先天性眼球震颤手术疗效的临床观察

目的探讨先天性眼球震颤的治疗方法。方法总结26例先天性眼球震颤采用parks(部分调整)法手术,合并水平斜视者同时进行斜视矫正手术。结果26中代偿头位消失21例,明显改善5例,建立双眼单视功能19例。结论采用parks(部分调整)法治疗先天性眼球震颤不仅可以矫正代偿头位和斜视,还有利于双眼单视功能的建立。     

先天性眼球震颤的立体视觉

采用随机点立体视觉检查图测定了５７例先天性眼球震颤患者的立体视觉功能，结果显示：绝大多数钟摆型及半数以上跳型及半数以上跳动眼震可造成立体视觉的严重损害；立体视觉随视力，特别是近视力的优劣而呈正比例变化。     

先天性眼球震颤的眼震图检查及应用

先天性眼球震颤是眼球有节律的不自主运动。由于多数病例的眼震频率较高，振幅小等原因，仅靠肉眼目测以精确测定其震频和振幅的数值，彩和ＥＯＧ方法描记眼震图是一较精确的客观定量检查，为临床观察眼震波形变化规律，分析震颤波形、测量震频、振幅及震强等提供了客观指标。通过眼震图描记，可以确定零带位置，为临床治疗眼震提供依据，对眼震图的具体描记方法及临床应用进行了叙述。     

先天性特发性眼球震颤手术疗效观察

目的为探讨先天性特发性眼球震颤手术治疗设计方法与效果。方法28例患者采用改良parks5-6-7-8法加减的原则，对头位扭转角、合并水平斜视和垂直斜视一次矫正，而转角的手术量设计在注视眼上，而转角矫正后带来的斜视度变化与原斜视度叠加或抵消后，把矫正斜视的手术量设计在斜视眼上。结果28例患者术后观察324个月，原在位双眼视力均较术前提高2-4行，原在位眼颤明显减轻或消失，代偿头位基本消失者26例（92．8％），所有伴斜视的患者外观矫正效果满意，结论我们的体会足手术前明确注视眼，中间带位置，而转方向及角度，斜视性质及斜视度，以及它们之间的相互关系是正确设计手术前提。parks法适合矫正代偿头位15°的先天性特发性眼球震颤。     

先天性眼球震颤眼球运动波形的相图特点分析

背景 先天性眼球震颤患者的眼球运动波形表现各异,其时间动力学的非线性特征复杂,常规的时间序列波形图不便于对患者进行临床诊断及评估.眼球运动系统是非线性反馈控制系统,而相图法是一 种用于描绘非线性系统运动特征的分析技术,但相图法在先天性眼球震颤检测中的应用尚未见报道. 目的尝试建立先天性眼球震颤眼球运动波形的相图法分析技术,为先天性眼球震颤的临床诊断与定量评估提供新的方法.方法 采用前瞻性病例观察设计,纳入2012年4月至2013年2月在天津市眼科医院就诊的25例先天性眼球震颤患者,其中先天性运动性眼球震颤(CMN)患者12例,隐性眼球震颤(LN)患者13例.所有患者行视频眼动图(VOG)检查,对VOG数据进行格式转换后,采用Matlab程序对数据进行处理,得到每个眼动波形周期的相位图,并从相位图上测得周期位移(CPS)、慢相峰值速度(SPV)及其标准化值(SSPV)、快相峰值速度(FPV)及其标准化值(SFPV).比较先天性眼球震颤波形速度递增型和速度递减型的测量参数.结果 先天性眼球震颤的眼球运动相图呈现周期性规律性往复运动轨迹,其慢相过程表现为密集带状轨迹,快相过程表现为稀疏环状轨迹.CMN的眼球运动波形以速度递增型为主,而LN的眼球运动波形以速度递减型为主,2种波形相图轨迹走行均呈顺时针方向.速度递增型CPS、SPV及FPV分别为(4.646±1.565)、(223.821±114.049)和(767.481±263.560)°/s,速度递减型CPS、SPV及FPV分别为(9.373±4.189)、(357.531±154.300)和(1 148.706±541.362)°/s;速度递增型中SPV和FPV与CPS间均呈显著正相关(rSPV-CPS=0.685,P=0.000;rFPV-CPS=0.680,P=0.000);速度递减型中SPV和FPV与CPS间均呈显著正相关(rSPV-CPS=0.783,P=0.000;rFPV-CPS=0.803,P=0.000).2种波形FPV均大于SPV,差异均有统计学意义(速度递增型:t=6.558,P=0.000;速度递减型:t=5.068,P=0.000).速度递增型SSPV为(48.062±15.365)°/s,略大于速度递减型的(41.099±17.027)°/s,但差异无统计学意义(t=1.070,P=0.296);速度递增型SFPV为(171.186±47.825)°/s,大于速度递减型的(125.317±38.266)°/s,差异有统计学意义(t=2.658,P=0.014).结论 相图法能够直观显示先天性眼球震颤眼球运动轨迹的周期性动态特征,便于测量其不同时相的运动幅度、速度等参数.     

