision, by week 14, over 60% were found to have a difference in vision between the eyes, despite refraction correction (mean 0.4 logMAR, range 0 to 1.4 logMAR). In a subgroup of patients (n = 8 at 6 weeks) with a small discrepancy of vision between the eyes (0.1 to 0.5 logMAR) there was no progressive worsening of vision during the period of observation and 50% of patients improved spontaneously, although two patients were lost to follow up. In the subgroup (n = 10 at 6 weeks) with a large discrepancy between the eyes (> 0.5 logMAR), all patients ultimately required occlusion, and there was minimal improvement in only three patients. Conclusion: Recorded vision at 6 weeks is more informative for making treatment decisions than that recorded at presentation. The 14 week review confers no benefit to those with reliable and improving visual acuity. Those patients presenting with a large discrepancy in visual acuity do not improve after 14 weeks and we feel that these patients could be occluded at 6 weeks. We propose a new algorithm for the treatment of this patient group.     

近视性屈光参差患者双眼角膜生物力学及眼压特点的研究

目的观察近视性屈光参差患者双眼角膜生物力学及眼压的特点。设计回顾性病例系列。研究对象116例(232眼)近视性屈光参差患者。方法按每人双眼等效球镜度(SE)高低分为低SE眼和高SE眼,比较双眼标志角膜生物力学参数的角膜阻力因子量(CRF)、角膜滞后量(CH)和眼压的特点;根据双眼间等效球镜度差值分为组1(SE差值2.5～3.0 D,37例)、组2(SE差值﹥3.0 D～6.0 D,44例)和组3(SE差值>6.0 D,35例),比较不同屈光参差程度组内低SE眼和高SE眼CRF、CH和眼压的特点。主要指标CRF、CH、角膜补偿眼压。结果总体低SE眼和高SE眼间的CRF分别为(10.40±1.74)mm Hg和(10.38±1.63)mmHg,差异无统计学意义(t=0.113,P=0.683),CH分别为(9.71±1.68)mm Hg和(9.66±1.90)mm Hg,差异亦无统计学意义(t=0.144,P=0.886)。在屈光参差程度不同的三组中,双眼间低SE眼与高SE眼CRF的差异均无统计学意义,组1:(10.58±1.74)mm Hg,(10.65±1.61)mm Hg(t=-0.175,P=0.862);组2:(10.31±1.88)mm Hg,(10.14±1.58)mm Hg(t=0.434,P=0.666);组3:(10.35±1.47)mm Hg,(10.31±1.65)mm Hg(t=-0.141,P=0.903)。各组双眼间CH差异亦均无统计学意义,组1:(9.66±1.59)mm Hg,(9.74±1.52)mm Hg(t=-0.210,P=0.834);组2:(9.89±1.90)mm Hg,(9.83±2.21)mm Hg(t=0.122,P=0.903);组3:(9.59±1.35)mm Hg,(9.35±1.71)mm Hg(t=0.336,P=0.512)。总体低SE眼和高SE眼间的角膜补偿眼压分别为(18.37±3.58)mm Hg和(18.67±3.48)mm Hg,也未发现差异有统计学意义(t=-0.607,P=0.545)。结论近视性屈光参差患者双眼间角膜生物力学参数及眼压无显著性差异。     

屈光参差性弱视治愈前后双眼视觉的检测与分析

目的:了解屈光参差性弱视治愈前后双眼视觉状况。方法:对56例103眼屈光参差性弱视儿童,分别在治疗前和基本治愈后检测其立体视锐度及同视机三级视功能。结果:基本治愈前后:同时视功能无明显差异(P>0.05);立体视锐度有显著性差异(P<0.01);融合功能和定性远立体视也有统计学意义(P<0.05)。结论:屈光参差性弱视不仅影响视力同时也影响双眼视觉发育,随着视力提高其双眼视功能也有明显改善,所以在弱视治疗时应注重双眼视觉的建立与完善。     

