25G晶状体切除联合前段玻璃体切除术治疗先天性白内障

目的：观察25G微创晶状体切除联合前段玻璃体切除术治疗先天性白内障的临床疗效。

方法：回顾性系列病例研究。选择2013-05/2017-08于我院眼科确诊为先天性白内障,年龄为3月龄～5岁4个月的患儿38例55眼纳入本研究。根据患者治疗方案分为A组和B组,A组17例25眼接受25G微创晶状体切除联合前段玻璃体切除术,B组21例30眼接受白内障超声乳化吸除联合前段玻璃体切除术。术后随访36～74(平均43.4)mo,对比观察两组患儿术后BCVA、眼轴、术中术后并发症。

结果：两组年龄、性别、病程、术前BCVA、术前眼轴等基线水平均无差异(P>0.05)。两组患者术后BCVA均较术前明显提高(P<0.05)。术后6mo A组BCVA明显优于B组(P=0.043),而术后12、24、36mo两组BCVA无差异(P=0.727、0.286、0.889)。A组、B组术后6mo眼轴与术前均无明显差异(P=0.206、0.082),术后12、24、36mo眼轴均较术前变长(A组：P=0.023、0.015、<0.01; B组：P=0.018、<0.01、<0.01)。两组术后6、12、24、36mo眼轴均无差异(P=0.195、0.313、0.485、0.089)。A组并发症的发生率明显低于B组(P=0.042)。

结论：25G微创晶状体切割联合后囊膜切开及前段玻璃体切除术能有效改善先天性白内障患者的视力,且术后并发症较少,是治疗先天性白内障的一种安全、有效的方法。     

Tessellated fundus appearance and its association with myopic refractive error

The appearance of tessellated fundus in an eye may act as a marker in identifying visual performance, degree of myopia or risk of progression of myopia in a given eye. A systematic literature search using key words was performed using PubMed, Web of Science and Google Scholar and of the 832 studies identified, 10 full‐length articles, which met the inclusion criteria, were considered for review. The primary outcome measures were association of tessellated fundus with: (i) visual acuity, (ii) refractive error, (iii) axial length, (iv) choroidal thickness and (v) future progression of myopia when compared to either no myopic maculopathy, or more severe myopic maculopathy. There was no significant difference in the visual acuity noted between eyes with normal fundus and tessellated fundus appearance. Compared to eyes with tessellated fundus, eyes with more severe myopic maculopathy had a four‐line decrease in best‐corrected visual acuity, more myopia (mean difference 2.75 D, range 0.28 – 5.78 D) and a longer axial length (mean difference 2 mm, range 2.29 to 1.71 mm). Eyes with tessellated fundus generally exhibited a significant decrease in choroidal thickness compared to eyes with no maculopathy. In mostly older individuals, eyes with tessellated fundus had a better outcome with respect to visual acuity, degree of myopia and axial length compared to other severe myopic maculopathies, but had a worse outcome for choroidal thickness and degree of myopia, compared to eyes with no myopic maculopathy. The features such as reduced choroidal thickness combined with a predilection to infra‐temporal and parapapillary regions may indicate regions of stress that are prone to more stretching/atrophic changes. This systematic review demonstrated an association of tessellated fundus with visual acuity, refractive error, axial length and choroidal thickness and hence emphasises the documentation of the presence and location of tessellated fundus appearance that may help in predicting the progression of myopia.     

高度近视眼球轴长、角膜曲率及后段眼球壁改变的临床观察

目的:为探讨高度近视眼球壁形态改变特征与视功能之关系。方法:对140例(280只眼),其屈光度在～6.25～-30.00D之间,进行眼轴长、角膜曲率等系列数据检测,经统计学处理。结果:1.高度近视眼矫正视力随屈光度增加而明显下降,有显著差异性(P<0.001)。2.96.1％的眼球前后内径轴长增长,其屈光度随之增高。3.有27.1％的眼球突出度向前变突。4.前表面角膜曲率与正视眼球相比无明显差异。5.有80.7％的眼球发生后巩膜葡萄肿。6.有82.3％的眼球发生视神经萎缩及视盘萎缩弧斑。7.有5.3％的眼球发生眼内压升高。结论:由于高度近视眼球壁发生一系列病理性改变,因而导致临床上视功能严重受损,是视力不能矫正的主要原因。眼科学报1996;11:188～190。     