X链显性遗传先天性眼球震颤一家系

先天性眼球震颤（congnital nystagmus，CN）是指不伴有其他眼部明显畸形、仅有双侧性眼球震颤的患者，临床多为散发病例，有家族史者较少见。我们在工作中遇到一遗传家系，现报告如下。     

紫绀型先天性心脏病的眼底病变

目的:探讨紫绀型先天性心脏病患者发生眼底病变的临床表现。方法:观察分析78例紫绀型先心病患者的眼部临床表现,必要时行眼底荧光血管造影、眼部B超检查等。结果:紫绀型先心病患者78例中有4例视力明显下降,其中3例眼底可见视网膜出血、周边视网膜血管闭塞;18例可见视网膜血管迂曲,2例周边血管旁小片状出血。结论:紫绀型先心病患者可伴发视网膜血管闭塞、视网膜出血等眼底病变,需定期行眼科检查。     

先天性眼球震颤发病机制及检测手段

先天性眼球震颤发病机制及检测手段彭广华暨南大学医学院眼科（５１０６３２）杨景存河南医科大学一附院眼科（４５００５２）先天性眼球震颤（ｃｏｎｇｅｎｉｔａｌｎｙｓｔｅｇｍｕｓ，ＣＮ）是一种病因不明的非随意性、节律性的眼球异常运动，临床上表现复杂，对视功能...     

Clinical features of strabismus and nystagmus in bilateral congenital cataracts

AIM: To evaluate the prevalence, clinical features, and the factors affecting onset of strabismus and nystagmus in patients with bilateral congenital cataracts. METHODS: This study evaluated 116 eyes of 58 patients who underwent lens removal for the treatment of bilateral congenital cataracts between January 1999 and January 2011. The presence and type of strabismus and nystagmus were determined before and after surgery. Type of strabismus and final visual acuity were compared in patients with and without nystagmus. Patients were divided into three groups (orthotropia/orthotropia, orthotropia/strabismus, and strabismus/strabismus) according to their preoperative and postoperative ocular alignment. Age at cataract surgery and associations of nystagmus and primary intraocular lens (IOL) implantation with strabismus were analyzed. RESULTS: Six patients (10.3%) had strabismus preoperatively and an additional 11 (19.0%) developed postoperative strabismus. Exotropia was more common than esotropia both preoperatively and postoperatively. Eighteen patients (31.0%) had postoperative nystagmus, with sensory nystagmus being the most common type. Of the 18 patients with nystagmus, 10 had strabismus, with exotropia being more common than esotropia. Postoperative visual acuity was poor in patients with nystagmus. Age at cataract surgery and rate of primary IOL implantation were significantly lower, and postoperative nystagmus was more common, in the orthotropia/strabismus group than in the other two groups. CONCLUSION: Exotropia and sensory nystagmus are common in patients with bilateral congenital cataracts. Age at cataract surgery and rate of IOL implantation are lower and nystagmus more common in patients with postoperative onset of strabismus. Nystagmus is associated with poor visual prognosis.     