综合治疗大龄儿童及青少年屈光参差性重度弱视疗效分析

目的:观察大龄儿童及青少年屈光参差性重度弱视综合性治疗的疗效。方法:将56例56眼9~19岁的屈光参差性重度弱视患者分成两组,两组患者均充分散瞳验光,观察组(A组)配戴高透氧性硬性角膜接触镜(rigid gas permeable contact lens,RGPCL),对照组(B组)给予足矫框架眼镜,两组均进行遮盖、增视治疗、脱抑制治疗,在弱视眼矫正视力>4.7时,除继续遮盖、增视治疗、脱抑制治疗外,增加双眼视觉及立体视觉训练,随访观察24mo。结果:弱视治疗18mo后,两组的总有效率均为100%。比较两组的弱视治疗24mo时临床治愈率、脱抑制率、立体视≤100"患者所占百分比。A组临床治愈率为33%,B组为8%,A组的临床治愈率高于B组,两组疗效差异有显著性(χ2=4.02,P<0.05)。A组的脱抑制率为37%,而B组的脱抑制率为4%,两组疗效差异有显著性(χ2=14.43,P<0.05)。A组立体视≤100"患者占30%,B组占4%,两组疗效差异有显著性(χ2=4.83,P<0.05)。A组全部患者均能满意接受配戴RGPCL,所有患者均未出现角膜上皮损伤、感染、结膜明显充血、分泌物增多及眼部磨痛、痒、异物感等不适。在配戴过程中未出现镜片护理方面问题。结论:对大龄儿童及青少年屈光参差性重度弱视应采取积极弱视治疗,两组的有效率达到了100%。配戴RGPCL组24mo脱抑制率、临床治愈率、立体视优于戴框架眼镜组。对于屈光参差性弱视,应建议患者戴RGPCL以提高临床治愈率,最大可能地恢复立体视。     

LASIK矫治高度屈光参差性弱视儿童的立体视觉研究

目的观察儿童高度屈光参差性弱视患者接受LASIK后立体视觉的恢复情况及其矫治儿童高度屈光参差性弱视的疗效。设计前瞻性非随机自身对照观察。研究对象36例36眼行LASIK手术的6～12岁高度屈光参差性弱视儿童患者。方法患者在LASIK术前、术后3、6及12个月检查视力、屈光度,采用颜氏立体视觉检查图检查立体视觉。立体视锐度≤60”为有中央立体视;80＂-800”为有周边立体视;〉800”为立体视盲。按最佳矫正视力分为轻、中、重度弱视三组。主要指标立体视锐度。结果LASIK术后12个月裸眼视力、最佳矫正视力、屈光参差程度较术前均明显改善（P均〈0．05）。术前、术后6个月和术后12个月立体视盲分别占55．6％（20例）、33．3％（12例）和16．7％（6例）（P均〈0．05）。术后12个月轻度弱视组100％恢复了立体视,其中40．0％（8例）恢复了中央立体视;中度弱视组有10．0％（1例）恢复了中央立体视,70．0％（7例）恢复了周边立体视;而重度弱视组仅33．3％（2例）恢复了周边立体视（P均〈0．05）。术后12个月,年龄〈10岁者与≥10岁者分别有89．5％、76．5％恢复了立体视（P=0．351）。结论屈光参差性弱视儿童立体视建立与弱视程度、弱视治疗时间有关。对于不能耐受戴镜矫正的严重屈光参差性弱视患儿,LASIK手术是一种安全、有效的治疗手段,术后可能恢复正常或部分立体视。     

角膜塑形镜对近视患者双眼视功能的影响

角膜塑形镜通过本身逆几何的特殊设计,可以改变角膜形态和控制眼轴的增长,对青少年近视的控制和矫正取得了显著的临床效果,因此,获得了国内外专家的高度评价,并得到了广泛的应用。近年来的实验表明,角膜塑形镜对近视性屈光参差患者屈光度数的控制以及对近视患者双眼视功能的改善,也有明显的效果。本文通过角膜塑形镜控制近视屈光度数增长的机制和效果、对屈光参差患者的治疗、对眼调节参数的影响和对双眼视功能的改善等方面最新的研究进展进行介绍。