后发性白内障患者行YAG激光后囊切开术后人工晶状体的偏移及眼轴的改变

目的:研究后发障患者在行YAG激光后囊切开术后人工晶体有无发生偏移,以及眼轴是否发生变化.方法:收集白内障超声乳化并人工晶体植入术后不同时间段内发生后发性白内障患者14例18眼.所有患者在行YAG激光术前均先参照标准对数视力表验光并获得最佳矫正视力,以眼前节OCT获得眼前段图像,并以CMOS测得眼轴.本研究中定义瞳孔所在的水平面与人工晶体的前表面所成的夹角为人工晶体偏移度(简称偏移度,单位:度).完成相关检查后,对患者逐一行YAG激光后囊切开术,术后双氯芬酸钠滴眼液滴术眼一次,术后1h,1wk后对患眼行验光,眼前节OCT及CMOS检查.分别记录患眼人工晶状体的偏移度、眼轴长度及最佳矫正视力,并以SPSS进行统计分析.结果:YAG激光术前各例眼的平均偏移度为2.896±2.286度,平均眼轴为23.56±0.55 mm;术后1h平均偏移度为4.702±2.991度,平均眼轴为23.40±0.59 mm;YAG术后1h较术前相比最佳矫正视力提高了平均3.72±1.74行.YAG术后1wk回访患者有9例12眼,此12眼的YAG术后1h的平均偏移度为3.175±1.791度,术后1wk的平均偏移度为3.434±1.835度.YAG术后1h与术前相比人工晶体偏移度的差异有统计学意义;术后1h与术前相比眼轴的差异无统计学意义;YAG术后1wk与术后1h人工晶体偏移度的差异无统计学意义;YAG术后1h较术前提高的最佳矫正视力行数与术后1h较术前人工晶体偏移度的差值具有相关性,相关系数为-0.523.结论:后发障患者行YAG激光后囊切开术后人工晶体发生偏移,而眼轴长度几乎不变;且YAG术后人工晶体发生的偏移量越小,最佳矫正视力提高越多.     

Habitual vs optimal distance visual acuity

PURPOSE: The maintenance of a good level of vision is desirable for developmental and social reasons; it is also a requirement that should not be overlooked in the clinical research environment. This study set out to quantify and analyse any difference between 'habitual' (pre-sight test) and 'optimal' (post-refraction) distance visual acuity in an optometric population. It is intended that the outcome of this work will inform not only clinicians but also those undertaking vision research. METHODS: Binocular logMAR visual acuity was determined at 6 m before and after optometric intervention in patients attending optometric practice for a routine sight test. Cases were recorded seriatim but restricted to the 'core' refraction range representative of typical optometric practice; three further exemption criteria included subject illiteracy, the necessity for a non-standard test distance and contact lens wear. Over a 12-month period, two-thirds of patients examined satisfied the study inclusion criteria; it is the clinical data of these 1288 individuals that are described and analysed here. RESULTS: These data provide a quantitative demonstration that an optometric intervention will most likely improve the habitual distance visual acuity of subjects, irrespective of gender, age group, time interval since last test, refractive status and whether or not the subject is a habitual spectacle wearer. The improvement found was typically within one logMAR chart line (<5 letters), being greatest in spectacle-wearing teenagers and in individuals beyond retirement age (increasing to eight letters in elderly habitual non-spectacle wearers); also in non-wearers who left an interval of 2 years or more between sight tests. CONCLUSIONS: Clinical and laboratory-based investigators are advised that a current and optimal refractive correction should be worn by subjects of all ages enrolled in vision-related studies. Refractive defocus may introduce or exaggerate test outcome variability.     

噪声视力表在儿童视力检查中的可重复性分析

目的探讨噪声视力表对儿童视力检查的可重复性及其相关影响因素。方法在门诊首诊患儿中,随机选择无理解障碍及除屈光不正外无其他器质性眼病儿童200例,使用噪声视力表进行噪声视力重复检查。采用配对t检验进行统计学分析。结果两次视力测量之间差异的均数为O.03行,（P=0.515）;两次视力测量结果按性别分组无明显差异（P=1.0,P=0.262）;按年龄分组亦无明显差异（P=0.159,P=0.786）;按屈光不正分组,其中近视组两次视力测量结果有明显差异（P=0.010）。近视儿童视力检查一致性较差,而正视及远视儿童的视力检查一致性较好（P=0.133,P=0.083）。结论结果提示噪声视力表适合儿童视力检查,建议推广使用。     