LASIK术前眼底病变的临床治疗选择

目的:了解准分子激光原位角膜磨镶术(LASIK)术前初诊患者视网膜病变的类型和程度,明确手术适应证选择,术前给予相应处理,进一步提高手术安全性。方法:对LASIK术前初诊4248眼屈光度-0.50D～-18.00D,散光≤6.00D的近视患者散瞳三面镜检查眼底,详细绘图记录检查结果,并给予相应处理,对实施LASIK手术者随访10～20mo。结果:被检4248眼中,发现各种视网膜变性778眼(18.31%);其中格子样变性60眼(1.41%),霜样变性432眼(10.17%),囊样变性72眼(1.69%),薄变22眼(0.52%),有两种以上混合变性的71眼(1.67%),视网膜增殖121眼(2.85%),周边视网膜干性裂孔71眼(1.67%)。其中严重视网膜变性65眼,干性视网膜裂孔71眼行氩激光光凝治疗,视网膜脱离9眼,4眼视网膜脱离需行手术,5眼局限性脱离行光凝.所有LAS1K术后患者均未发现眼底病变加重或发生视网膜脱离。结论:LASIK术前详细了解视网膜病变是必要的,它能够为明确手术适应证,把握手术时机提供重要的参考依据。     

先天性眼球震颤治疗方法研究进展

先天特发眼球震颤是以眼部表现为主的疾病,虽然不属于常见或多发病,但在临床上并非罕见,多见于婴幼儿,发病时间一般都在半岁以内。该病的特点为:发病早或发病时间不能确定,眼球不自主的持续跳动或摆动,极少患者有晃视感,大多数患者都有不同程度的视力损害,有的视力减低比较严重,而且不能矫正,较多患者有侧视现象和代偿头位表现,有的头部摇晃,还有的表现为频繁眨眼等代偿现象。该病的主要治疗手段是手术治疗,但影响手术效果的因素很多:发病年龄,眼震强度,代偿头位,休止眼位,视力,手术方式和手术量等。随着近年的发展,对该病有了更深入的认识,我们就一些问题做一简要回顾。     

直肌边切术在先天性眼球震颤治疗中的疗效观察

目的探讨治疗先天性眼球震颤的简捷、有效的手术方法。方法对21例年龄在7~12岁的先天性眼球震颤患者,采用改良的Parks手术方法,即在Parks手术方法的基础上采用直肌边切术代替Parks法中的直肌后退,而Parks法中的直肌缩短仍保持不变。结果15例(71·43%)患者相对静止眼位移至正前方,正前方眼震基本消失,6例(28·57%)眼震明显减轻,正前方为低幅低频震颤,视力提高2~5行;18例(85·71%)代偿头位基本消失,3例(14·29%)明显改善。16例术后随访2年,其中8例术后有轻度回退现象,6周后稳定者7例,经过2年随访,情况稳定者15例。经1~2年随访,18例效果满意。结论该术式效果肯定,手术操作简捷。手术因不需缝合巩膜,故不会有发生巩膜穿孔的危险,提高了手术的安全性。     

家族性腺瘤性息肉病患者中先天性视网膜色素上皮肥厚的FFA研究

目的:研究家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)患者中双眼多灶性先天性视网膜色素上皮肥厚(congenital hypertrophy of the retinal pigment epithelium,CHRPE)患者的眼底荧光素血管造影(fundus fluoresceinangiography,FFA)的特点。方法:我们对22例有65处CHRPE病灶的FAP患者前瞻性进行FFA和眼底检查。结果:发现86%CHRPE病损面积>0.5个视盘直径,74%的CHRPE病变接近视网膜血管,视网膜血管有以下变化:46%CHRPE病变中出现毛细血管无灌注区,8%穿过病灶的视网膜血管部分阻塞,6%出现脉络膜视网膜吻合支,3%病变有毛细血管微血管瘤,5%可观察到脉络膜毛细血管,20%的脉络膜毛细血管出现在脱色素边缘晕环中。约10%的CHRPE病变眼底检查未发现,只能通过FFA观测到。结论:虽然通过眼底检查能诊断CHRPE,但有些病变仍需通过FFA确诊,其对此病变仍是非常有用的诊断方法。     

