不同类型屈光参差与弱视和立体视的相关研究

目的:观察不同类型不同差值的屈光参差对视力发育和立体视形成的影响,分析屈光参差与单眼弱视、立体视之间的相关因素.方法:收集2013-01/2014-12在我院门诊初诊屈光参差患者326例的临床资料,记录最佳矫正远、近视力,以及矫正后近立体视,分析弱视和立体视异常的比例.结果:随着屈光参差差值的增大,高屈光眼远近矫正视力下降,弱视发生率增高,异常立体视增多,有统计学差异.远视组出现弱视和立体视异常最早且比例最大,有显著统计学差异.结论:屈光参差差值的大小直接影响弱视和立体视异常的比例,远视性屈光参差形成弱视的差值最小,与其高屈光眼调节功能不足,近视力无法正常发育有关.     

老视矫治的研究进展

老视是一种与年龄相关、因调节能力下降而引起的渐进性视近困难,目前发生机制尚不明确,但矫正方法很多,包括配镜、角膜手术、巩膜手术、晶状体手术和药物治疗,也是屈光手术矫正近视、远视、散光取得良好效果后需要突破的重点;但各种方法均以增加屈光力为目的,并不能真正逆转老视的发生。就老视治疗的方法和集中关注的问题进行综述。     

屈光参差与双眼视觉相关性的临床观察

目的:观察远、近视性屈光参差对患者双眼视功能的影响。方法:采用颜少明等的《立体视觉检查图》和同视机,对矫正视力≥0.9的近视和远视性屈光参差患者174例,分别测定其近立体视和同视机三级视功能。结果:(1)远、近视性屈光参差患者视力矫正后双眼视功能明显好于裸眼,两者矫正前后比较差异均有统计学意义(P均<0.05)。(2)矫正后近视性屈光参差近立体视及融合功能正常者的例数明显多于远视性屈光参差者(P均=0.000);远视性屈光参差远立体视功能正常者的例数明显多于近视性屈光参差者(P=0.000)。(3)矫正后近视性屈光参差者的近立体视锐度与屈光参差差值大小相关(P=0.000),屈光参差差值越大,近立体视功能越差;远视性屈光参差者的近立体视锐度与屈光参差差值大小相关性不明显(P=0.159)。(4)远、近视性屈光参差患者矫正后,近立体视正常患者的构成比小于正常范围为17%及44%。结论:(1)远、近视性屈光参差对双眼视功能的影响不相同,远视性屈光参差对双眼视功能的影响大于近视性屈光参差。(2)无论近视或远视性屈光参差,其对双眼视觉的损害是明显的。     

单眼视LASIK治疗伴有老视的屈光不正临床观察

目的:探讨单眼视准分子激光原位角膜磨镶术(单眼视LASIK)治疗伴有老视的屈光不正对患者视觉质量、生活质量的影响。方法:屈光不正伴老视的患者172例中124例施行单眼视LASIK(主视眼按最佳矫正远视力完全矫正,非主视眼近视者低矫-0.75~-2.00D,远视者过矫0.75~2.00D),35例放弃手术,13例患者双眼全部矫正。观察术后1d;1wk;3mo时的检查结果。结果:术后3mo单眼视LASIK组124例患者双眼远视力0.7~1.2,双眼近视力J1~J3。无因为难以耐受的不适而需要戴镜补充矫正或再次手术者。双眼完全矫正组术后双眼远视力0.7~1.2,双眼近视力J3~J6,8例(62%)视近困难,需配近用眼镜。结论:单眼视LASIK治疗伴有老视的屈光不正安全有效。单眼视治疗在设计手术方案时需根据患者年龄及调节能力、近附加度数、阅读距离、工作性质等综合考虑。     

内斜视相关因素分析

目的探讨影响内斜视的因素。方法观察136例远视度大于 2D的儿童,年龄2～14岁,随访至少2年(24月),观察其发生内斜视的可能性及内斜视矫正的情况。结果1.未被矫正的远视并不都过度使用调节引起集合过强而致内斜视;2.高度远视合并内斜视其内斜视的矫正满意度明显较中低度远视差;3.斜视矫正满意与否与发病到就诊时间明显相关;4.斜视矫正满意与否与弱视程度有关;5.斜视矫正满意与否与立体视有一定关系。结论影响内斜视的因素包括弱视程度,双眼视功能,屈光参差,远视的程度等。     