两种干涉条纹视力计对白内障患者术后视力预测的对照研究

目的通过国产干涉条纹视力计与Heine干涉条纹视力计在预测白内障患者术后视力中的应用对比,探讨国产干涉条纹视力计预测白内障患者术后视力的准确性、实用性、可行性。方法将71例(92眼)白内障患者平均分成2组,术后的视功能情况分别用国产干涉条纹视力计与Heine干涉条纹视力计2种方法进行预测,结果与患眼术后最佳矫正视力进行相关性分析对比。结果国产干涉条纹视力计预测的准确率为81.0%(预测视力与术后视力相差2行以内者认为准确),平均预测视力(4.695)与平均术后最佳矫正视力(4.771)比相差不到1行。Heine干涉条纹视力计预测的准确率为43·9%,平均预测视力(4.481)与平均术后最佳矫正视力(4.771)比相差约3行。结论比起Heine干涉条纹视力计,国产干涉条纹视力计检查更能合理的反映视觉功能,对白内障术后视力具有较好的预测性。     

灯箱视力表与电脑视力表临床应用对比研究

目的:通过与灯箱视力表的对比研究了解电脑视力表的临床使用价值。方法:选取初三学生63例(126眼)同时用灯箱和电脑视力表进行远用视力检测,对视力检测值进行配对检验。结果:两种视力表检测值的t检验等于1.2671,P>0.20,两种视力表的检测在统计学上无显著性差异。结论:电脑视力表和灯箱视力表在临床上具有相同的应用价值,可以推广和普及。     

灯箱视力表与Freiburg电子视力表应用对比研究

目的 比较灯箱视力表与Freiburg电子视力表结果的一致性与可重复性,评价Freiburg电子视力表的临床应用价值。设计 诊断性技术评价。研究对象 空军杭州航空医学鉴定训练中心的工作人员86例,平均年龄（26.3±2.1）岁。方法 所有入选者均随机由2位固定检查者分别使用灯箱视力表和Freiburg电子视力表进行检查,两种视力表检查的顺序随机决定。所有检查均在同一房间内完成,房间内亮度小于3 lux。检查距离均为3 m。对不同视力表间与检查者间测量重复性采用配对t检验比较结果的差别并计算相关系数r值。主要指标 使用两种视力表获得的logMAR视力。结果 在检查者一,用灯箱视力表查,被检者logMAR视力为0.19±0.23,Freiburg电子视力表0.20±0.15,两者差值为-0.011±0.141,差异无统计学意义（t=-0.741, P=0.461）,但有显著相关性（r=0.808,P=0.000）。在检查者二,用灯箱视力表查,被检者logMAR视力为0.32±0.25,Freiburg电子视力表为0.20±0.15,两者差值为-0.118±0.151,差异有统计学意义（t=7.191, P=0.000）及显著相关性（r=0.810,P=0.000）。均用灯箱视力表,检查者一、二的差异有统计学意义（F=11.872,P=0.001）,两者显著相关（r=0.938,P=0.000）。而均用Freiburg电子视力表,检查者一、二的差异无统计学意义（F=0.019,P=0.890）,两者显著相关（r=0.986,P=0.000）。结论 Freiburg电子视力表受检查者因素的影响小于灯箱视力表,其在不同测量者间的可重复性优于灯箱视力表。（眼科, 2013, 22: 117-120）     

Habitual visual acuity in a large urban cohort of Western India and factors influencing poor habitual vision

Purpose:The aim of this study was to determine habitual visual acuity (HVA) in a large urban cohort in western India and identify factors associated with poor HVA.Methods:This was a prospective study conducted over 10 days in September 2018 to assess the HVA in individuals attending a 10-day festival in Western India. Participants who volunteered to undergo vision screening and also filled the questionnaire form pertaining to demographic information including their age, gender, address, income, and educational status were included in this study. HVA was recorded with the distance correction that the participants were wearing when they attended the screening. The study evaluated the prevalence of visual acuity 6/6 or <6/6, 6/12, and 6/18 and the factors associated with lower visual acuity.Results:Of the 6300 participants, 1660 (26.3%) were females. Majority of the participants were from urban background (6084, 96.6%) and were of younger age group (18–40 years––3786, 60.1%; 41–60 years––2187, 34.7%; >60 years––327, 5.2%). HVA was recorded as 6/6 both eyes in 4136 (65.6%), at least 6/12 both eyes in 5691 (90.3%), and at least 6/18 both eyes in 5974 (94.8%) individuals. Only 11 patients (0.17%) had VA worse than 6/60 with only 3 patients (0.003%) having bilateral VA <6/60. Older age, female sex, lower education status, and low annual income were significant risk factors for poor HVA.Conclusion:Poor education, lower income, female gender, and old age are significantly associated with poor HVA even in urban Western India despite relatively easy access to affordable eye care facilities.     

