一项阿托品与遮盖治疗儿童中度弱视的随机试验

目的：比较遮盖与阿托品对7岁以下儿童中度弱视的疗效。方法：在一项随机的临床实验中，419例7岁以下、视力在20／40到20／100范围的弱视儿童在47个临床地点被指定接受遮盖或阿托品治疗。主要结果测量：6个月后的弱视眼和健眼的视力。结果：2组弱视眼的视力均有进步（遮盖组从基线到6个月进步3．16行，阿托品组为2．84行）。遮盖组进步初期较快，但6个月后治疗组间视力差异小且无临床的重要意义（6个月时平均差为0．034log MAR单位，95％可信区间，0．005－0．064log MAR单位）（译者注：logMAR:logarithm of the minimal angle of resolution）。遮盖组有79％、阿托品组有74％患者在6个月时弱视眼视力为20／30或更好，和（或）从基线进步3行或以上。2种治疗耐受均良好，和（或）从基线进步3行或以上。2种治疗耐受均良好 ，但阿托品组在家长问卷调查时接受程度稍高。阿托品组在6个月时健眼视力减低的患者多于遮盖组，但在进一步的随访中没有持续存在。结论：阿托品和遮盖产生的进步幅度相似，对年龄3－7岁以下的中度弱视儿童，2种方法作为初始治疗都是合适的方式。     

7岁以下儿童中度弱视的临床概况

目的：描述一组中度弱视儿童参加弱视治疗研究1的人口统计学和临床特征，其为1项比较阿托品与遮盖治疗的随机验证。方法：入选的儿童在7岁以下，有斜视性、屈光参差性、或混合的斜视性和屈光参差性弱视。采用围有干扰视标的单独HOTV视标，以标准化的测试方案测定视力，弱视眼的视力为20／40－20／100，双眼间视力差为3行或3行以上logMAR(logarithm of the minimal angle of resolution，即最小分辨角的对数－译注），入选儿童有419例，其中409例符合标准进入分析。结果：409例儿童的平均年龄为5.3岁。弱视的原因，斜视占38％、屈光参差占37%、斜视和屈光参差两均占24％。在斜视、屈光参差和混合组中，弱视眼的平均视力（约20／60）相似（P＝0.24），但健眼视力斜视组比屈光参差组更差（P＜0.001）。随机分至遮盖组患，开始有43％患每天作6h治疗，而有17％患进行全日遮盖。弱视眼视力较差的患比视力较好的患被嘱咐遮盖的时间更多（P＝0.03）。结论：在弱视治疗研究1中，斜视性和屈光参差性弱视患的比例几乎相等。不考虑弱视的原因，视力受损的水平相同。关于初期遮盖嘱咐多少小时，在治疗实践中有相当大的变化。     

儿童弱视治疗研究进展

弱视是视觉发育期内由于异常视觉经验(单眼斜视、屈光参差、高度屈光不正以及形觉剥夺)引起的单眼或双眼最佳矫正视力下降,眼部检查无器质性病变。儿童弱视治疗一直是眼科的热点研究问题,近些年来弱视治疗的研究有所进展且应用的方法多种多样,但是根据不同类型、程度,弱视的最佳治疗方案还在研究进行中。我们参考近年来国内外关于儿童弱视治疗的文献,对目前最新儿童弱视治疗方法以及其中存在的问题进行综述。     

弱视儿童的治疗护理

我们自2000年2月～2003年2月诊治弱视患者116例，取得良好治疗效果，报告如下。     

BS弱视仪治疗儿童弱视

我院于2001年7月～2002年6月对广州市博视医疗保健研究所研制的BS综合增视仪治疗儿童弱视进行临床疗效观察,现报告如下。1 资料与方法1.1 一般资料 弱视儿童500例920眼,男350例680眼,女150例240眼,年龄3.5～9.0岁,平均5.2岁。所有病例为中心注视,不伴斜视及其他器质性眼病。随机分为治疗组和对照组。治疗组250例470眼,轻度200眼,中度250眼,重度20眼;对照组250例450眼,轻度180眼,中度250眼,重度20眼。弱视分度按1996年全国儿童斜视、弱视防治组的分度标准。     