准分子激光原位角膜磨镶术治疗儿童高度远视屈光参差性弱视的效果

目的评价准分子激光原位角膜磨镶术（LASIK）矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性,并探讨其对术后弱视治疗效果的影响。方法采用前瞻性自身对照法观察42例高度远视屈光参差性弱视儿童病例,年龄范围6～14岁。使用SVS Apex plus准分子激光系统（其中联合L型mask盘矫正单纯远视9例,联合P型mask盘矫正远视合并散光12例）及鹰视世纪波准分子激光系统（21例）,在局部麻醉或全身麻醉下对患儿高度远视眼行LASIK,术后进行弱视治疗。术后对视力、屈光度和双眼视功能进行分析。随访时间6～24个月。结果矫治屈光度数为＋3．00-＋7．50D,术后2年66．6％术眼残余屈光度数在预计矫正屈光度数±1．00D的范围内。术后随访发现睫状肌麻痹下等值球镜屈光度数波动范围为＋0．99～＋0．67D。最佳戴镜矫正远、近视力均不丢失。术后2年平均最佳戴镜矫正远视力为0．40±0．28,平均最佳戴镜矫正近视力为0．78±0．39。经规范弱视治疗,双眼不等像、同时视、融合、立体视及隐斜均得以改善。结论对患有高度远视性屈光参差且不能耐受戴镜矫治的儿童,采用LASIK矫治屈光参差是安全、有效的,具有良好的可预测性和稳定性,且这一手术有助于提高高度远视屈光参差性弱视的治愈率。     

屈光不正儿童非斜视性双眼视异常状况分析

目的 探讨屈光不正患儿非斜视性双眼视异常状况。方法 随机抽取门诊153名6～12岁屈光不正患儿，近视79例，远视74例，男85例，女68例，平均年龄9．6岁，对照组94例，平均年龄9．2岁，给予屈光状态检查并根据Morgan正常值，Sheard、Percival准则，综合分析远、近分离性隐斜、辐辏近点、远近相对辐辏、调节幅度、调节灵活度等非斜视性双眼视觉检查指标。结果 1．本组研究中非斜视性双眼视异常最常见症状为视疲劳34．64％、视物模糊32．68％、不能持久阅读22．87％。2．本组调节异常检出率为11．11％，双眼视觉异常检出率为28．76％；3．非斜视性双眼视异常检出率在远视、近视组与正常组间差异有显著性（P＜0．05），在近视重、中度与轻度组间差异有显著性（P＜0．05），在远视重度组与中、轻度组间差异也有显著性P＜0．05。结论 屈光不正患儿进行标准屈光矫正前调节、非斜视性双眼视异常检出率高；其调节、非斜视性双眼视异常检出率与屈光程度相关。提示伴有非斜视性双眼视异常的屈光不正患儿，在医学验光配镜过程中，不仅要注意矫正患儿单眼视力，还应同时关注并训练提高患儿的双眼视功能。     

学龄儿童屈光矫正前后非斜视性双眼视异常研究

目的 比较学龄儿童屈光矫正前后非斜视性双眼视功能异常状况。方法 随机抽取门诊156名6-12岁屈光不正患儿,经双眼视觉各项检查,根据Morgan正常值及Sheard Percival准则,综合分析判定其双眼视功能。结果 ①屈光矫正后非斜视性双眼视异常检出率明显低于矫正前。②屈光矫正后,远、近视组非斜视性双眼视异常检出率相近,但近视组非斜视性双眼视异常恢复率较远视组高。结论 ①未经标准屈光矫正的患儿非斜视性双眼视异常检出率高,其恢复率与屈光状态相关,戴镜矫正是防治屈光不正儿童非斜视性双眼视异常的有效方法。②在配镜矫正前应全面了解,并根据其调节、双眼视功能状况确定配镜处方,对治疗非斜视性双眼视异常具有重要的临床意义。     

