儿童癔症性双眼视力下降一例

癔症性眼病是以眼部症状为主而首诊于眼科的心理性疾病。该病多见于成年人,儿童期发病较少,但资料显示儿童癔症的发病率逐年上升[1、2]。因儿童语言表达能力较差,且癔症性眼病的临床表现复杂多变,易造成诊断延迟及误诊。故眼科医生应提高对该病的认识,给予及时治疗。现我院有儿童癔症性视力下降1例报道如下。     

双暗示疗法治疗儿童癔症性弱视

目的 探讨双暗示疗法在治疗儿童癔症性弱视中的作用.方法 对2009年～2011年中来我院儿童眼科就诊的31例癔症性弱视的患者采用双暗示疗法治疗.结果 经双暗示疗法治疗后,31例患者均治愈.其中4例出现反复,但经过巩固治疗后,又恢复正常.所有患者6个月内随诊,完全康复.结论 儿童癔症性眼病的临床表现多样,而癔症性弱视为主要表现,运用双暗示疗法进行治疗不仅方法简单易行而且疗效显著.     

两种手术方式治疗中重度先天性上睑下垂的疗效比较

目的：评价上睑提肌缩短术(LS)和额肌筋膜悬吊术(FMFS)治疗中重度先天性上睑下垂的疗效。

方法：回顾性分析2014-01/2017-12于我院住院手术的中重度先天性上睑下垂患者145例188眼,根据手术方式分为LS组(55例71眼)和FMFS组(90例117眼)。术后随访观察两组患者的手术疗效及并发症发生情况。

结果：术后12mo,LS组和FMFS组的手术效果\〖满意率(20.0% vs 32.2%)、基本满意率(70.9% vs 60.0%)、不满意率(9.1% vs 7.8%)\〗无明显差异(U=-1.415,P=0.147),但年龄<5岁的患者中FMFS组满意率高于LS组(32.0% vs 8.7%),两组患者手术疗效有明显差异(U=-2.244,P=0.025)。本组患者手术并发症均发生于术后1～15d,其中结膜脱垂仅发生于LS组(11例11眼),眼睑血肿仅发生于FMFS组(4例4眼),暴露性角膜炎、睑内翻倒睫、睑缘畸形、睑球分离在两组患者中均有发生。

结论：LS术和FMFS术对中重度先天性上睑下垂均有良好的矫正效果,FMFS术在5岁以下患者中手术满意率更高。     

三种手术方式治疗翼状胬肉疗效比较

目的:通过翼状胬肉单纯切除术、角膜缘干细胞移植及角膜缘干细胞移植联合金因舒治疗翼状胬肉疗效比较,观察其治愈、复发率及角膜修复时间,评价其疗效。方法:将120例121眼翼状胬肉患者随机分为三组:翼状胬肉单纯切除组、角膜缘干细胞移植组及角膜缘干细胞移植联合金因舒治疗组,随诊0.5a,观察三组患者的治愈率、复发率及角膜修复时间,数据用SPSS13.0统计软件处理。结果:角膜缘干细胞移植联合金因舒治疗组患者翼状胬肉的治愈率明显提高,复发率低,角膜修复时间明显短于其余两组,结果具有统计学意义(P<0.05)。结论:角膜缘干细胞移植联合金因舒治疗翼状胬肉能明显提高治愈率,缩短角膜修复时间,为临床上翼状胬肉的治疗提供新的方法。     

物理治疗仪器治疗幼儿视力不良疗效观察

目的探讨应用物理治疗仪器在治疗幼儿视力不良的疗效,研究幼儿视力不良群体防治的治疗措施。方法对100例(198只眼)视力不良幼儿,采用综合的物理治疗方法进行治疗。结果在100例参加治疗的幼儿中,总有效率为81.3%,基本治愈率为65.2%,其中,3～4岁组为85.7%,4～5岁组为89.5%,>5岁组为73. 5%。结论应用综合的物理治疗方法治疗幼儿视力不良有较好的效果,早发现、早治疗,可提高治疗效果。     