283例儿童弱视治疗的疗效观察

弱视是儿童常见的眼病，发病率约为3％左右。随着人民生活水平的不断提高，人们的健康意识逐渐增强，对儿童弱视的治疗越来越引起家长和眼科医师的重视。目前弱视治疗的方法较多，效果不尽一致，近年来，我们采用传统遮盖法和后象疗法对283例425只眼进行治疗观察，取得较好效果，现报道如下。临床资料一、本组283例（425只眼）均系我院斜视弱视门诊病人，经眼底、屈光等检查排除眼球器质性病变且矫正视力低于0．9者。男性174例（61．48％），女性109例（38．52％），年龄3～12岁，平均556岁。本组统计时划分为两个年龄组，即3～6岁和7～Ic…     

儿童弱视206眼治疗的思考

目的观察弱视的综合治疗效果以了解不同年龄儿童弱视治疗后治愈、好转、无效的分布情况。方法把206眼经过1-2年弱视综合治疗儿童分成3—6岁组、6—9岁组、9—12岁组及斜视性弱视、屈光不正性弱视、屈光参差性弱视3种类型进行疗效分析并了解各组治愈、好转、无效分布情况。结果3—6岁组、6—9岁组好转明显（好转率87％、68％），但基本治愈率不高（25％、13％），9—12岁组欠佳（好转率18％、治愈率3％）；斜视性弱视、屈光不正性弱视、屈光参差性弱视3种类型均有不错的好转率（65％、86％、59％）而治愈率亦不高（15％、26％、15％）。结论各种弱视只要及时治疗都能获得良好效果，治疗的最佳年龄为2—5岁，已被大家所公认，年龄偏大亦不可放弃。目前弱视治疗的主要问题是如何组织、指导患儿进行治疗，加强患儿及家长同医院的配合以提高治愈率，使更多的患儿恢复正常视力。     

儿童远视性弱视的临床治疗

目的探讨儿童远视性弱视的临床治疗及疗效。方法对儿童远视性弱视105例（眼）的发病、治疗及愈后进行分析。治疗措施有：（1）检影验光，以充分矫正远视为原则佩戴眼镜；（2）遮盖疗法＋增视疗法治疗弱视；（3）眼外肌手术矫正斜视。结果诊治年龄越小、弱视的程度越轻、疗程越长的患者预后越好。结论该病对儿童视功能危害较大，且治疗困难。建议采用早期发现、综合治疗及有效巩固等方法。早期发现是基础，综合治疗是关键，有效的巩固是保障。     

儿童弱视治疗时间概念的探讨

儿童弱视治疗时间概念的探讨广东省鹤山市中医院眼科马文贵众所周知，儿童弱视的治疗具有一定的时间性．一但错过时ｔ）ｔ，较难治愈ｌ＇－＇＇．我们在弱视的治疗过程中，深深地感到难度最大的因素之一是，患儿及其家长对弱视长时间的治疗缺乏信心，不能持续．然而，对多...     

Comparative efficacy of penalization methods in moderate to mild amblyopia

PURPOSE: To compare the efficacy and sensory outcome of pharmacologic and optical penalization in the treatment of moderate to mild amblyopia. DESIGN: Randomized clinical trial. METHODS: In an institutional setting, two- to 10-year-old children with strabismic or anisometropic amblyopia (visual acuity in the amblyopic eye at least 20/60) who were cooperative to measure visual acuity using the logarithm of the minimum angle of resolution (logMAR) crowded Glasgow acuity cards were randomized into two groups of therapy (n=35 in each group), 1% atropine, and optical penalization with positive lenses, after stratification by cause of amblyopia. Visual acuity was tested by the logMAR crowded Glasgow acuity cards, after retinoscopic refraction, and deviation angle were measured by the simultaneous prism and cover or Krimsky test. Stereoacuity was determined using the Titmus fly test and Randot preschool or Randot circles stereoacuity test. Change in visual acuity of the amblyopic eye and in interocular difference of visual acuity after six months of amblyopia therapy was the main outcome measure; stereoacuity at six months of therapy was a secondary outcome measure. RESULTS: Thirty-one and 32 children completed the outcome examination in the atropine and optical penalization group, respectively. Average improvement in visual acuity of the amblyopic eye was larger in the atropine than in the optical penalization group (3.4 and 1.8 logMAR lines, respectively), as well as average improvement in interocular difference of visual acuity (2.8 and 1.3 logMAR lines, respectively). Better stereoacuity, but nonsignificantly different, was detected in the atropine group. CONCLUSIONS: Atropine penalization may be considered more effective than optical penalization with positive lenses.     

The course of moderate amblyopia treated with patching in children: experience of the amblyopia treatment study

Purpose

To assess the course of the response to patching treatment of moderate amblyopia and to assess factors predictive of the response in children 3 years old to younger than 7 years old.