大龄近视患者行LASIK的体会

目的:探讨大龄近视伴调节力下降患者行准分子激光原位角膜磨镶术(LASIK)的手术设计对视力的影响。方法:屈光不正伴老视的患者32例63眼中27例53眼行单眼LASIK主视眼按最佳矫正远视力完全矫正,非主视眼近视欠矫-0.5～-2.00D,5例10眼双眼远视力全部矫正。观察术后3mo视力。结果:术后3mo,27例53眼远视力主视眼1.0～1.2,非主视眼0.3～0.6;近视力主视眼0.6,非主视眼1.0。5例10眼双眼远视力完全矫正。结论:LASIK矫正大龄调节力下降患者,在设计手术方案时需按患者要求、年龄等综合考虑。     

远、近视性屈光参差视功能对比研究

目的：对比分析远、近视性屈光参差对患者双眼视功能的影响。

方法：对238例屈光矫正后的屈光参差者和30例正常者进行近立体视和同视机三级视功能检查,并记录其结果。

结果：近视性屈光参差远、近立体视及融合功能正常者的例数高于远视性屈光参差者。远视性屈光参差组有正常立体视者少,低度屈光参差组以亚正常立体视者为主,而高、重度屈光参差组多无立体视; 近视性屈光参差组多有正常立体视或亚正常立体视。

结论：近视性屈光参差的双眼视功能总体优于远视性屈光参差,但屈光参差与立体视的关系应按性质分别进行分析。     

Visual acuity outcome in isometropic hyperopia

Refractive amblyopia may occur as a unilateral or bilateral condition. Although bilateral refractive amblyopia may account for 1 to 2% of all refractive amblyopia, there is little consistent information in the literature regarding isoametropic amblyopia resulting from bilateral hyperopia. Hence, this retrospective study investigated the prevalence of reduced aided acuity in patients aged 10 years and younger (mean age 3.97 years) with 5 D or more of isometropic hyperopia and considered the following factors that may influence visual acuity: (1) age at first correction; (2) magnitude of hyperopia; and (3) duration of refractive correction of the hyperopia. The results indicate that the majority of patients (87%) have aided acuity poorer than 6/6 at initial correction of refractive error. However, if the full hyperopic correction was worn for 1 year or longer, only 43% of these patients demonstrated acuity poorer than 6/6 and none showed acuity poorer than 6/12. The magnitude of the hyperopia appeared to have the greatest influence on the visual acuity outcome both at initial correction of refractive error and 1 year or longer after correction. Duration of correction also influenced the visual acuity outcome, but to a lesser extent than the magnitude of refractive error. In contrast, the age of first correction showed little correlation with visual acuity either at the time of first refractive correction or after a minimum of 1 year of correction.     

准分子激光屈光性角膜手术后人工晶状体度数的计算

准分子激光屈光性角膜手术后,患者发生白内障需行白内障摘除及人工晶状体植入术时,按常规方法计算人工晶状体屈光度往往会在术后产生远视,而这样的误差主要来源于角膜屈光力的测算误差和计算公式的误差,另外还有眼轴长度测量和有效人工晶状体位置计算的准确性降低这两个方面的原因.因此,对于曾行角膜屈光手术的白内障患者,术前运用适当的方法准确估算角膜屈光力,并选择合适的人工晶状体计算公式,可以减少屈光误差.     

学龄儿童远视眼戴镜矫正对发生近视的影响

目的:探讨儿童远视眼与发生近视的相关性。方法:经常规扩瞳验光后诊断+0.75～+4.00D的远视眼儿童122例244眼,分戴镜治疗组和非戴镜对照组;每3mo复查常瞳的裸眼、戴镜视力和显性屈光状态1次,每年常规扩瞳验光1次;应用复方托吡咔胺滴眼液作睫状肌麻痹剂,滴眼共6次,滴最后1次40min后检影验光;连续3a观察屈光状态的演变。结果:戴镜组7,8,9岁的平均远视度分别是+1.66D,+1.71D和+1.65D,非戴镜组7,8,9岁的平均远视度分别是+1.28D,+1.08D和+1.10D;观察满3a时,戴镜组年均下降远视度分别是+0.26D,+0.26D和+0.31D,发生近视分别有2眼(4.8%),1眼(2.5%)和4眼(10.0%);非戴镜组年均下降远视度分别是+0.58D,+0.59D和+0.66D,发生近视分别有18眼(42.9%),24眼(60.0%)和33眼(82.5%)。两组相比,有非常显著性的差异(P<0.01)。结论:戴镜矫治远视眼儿童的远视屈光度比不戴镜矫治的下降慢,近视的发生率比不戴镜矫治的明显低。     