Effects of acupuncture on foveation characteristics in congenital nystagmus

AIMS/BACKGROUND—To examine the effects of acupuncture at the sternocleidomastoid muscles on foveation characteristics in congenital nystagmus.
METHODS—Six patients with congenital nystagmus (CN) received a series of treatments consisting of two needles inserted into each sternocleidomastoid, stimulated by tapping gently every 5 minutes, for 20 minutes per session. Their eye movements were recorded using scleral search coils and changes in their CN waveforms analysed at each point in the treatment. Changes in the stability and duration of foveation periods were examined.
RESULTS—Four of the six patients showed improved foveation at the commencement of treatment; three maintained this response throughout the treatment period and after the needles were removed. In two, the CN waveform itself was modified.
CONCLUSION—This study and others involving afferent stimulation to the neck and face suggest that projections from these areas to the reticular formation and vestibular nucleus may alter the behaviour of the pathophysiological mechanism underlying congenital nystagmus.

Keywords: congenital nystagmus; foveation; acupuncture     

Characteristics of braking saccades in congenital nystagmus

Several of the characteristic waveforms of congenital nystagmus (CN) contain braking saccades. We test the hypothesis that braking (including foveating) saccades, while not always satisfying the standard relationships for saccades, are normal; any differences are due to the presence of high-velocity, slow-phase eye movements. Better measurements of saccadic properties, including position- and velocity-based measures and skewness, can eliminate some of this apparent distortion. We also evoked an analogous effect in normal subjects by use of a ramp-step-ramp stimulus. Finally, we used a model to further demonstrate this distortion in the saccades of normals, deviating from their intended magnitude as a function of the magnitude of the opposing velocity. The saccadic analysis methods developed herein are applicable to all saccades made during ongoing eye movements, whether normal or pathological. The above findings support the hypothesis that the braking saccades integral to many CN waveforms have normal characteristics and are the result of a normal saccadic system's responses to a slow-eye-movement oscillation.     

肉毒杆菌毒素A治疗先天性眼球震颤22例

目的:观察肉毒杆菌毒素A(BTA)治疗先天性眼球震颤(CN)的效果。方法:先天性眼球震颤患者22例,男17例,女5例。用眼震图(ENG)检查BTA注射相应眼外肌前与注射后1wk,1,3,6mo的近、远距离眼震,视力,3级视功能情况,各组进行统计学处理,并比较统计学差异。结果:各组注药前后视力改变无统计学差异(P>0.05)。注药后1mo与注药前相比,远近距离原眼位的各眼震参数降低均有明显统计学差异(P<0.05);注药后3,6mo与注药前相比近、远距离原眼位振幅降低有明显统计学差异(P<0.05);最小震强位置注药后1wk,1,3,6mo与注药前相比虽无明显差异,但从频数分布图中可见最小震强出现的位置有向原眼位集中的趋势。注药后3,6mo3级视功能与注药前相比仅融合范围扩大有显著差异(P<0.05)。结论:该方法治疗先天性眼球震颤可使近、远距离原眼位眼震有所减轻,视力、代偿头位及3级视功能有所改善。注药后1mo疗效最显著,6mo后疗效下降。该方法治疗先天性眼球震颤有明显效果。     

调整Parks法治疗有代偿头位的先天性眼球震颤

目的 观察采用调整Parks法手术量治疗有代偿头位(compensatory head posture,CHP)的先天性眼球震颤(congenital nystagmus,CN)的临床效果.方法 对28例伴有CHP的CN患者,采用调整Parks方法的手术量行中间带移位术,当代偿头位为15°～25°、25°～30°、30°～40、＞40时,从慢相侧到快相侧4条水平直肌手术量分别为7050 mm、6446mm、7557 mm、7658 mm.对比观察术前、术后视力及CHP情况.结果 与术前相比,术后单眼或双眼同时注视时的最佳矫正视力和第一眼位视力均有显著提高.CHP基本消除者(CHP＜10°)21例,明显改善者(CHP＞10°)6例,无变化者1例,与术前相比疗效显著.3例伴水平斜视者全部矫正为正位.结论 调整Parks法手术量适用于治疗各种大小CHP的CN患者.