Design

Multicenter, randomized clinical trial comparing patching and atropine (one of the amblyopia treatment studies).

Methods

A total of 209 children 3 years old to younger than 7 years of age with amblyopia in the range of 20/40 to 20/100 from the patching treatment arm of this trial were treated with patching of the sound eye from 6 hours per day up to all waking hours. Follow-up examinations were performed at 5 weeks, 16 weeks, and 6 months. The primary outcome measure was visual acuity in the amblyopic eye at 6 months.

Results

After 5 weeks of treatment, mean amblyopic eye acuity improved from baseline by 2.2 lines. For patients with baseline acuity of 20/80 or 20/100, a greater number of hours of prescribed patching was associated with greater improvement in the first 5 weeks (P = .05). However, this relationship was not present when baseline acuity was 20/40 to 20/60 (P = .57). At 6 months, visual acuity was improved from baseline by a mean of 3.1 lines, with the amount of improvement no longer related to the number of hours patching prescribed at baseline (P = .93). Among the 157 patients improving at least 3 lines from baseline, 15% achieved their maximum improvement by 5 weeks and 52% by 16 weeks. None of the demographic or clinical factors assessed was predictive of the response to treatment.

Conclusions

In the treatment of moderate amblyopia, a beneficial effect of patching is present throughout the age range of 3 years old to younger than 7 years old and the acuity range of 20/40 to 20/100. At 6 months, the amount of improvement appears to be similar when 6 hours of daily patching are initially prescribed vs a greater number of hours. However, when the baseline acuity is 20/80 to 20/100, a greater number of hours of prescribed patching may improve acuity faster.     

The course of moderate amblyopia treated with atropine in children: experience of the amblyopia treatment study

Purpose

To assess the course of the response to atropine treatment of moderate amblyopia and to assess factors predictive of the treatment response in children 3 years old to younger than 7 years old.

Design

Multicenter, randomized clinical trial comparing atropine and patching (one of the amblyopia treatment studies).

Methods

A total of 195 children 3 years old to younger than 7 years of age with amblyopia in the range of 20/40 to 20/100 from the atropine treatment arm of this trial were enrolled and included in this analysis. At baseline, daily topical atropine was prescribed for the sound eye. During follow-up, a plano spectacle lens was prescribed for the sound eye for patients whose amblyopia had not been successfully treated with atropine alone. Follow-up examinations were performed at 5 weeks, 16 weeks, and 6 months. The primary outcome measure was visual acuity in the amblyopic eye at 6 months.

Results

Mean visual acuity improved from baseline by 1.3 lines after 5 weeks of treatment, by 2.4 lines after 16 weeks, and by 2.8 lines at 6 months. Visual acuity of 20/30 or better and/or 3 or more lines of improvement from baseline was achieved by 75% of the patients. Improvement occurred over the entire range of baseline acuities (20/40 to 20/100) and was not related to patient age (P = .36). Among the 134 patients improving 3 or more lines from baseline, 7% achieved their maximum improvement by 5 weeks and 46% by 16 weeks. Among the 55 patients who did not respond adequately to atropine alone and were prescribed a plano lens for the sound eye, the mean improvement before the use of the plano lens was 1.0 lines, compared with 1.6 lines after prescribing the plano lens (P = .11). None of the demographic or clinical factors assessed was predictive of the response to treatment. A shift in fixation preference at/near from the atropinized sound eye to the amblyopic eye was not required for the amblyopic eye to improve; amblyopic eye acuity improved 3 or more lines in 29 (60%) of the 48 patients who were found to be using the atropinized sound eye on fixation preference testing. A 2 or more line decrease in sound eye visual acuity occurred more frequently when a plano lens was prescribed in addition to atropine (7 of 43, 16%) compared with treatment with atropine alone (4 of 123, 3%; P = .01).

Conclusions

A beneficial effect of atropine is present throughout the age range of 3 years old to younger than 7 years old, and with an acuity range of 20/40 to 20/100. A shift in near fixation to the amblyopic eye is not essential for atropine to be effective in all cases. Sound eye acuity should be monitored when a plano spectacle lens is prescribed for the sound eye to augment the treatment effect of atropine.     