欠矫和足矫对高度远视屈光不正性弱视患儿的疗效分析

目的:探讨欠矫正与足矫正是否影响高度远视屈光不正性弱视患儿屈光度的变化和视力的提升。方法:回顾性病例研究。收集2015-01/2019-12在遂宁市中心医院行弱视治疗满3a及以上的高度远视屈光不正性弱视患儿49例98眼。根据患儿配镜处方与睫状肌麻痹验光结果的差别分欠矫正组29例58眼(球镜度数相差≥1.5D)和足矫正组20例40眼(球镜度数相差≤0.25D)。分析两组患儿3a治疗过程中矫正视力和屈光度的变化。结果:初诊时两组患儿的年龄、屈光度和矫正视力均无差异(P>0.05)。矫治过程中两组患儿的屈光度均逐渐降低,且欠矫正组患儿屈光度下降幅度高于足矫正组(F时间=500.299,P时间<0.01;F组间=6.949,P组间=0.010)。治疗过程中欠矫正组患儿总的屈光度下降1.215±0.262D,高于足矫正组0.612±0.211D(t=-12.068,P<0.01)。两组患儿的矫正视力都随治疗时间的延长而改善,欠矫正组患儿视力改善优于足矫正组(F时间=1138.526,P时间<0.01;F组间=14.206,P组间<0.01)。结论:远视欠矫正患儿屈光度下降和视力提升优于足矫正,适当的远视欠矫正能更好地促进高度远视屈光不正性弱视患儿眼球的生长和视力提升。     

Relation between preoperative hyperopia and surgical outcome in infantile esotropia

AIM: To evaluate the relation between preoperative hyperopia and surgical outcomes of infantile esotropia in patients younger than 24 months of age. METHODS: Medical records of patients who underwent bilateral medial rectus muscle recession for infantile esotropia between November 1, 2002 and December 1, 2011 were retrospectively reviewed. Patients were divided into two groups according to the degree of preoperative hyperopia. Group I had less than +3.0 diopter (D) of hyperopia and group II had between +3.0 and +5.0 D of hyperopia. Postoperative alignments were evaluated 1wk, 3, 6mo, and 1y after surgery. Following the 1-year postoperative visit, patients were monitored yearly. Relationships between preoperative factors including hyperopia and postoperative outcomes were evaluated. RESULTS: Forty-six patients were included, with 33 patients in group I and 13 patients in group II. The preoperative mean refractive error was +0.88 D in group I and +3.45 D in group II. Surgical outcomes were not significantly different between groups at any postoperative time point examined. Cumulative probability of surgical success, prevalence of inferior oblique overaction, dissociated vertical deviation, and re-operation rate were not significantly different between groups. CONCLUSION: Preoperative moderate hyperopia (less than +5.0 D) did not affect the surgical outcome of infantile esotropia. Therefore, the surgical correction of esotropia should be considered when the angle of esodeviation is unchanged following hyperopia correction, even in children with moderate hyperopia.     

Conductive keratoplasty for the correction of residual hyperopia after LASIK

PURPOSE: To report the 6-month results concerning efficacy, safety, predictability, and stability of conductive keratoplasty for the correction of residual hyperopia after corneal refractive surgery. METHODS: A total of 35 eyes (26 patients) with residual hyperopia after corneal refractive surgery ranging between +1.00 to +4.75 diopters (D) of spherical equivalent refraction were enrolled in the study and underwent conductive keratoplasty following a modified nomogram. RESULTS: Variables and data were available for all eyes at 6 months postoperatively. A total of 24 (69%) eyes had uncorrected visual acuity (UCVA) of > or = 20/40, and 10 (29%) eyes had UCVA of 20/20. Manifest refractive spherical equivalent was within +/- 0.50 D in 17 (49%) eyes and within +/- 1.00 D in 25 (71%) eyes in cases of previous hyperopic LASIK; the optical zone was significantly increased. CONCLUSIONS: Using a modified nomogram, conductive keratoplasty for correction of residual hyperopia was effective, but predictability was not satisfactory and safety needs to be established.     