视觉训练对功能性视力下降患者的疗效

目的 分析功能性视力不良患者集合功能、调节功能特点,研究双眼视觉训练对功能性视力不良患者的疗效.方法 回顾性研究.收集2012年7月至2013年10月于天津市眼科医院视光中心视觉训练工作室就诊的功能性视力不良的患者20例,平均年龄(11.2±5.9)岁.所有患者均排除眼部疾病、弱视危险因素和全身性疾病.在屈光矫正的基础上进行双眼视功能检查.分析、诊断后进行视觉训练治疗以提高矫正视力.采用配对t检验、Spearman相关性分析等进行统计分析.结果 患者右眼屈光度为+2.25～-8.75 D,左眼屈光度+2.87～-8.63 D.根据双眼视功能检查结果发现20例患者中,有13例诊断为集合不足并伴调节功能异常,有4例诊断为调节过度,2例为基本型外隐斜,1例为散开不足.经过2个月的视觉训练治疗,所有患者远、近矫正视力均提高到1.0(Z=-3.948,P＜0.01;Z=-3.193,P＜0.01).视力恢复后集合功能指标近距离融像范围(PRV)破裂点增加(t=-5.173,P＜0.01);单眼调节灵敏度(MAF,Z=3.928,P＜0.01)、双眼调节灵敏度(BAF,Z=-3.835,P＜0.01)、正负相对调节(PRA,t=4.094,P＜0.01;NRA,t=-4.254,P＜0.01)等调节功能均恢复到正常,差异有统计学意义.进行相关分析发现,训练前矫正远视力(r=-0.584,P＜0.01;r=-0.658,P＜O.01)、训练前矫正近视力(r=-0.451,P＜0.01;r=-0.540,P＜0.01)均与远隐斜、近距离融像范围呈负相关.结论 功能性视力不良患者通常伴有集合功能、调节功能不良,进行有效的视觉训练治疗,可以提高视力.     

两种手术方式治疗先天性白内障的疗效比较

目的：比较两种治疗先天性白内障手术方式的临床疗效。方法：选择2009-12/2012-12在我院行白内障手术治疗的患儿52例84眼,按手术方式分为两组：A组超声乳化吸除＋后囊膜环形撕开,B组采用超声乳化吸除＋后囊膜环形撕开＋前节玻璃体切割术。术后随访6~12mo,并记录术后视力以及并发症情况。 结果：所有患儿术后矫正视力较术前均有提高,差异有统计学意义（P〈0.05）;两组患儿术前视力差异无统计学意义（P〉0.05）,而术后矫正视力差异有统计学意义（P〈0.05）,B组矫正视力高于A组;两组术后并发症比较,仅后囊膜混浊（ posterior capsule opacification,PCO）差异有统计学意义（P〈0.05）,B组术后PCO发生率（12%）远低于A组（53%）,其他并发症组间差异均无统计学意义（ P〉0.05）。 结论：与超声乳化吸除＋后囊膜环形撕开相比,联合了前节玻璃体切割的手术方式能更好的改善术后矫正视力和减少PCO的发生。     

不同方式治疗儿童后发性白内障的疗效观察

目的　通过对儿童后发性白内障使用不同方式治疗并分析治疗效果,优化儿童后发性白内障的治疗策略。方法　收集４１例（５９眼）后发性白内障患儿,根据后发性白内障的严重程度及患儿年龄分为３组,分别为ＹＡＧ激光治疗组（１９眼）、后囊增殖膜吸除联合后囊膜抛光治疗组（１４眼）和后囊膜切除联合前段玻璃体切割治疗组（２６眼）。３组治疗术后１ｄ、１周、１个月、６个月进行常规检查并进行比较。结果　术后１个月矫正视力较术前均有提高,术后６个月矫正视力较前提高０．１以上占８７．５０％,提高０．３以上占５２．５０％。术后１ｄ术眼均有轻度的结膜充血及前房反应,后囊膜切除联合前段玻璃体切割治疗组较ＹＡＧ激光治疗组和后囊增殖膜吸除联合后囊膜抛光治疗组炎症较重,未见明显玻璃体脱出于前房,ＹＡＧ激光治疗组发现人工晶状体损伤３眼。术后６个月复查,后发性白内障复发率ＹＡＧ激光治疗组为１０．５３％、后囊增殖膜吸除联合后囊膜抛光治疗组为２８．５７％、后囊膜切除联合前段玻璃体切割治疗组为３．８５％。结论　对于轻度后发性白内障能够配合的患儿早期可给予ＹＡＧ激光治疗。对于严重后发性白内障,应根据后发性白内障机化膜的程度及患儿年龄采用后囊增殖膜吸除联合后囊膜抛光治疗或是后囊膜切除联合前段玻璃体切割治疗。     