儿童弱视经不同遮盖方法治疗前后视觉电生理的变化

目的：应用图形视觉诱发电位检查评价不同遮盖方法在治疗弱视中的疗效。 方法：采用前瞻性研究方法从儿童视光专科门诊中选取年龄在3~6岁136例单眼弱视儿童,将其分为全日遮盖组69例和部分遮盖组67例,在准确屈光矫正基础上,分别每天遮盖健眼10h以上和遮盖健眼5h,并同时进行等量精细目力训练,分别于治疗后1mo和6mo对图形视觉诱发电位（P100波幅值及潜时）检测结果及视力提高程度进行分析。 结果:发现136例弱视患儿经过两种不同遮盖法治疗1mo后,全日遮盖组与治疗前相比P100波幅值增加、潜时缩短,差异有统计学意义（P<0.05）,部分遮盖组与治疗前相比P100波幅值、潜时差异无统计学意义（P>0.05）,两组之间比较差异有统计学意义,两组视力提高程度：基本治愈率、进步率和总有效率差异有统计学意义（P<0.05）,治疗6mo后,全日遮盖组与治疗前相比P100波幅值增加、潜时缩短,差异有统计学意义（P<0.05）。部分遮盖组与治疗前相比P100波幅值、潜时差异有统计学意义（P<0.05）,两组之间比较差异无统计学意义（P>0.05）,两组视力提高程度：基本治愈率、进步率和总有效率差异无统计学意义（P>0.05）。 结论：弱视经两种不同遮盖方法治疗后,早期全日遮盖组P100波幅值及潜时较治疗前得到改善,部分遮盖组较治疗前无明显变化,视力提高程度两组有差异,说明全日遮盖法治疗弱视近期疗效较部分遮盖法为佳,长期来看,两组P100波幅值及潜时无明显差异,两组视力提高结果分析无明显差异,进一步说明全日遮盖法与部分遮盖法长期疗效相同,说明弱视治疗过程中定期检测图形视觉诱发电位能评价治疗效果,从而指导下一步治疗。     

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。     

轻中度远视性弱视儿童视网膜明视负波研究

目的研究轻中度远视性弱视儿童在不同颜色和强度的背景光和刺激光下视网膜神经节细胞明视负波(Photopic negative response,PhNR)的反应。方法对32例(41只眼)远视性弱视儿童和18例(18只眼)正常儿童进行视网膜PhNR检查,记录PhNR的振幅和潜伏期,分析比较不同程度远视性弱视儿童PhNR的特征。结果在亮度为20cd/m2蓝色背景光,1cd.s/m2红色光线刺激下,三组PhNR振幅有差别,P<0.05;在亮度为40cd/m2蓝色背景光,3cd.s/m2及7cd.s/m2红色光线刺激下,在亮度为30cd/m2白色背景光,3cd.s/m2及7cd.s/m2红色光线刺激下,中度弱视组PhNR振幅较轻度弱视组高,P<0.05;其余刺激条件下,三组PhNR振幅差别无统计学意义,P>0.05。各组光线刺激条件下,轻度、中度弱视组和对照组PhNR潜伏期均无差别,P>0.05。结论中度远视性弱视儿童视网膜神经节细胞对特定强度和颜色的刺激光敏感,PhNR振幅增高明显,而潜伏期正常。     

厦门市10585名儿童弱视调查及防治

目的　了解我市儿童弱视患病情况 ,为制定群体防治措施提供科学依据。方法　用国际标准视力表检查视力 ,并行眼科常规检查 ,排除器质性病变。视力≤ 0 8及斜视者用 0 5 %阿托品眼药水散瞳验光 ,矫正视力≤ 0 8者为弱视。结果　普查 1 0 5 85人 ,弱视患病率为 4 3 2 % ,弱视首次检出率为 74 84% ,男女之间、各年龄组之间患病率差别无统计学意义。结论　定期对幼儿进行斜视弱视普查及给家长上眼保健课 ,督促患儿及早治疗 ,按时复诊 ,是防治弱视的关键 ,应纳入幼儿园《儿童眼保健常规》。     

单眼弱视的临床分析

目的　探讨单眼弱视的临床特点。方法　对 96例单眼弱视进行追踪观察 ,对弱视类型、程度、注视性质与疗效的关系进行统计分析 ,并观察其立体视变化。结果　单眼弱视中屈光参差性弱视占 66 67% ,斜视性弱视占 33 33%。斜视合并屈光参差性弱视患者基本治愈率仅 50 % ,单眼弱视中重度弱视较多 ,占 33 33% ,立体视恢复正常者 55 2 1 % ,均为屈光参差性弱视。结论　单眼弱视患者中常见斜视性弱视和屈光参差性弱视两种临床类型 ,其中以斜视伴有屈光参差的弱视治疗效果最差 ,而斜视对患者的立体视损害最严重