Cyclotherapy in the treatment of symptomatic latent hyperopia

Many practitioners have long been frustrated with traditional treatments of symptomatic latent hyperopia (fogging techniques, bifocals, etc.). A technique employing short-acting cycloplegia has been developed which provides rapid relief of symptoms by promoting full correction of latent refractive error. Fifteen symptomatic subjects ages 3-40 were diagnosed as latent hyperopes with the aid of 1% cyclopentolate, and subsequently recyclopleged utilizing full correction in constant wear spectacles. Acuity was maintained via slow diminution of cycloplegia. Short-term and long-term follow-up, with continued use of spectacles or contact lenses, revealed rapid and complete resolution of symptoms and restoration of visual efficiency in each case. Cyclotherapy offers both practitioners and patients an efficient, rapid-acting, and satisfying alternative treatment for this vexing accommodative anomaly.     

Abnormal head posture associated with high hyperopia.

BACKGROUND: An abnormal head posture may be adopted for ocular or nonocular reasons. The most common ocular reasons are to maintain binocularity and to obtain the best possible visual acuity. Patients with undercorrected or overcorrected refractive errors have been reported to adopt a variety of head positions, thought to be an attempt to obtain the best possible visual acuity. METHODS: Five patients with symmetric high hyperopia (at least + 5.00 D) and an abnormal head posture are presented. RESULTS: All five patients demonstrated an abnormal head posture of chin down for fixation without the spectacle correction in place. This abnormal head posture was eliminated by occlusion of either eye and also by wearing of the refractive correction. No patient demonstrated significant strabismus. CONCLUSION: An abnormal head posture when not wearing spectacle correction can occur in children who have high hyperopia and insignificant strabismus. This may be a mechanism by which the best visual acuity is obtained (indicated by the disappearance of the abnormal head posture on wearing of the glasses) and also to maintain binocularity (indicated by the disappearance of the abnormal head posture under monocular testing conditions). The presence of a chin-down abnormal head posture should alert the examiner to the possible presence of high hyperopia and therefore the necessity for a cycloplegic refraction.     

上海市学龄儿童屈光与立体视锐度的调查

目的 探讨学龄儿童屈光状态和立体视的分布特征以及立体视锐度、屈光状态与年龄、眼轴长度之间的关系.方法 横断面调查研究.采用整群抽样,随机抽取上海市8所小学,对抽取到的学校的所有学生进行问卷调查和视力、立体视、电脑验光、眼轴长度等眼科检查.根据年龄（6岁组、7岁组、8岁组、9岁组及10岁组）及屈光状态（正视组、轻度近视组、中高度近视组、轻度远视组及中高度远视组）分组.对计数资料组间比较采用卡方检验,计量资料中正态分布的数据组间比较采用单因素方差分析,非正态分布的数据采用非参数检验.并采用等级相关分析变量之间的相关性.结果 学龄期儿童随年龄的增长,近视的检出率有上升的趋势,远视的检出率有下降的趋势,经等级相关分析,近视的检出率与年龄呈正相关（r=0.427,P＜0.01）,远视的检出率与年龄呈负相关（r=-0.269,P＜0.01）.不同年龄组裸眼视力正常儿童的立体视锐度差异具有统计学意义（Kruskal Wallis检验,x2=88.867,P＜0.01）,其中6岁组与7岁组立体视锐度差异有统计学意义（Z=2.584,P＜0.01）,7岁组与8岁组、8岁组与9岁组、9岁组与10岁组间差异无统计学意义.不同屈光状态儿童立体视异常检出率差异具有统计学意义（x2=57.294,P＜0.01）.不同屈光状态立体视锐度组间差异具有统计学意义（Kruskal Wallis检验,x2=67.428,P＜0.01）,其中中高度远视组（Z=2.584,P＜0.01）、中高度近视组（Z=2.138,P＜0.01）及轻度远视组（Z=1.819,P＜0.01）立体视锐度与屈光正常组比较,差异均有统计学意义,而轻度近视组与屈光正常组比较差异无统计学意义.眼轴长度有随年龄而增长的趋势,不同年龄组眼轴长度差异具有统计学意义（F=115.248,P＜0.01）,各组间两两比较差异均具有统计学意义（P＜0.01）.结论 学龄儿童眼球存在由远视到正视再到近视的发展过程;立体视发育成熟年龄在7～8岁,远视及中高度近视对学龄儿童立体视的建立影响较大;学龄儿童眼轴长度随年龄增长逐渐增加.