配戴RGP治疗屈光参差性弱视探讨

目的:比较屈光参差性弱视分别使用高透氧硬性角膜接触镜(RGP)或框架眼镜,进行弱视综合训练的临床效果。方法:选择屈光参差性弱视患者106例189眼,分为试验组即A组(53例99眼)配戴RGP;对照组即B组(53例90眼)配戴框架眼镜。两组分别戴镜1mo后,选择相同的弱视综合训练方案观察3,6mo;1a的治疗情况。结果:配戴RGP安全、有效,无急性结角膜炎等并症发生。A组弱视治愈率明显优于B组,尤是高度屈光参差患者有明显优势。Ridit检验,差异有显著性(P<0.05)。A组配戴RGP 1mo后,未经弱视训练而矫正视力>0.8者5例7眼。结论:配戴RGP比配戴框架眼镜有更优秀的视觉质量,是一种治疗屈光参差性弱视安全、有效,值得使用推广的方法。     

三种手术方式治疗青光眼合并白内障疗效的比较

目的 探讨治疗青光眼合并白内障3种手术方式的适应证和临床疗效.方法 对青光眼合并白内障患者135例152只眼进行手术分组:其中30例36只眼先行抗青光眼手术,待白内障发展到一定程度再行白内障手术,即所谓的两阶段手术(A组);87例98只眼行-白联合手术-复合式小梁切除联合小切口白内障晶体吸除+人工晶状体植入术(B组);18例18只眼行单纯白内障手术+人工晶状体植入术(C组).比较不同适应证下3种手术方式的临床疗效,包括眼压控制情况、角膜内皮细胞、视力以及术后并发症等.随访时间(12±1)月.结果 均经统计学处理.结果 手术前后视力≥0.2的眼数3组比较,差异有统计学意义(x~2=16.00,P<0.01).A组与B组手术前后眼压有显著性差异(t_1=1.89,P_1=0.01:t_2=2.87,P_2=0.03),C组手术前后无显著性差异(t=0.43,P=0.78).术前术后角膜内皮细胞数量无显著性差异(P>0.05),3组均未见严重术中并发症,其个A组滤泡形成良好,眼压控制满意,B组术后角膜水肿17例,未特殊处理,1周后全部消退;有2只眼出现瞳孔区纤维膜,滤泡形成欠理想.C组术后视力均显著捉高,有2只眼轻度角膜水肿,有2只眼需加用药物控制眼压,其中1只眼最后接受抗青光眼手术.结论 青光眼合并白内障患者应根据具体情况选择适当的手术方式,以获得较好的视力和眼压控制.     

Methods for a population-based study of eye disease: the Melbourne Visual Impairment Project

The methodology of the Melbourne Visual Impairment Project, a major population-based survey of eye disease on 3,500 randomly selected individuals aged 40 years of age and over in the Melbourne metropolitan region, is presented. The aims of the study are to determine the distribution and determinants of eye disease in an urban population; the impact of eye disease on visual function and the activities of daily living; and the accessibility of eye health care services in the community. All procedures are conducted according to a standardised protocol to allow for comparison with other population-based studies, both in Australia and overseas. Information collected from this study will be employed in the development of recommendations related to eye health care service delivery and establishment of priorities for future public education programmes and health research.     

Visual field in hysteria-reliability of visual field by Goldmann perimetry

Four cases with hysterical amblyopia in youngsters under 15-year-old showed the poor reproducibility of visual field, that is, when the same target was moved from the periphery toward the fixation ten times along the same meridian during the same examination, the position of the plotted points were rather variable. The range of variation was measured from the innermost point to the outermost one, after the two first points were omitted because points first detected were usually far from the others. The variation of cases measured by this method was compared with that of normal persons. Results were as follows; 1. in normal person, the mean value of its range was 5.5° in first decade and 4.2° in second to seventh decade; 2. patients with psychogenic visual disturbances showed a variability of 14.2°, and this was significantly different from normal (p < 0.01). These results suggest that this convenient method was helpful for diagnosis of hysteria. It should also be remembered that when we evaluate the visual field, changes under 4° are probably not significant.     

Antituberculous Treatment Itself Might Prevent Visual Impairment in Presumed Tuberculosis-Related Uveitis

ABSTRACT

Purpose: To study the risk factors for visual loss in presumed tuberculosis-related uveitis (TRU).

Methods: Retrospective observational cohort study of patients with TRU, either treated or not for tuberculosis, from January 2005 to January 2017. Clinical and demographic variables were recorded. Main outcome measure was a loss of visual acuity (VA) of ≥2 Snellen lines. A Generalized Estimation Equation was used to control between-eyes bias. A backward stepwise logistic regression multivariate analysis was conducted to elucidate independent risk factors.

Results: One hundred and thirty-eight eyes from 82 patients were included. There were 45 males, median age at onset of uveitis was 40 years (Interquartile range, IQR 24). The median follow-up was 36 months (IQR 49.75) and 51 patients completed antituberculous treatment (ATT) for a mean of 9.37 months. In the multivariate model, ATT was the only independent protective factor for loss of VA (OR 0.13, 95% CI 0.04–0.37, p < 0.001).

Conclusion: ATT itself may prevent visual loss in TRU.     

International Practice in Care Provision for Post-stroke Visual Impairment

ABSTRACT

Purpose: This study sought to explore the practice of orthoptists internationally in care provision for poststroke visual impairment.

Methods: Survey questions were developed and piloted with clinicians, academics, and users. Questions addressed types of visual problems, how these were identified, treated, and followed up, care pathways in use, links with other professions, and referral options. The survey was approved by the institutional ethical committee. The survey was accessed via a web link that was circulated through the International Orthoptic Association member professional organisations to orthoptists.

Results: Completed electronic surveys were obtained from 299 individuals. About one-third (35.5%) of orthoptists saw patients within 2 weeks of stroke onset and over half (55.5%) by 1 month post stroke. Stroke survivors were routinely assessed by 87%; over three-quarters in eye clinics. Screening tools were used by 11%. Validated tests were used for assessment of visual acuity (76.5%), visual field (68.2%), eye movement (80.9%), binocular vision (77.9%), and visual function (55.8%). Visual problems suspected by family or professionals were high (86.6%). Typical overall follow-up period of vision care was less than 3 months. Designated care pathways for stroke survivors with visual problems were used by 56.9% of orthoptists. Information on visual impairment was provided by 85.9% of orthoptists.

Conclusions: In international orthoptic practice, there is general agreement on assessment and management of visual impairment in stroke populations. More than half of orthoptists reported seeing stroke survivors within 1 month of the stroke onset, typically in eye clinics. There was a high use of validated tests of visual acuity, visual fields, ocular motility, and binocular vision. Similarly there was high use of established treatment options including prisms, occlusion, compensatory strategies, and oculomotor training, appropriately targeted at specific types of visual conditions/symptoms. This information can be used to inform choice of core outcome orthoptic measures in stroke practice.     

Clinical versus Evidence-based Rehabilitation Options for Post-stroke Visual Impairment

The aim of this study was to identify which treatments for post-stroke visual impairment have a supportive evidence base, and which are being used in practice without supportive evidence. A systematic review of the literature reporting on the available treatment options was compared against the visual treatments used in the Vision In Stroke (VIS) study. Treatments were identified for visual field, visual neglect, visual perception and ocular motility disorders. Visual scanning therapies for hemianopia and neglect have an established evidence base. However, a number, such as typoscopes and advice options, have limited detail of their effectiveness and require further research.     

视觉虚拟现实训练与传统训练方法治疗儿童弱视的比较

目的：比较视觉虚拟现实训练与传统训练方法治疗儿童弱视的疗效。方法：前瞻性随机对照试验。 选取2018年6月至2019年12月于武汉大学中南医院确诊的并首次接受治疗的3～12岁弱视患儿90例 （146眼）,虚拟组45例（74眼）,传统组45例（72眼）。在屈光矫正及定量遮盖的基础上,虚拟组采用视 觉虚拟现实训练方法治疗,传统组采用传统训练方法治疗,时间为3个月,比较2组患儿治疗前后视 力及立体视的变化。采用t检验或秩和检验、χ2 检验及Fisher确切概率对数据进行分析。结果：虚拟组 总有效率87%,传统组总有效率68%,2组比较差异有统计学意义（χ2 =7.086,P=0.008）。3～6岁,虚 拟组有效率91%,优于传统组74%（χ2 =4.652,P=0.031）;7～9岁和10～12岁患儿,虚拟组和传统组之 间差异无统计学意义;轻度弱视患儿,虚拟组有效率为92%,优于传统组的75%（χ2 =2.908,P=0.018）; 中度、重度弱视患儿,虚拟组和传统组之间差异无统计学意义;屈光不正性弱视患儿,虚拟组有效 率为89%,传统组为74%,差异无统计学意义;屈光参差性弱视患儿,虚拟组有效率为85%,传统 组为57%,差异有统计学意义（χ2 =3.840,P=0.045）。在治疗后1、2、3个月后虚拟组有效率为43%、 54%和87%,持续高于传统组的24%、40%和68%,差异有统计学意义（χ2 =6.308,P=0.012;χ2 =2.779, P=0.016;χ2 =7.086,P=0.008）;3个月后,虚拟组立体视觉正常者比例为72%,高于传统组61%（χ2 =8.214, P=0.004）。结论：视觉虚拟现实训练较传统方法治疗儿童弱视疗效更显著,特别是对3～6岁轻度的 屈光参差性弱视;该方法不仅可以较快提高患儿视力,还有助于双眼立体视觉的改善。     

Comparison of Visual Virtual Reality Training and Traditional Treatment for Childhood Amblyopia

Objective: To compare the clinical effects of a visual virtual reality training system and a traditional method for amblyopia in children. Methods: This was a prospective, randomized, controlled study. A total of 90 children (146 eyes) from 3 years to 12 years of age underwent treatment for amblyopia for the first time. They were divided into an experimental group (45 cases, 74 eyes) and control group (45 cases, 72 eyes). Children in the experimental group had treatment with a visual virtual reality training system, and the control group had conventional integrated therapy. Visual tests were conducted every month, and a stereopsis examination was conducted after 3 months. The efficacy and safety of the visual virtual realitytraining method was evaluated by comparing the effects for the two groups. Data were analyzed using t test, rank sum test, Chi-square test and Fisher exact test. Results: The total effective rate for the experimental group was 87%, and was 68% for the control, and the difference was significant (χ2 =7.086, P=0.008). The results were significantly different for the patients in the 3 to 6 age group (91% vs. 74%, χ2 =4.652, P=0.031). For mild amblyopia, the effective rate was 92% in experimental group, which was significantly better than the 75% in control group (χ2 =2.908, P=0.018). For anisometropic children the effective rate in the experimental group was significantly better than the rate in the control group (85% vs. 57%, χ2 =3.840, P=0.045). When the effective rates for the two treatments were compared at 1, 2 and 3 months, the effective rates in the experimental group (43%, 54% and 87%) were significantly better than the rates in the control group (24%, 40% and 68%) (χ2 =6.308, P=0.012; χ2 =2.779, P=0.016; χ2 =7.086, P=0.008). When stereopsis was compared after 3 months, stereopsis in the experimental group (72%) was better than that in the control group (61%)(χ2 =8.214, P=0.004). Conclusions: The efficacy of visual virtual reality training is better than traditional treatment, especially for children 3 to 6 years of age and for anisometropia amblyopia. Visual virtual reality training cannot only improve visual acuity, it helps to improve stereopsis as well.