The binocular intraocular lens power difference in eyes with different axial lengths

AIM: To investigate the binocular intraocular lens (IOL) power difference in eyes with short, normal, and long axial lengths (AL) using Lenstar LS 900 optical biometry. METHODS: A total of 716 (1432 eyes) participants were included. The groups were categorized into short (group A: AL<22 mm), normal (group B: 22 mm≤AL≤25 mm), and long AL groups (group C: AL>25 mm). The central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), AL, anterior corneal keratometry, white-to-white (WTW), pupil diameter (PD), as well as IOL power calculated using embedded Barrett formula were assessed. Bland-Altman plots were used to test the agreement of the binocular parameters. RESULTS: In group A, the CCT of the right eye was significantly thinner than that of the left eye (P=0.044) with a difference of -2±8 μm [95% limits of agreement (LoA), -17.8 to 13.2 μm]. For group B, the PD and IOL power in the right eye were significantly lower than those of the left eye (P=0.001, <0.001) with a difference of -0.05±0.32 mm (95%LoA, -0.68 to 0.58 mm) and -0.18±1.01 D (95%LoA, -2.2 to 1.8 D). The AL of right eye was longer than that of the left eye (P=0.002) with a difference of 0.04±0.25 mm (95%LoA, -0.45 to 0.52 mm). No significant difference was observed for all the binocular parameters in group C. The percentage of participants with binocular IOL power difference within ±0.5 D were 62% (31/50), 68.3% (339/496), and 38.8% (66/170) in groups A, B, and C, respectively. CONCLUSION: The binocular parameters related to IOL power are in good agreement, but the binocular IOL power difference of more than half of participants with long AL is more than 0.50 D.     

Methods of visual acuity determination with the spatial frequency sweep visual evoked potential

Purpose The spatial frequency sweep visual evoked potential (sVEP) is used to rapidly determine visual acuity in children or non-responsive patients. Two techniques have been used to separate signal from noise: (1) the 95% confidence interval for the signal amplitude (95% CI) or (2) the amplitude of a Fourier frequency adjacent to 2×the signal frequency (DFT). The purpose of this study is to determine if there is a significant difference in acuity estimates with these techniques.Methods Ten normal subjects (approximately 0.00logMAR acuity) and 11 patients with decreased visual acuity took part in this project. Stimulus production and data analysis were done with an Enfant 4010 (Neuroscientific Corp). Standard VEP recording techniques were employed. The stimulus was a horizontal-oriented, sine wave grating that swept up the spatial frequency spectrum (contrast 80%, temporal reversal rate 7.5Hz). Sweeps were repeated until the confidence intervals for the data were no longer decreasing. The Bailey LovielogMAR chart was used to determine visual acuity. A line was fit to the high spatial frequency data using either the 95% CI or the DFT as the noise estimate. By using these linear equations, acuity estimates were obtained at 0, 1, and 2V signal amplitudes.Results The average logMAR acuity for the subjects with normal acuity was –0.06±0.070 (SD). The sVEP acuity estimates were 0.08±0.098, 0.18±0.092, and 0.33±0.195 (0, 1, and 2V extrapolations) with the 95% CI used as noise and 0.07±0.100, 0.18±0.103, and 0.33±0.202 (0, 1, and 2V extrapolations) with the DFT used as noise. By using the average noise from the Fourier frequency as the extrapolation level, the acuity was 0.10±0.098logMAR. The averagelogMAR acuity for the subjects with decreased visual acuity was 0.67±0.306 (SD). The sVEP acuity estimates were 0.53±0.175, 0.66±0.171, and 0.88±0.295 (0, 1, and 2V extrapolations) with the 95% CI used as noise and 0.53±0.179, 0.65±0.176, and 0.86±0.268 (0, 1, and 2V extrapolations) with the DFT used as noise. By using the average noise from the Fourier frequency as the extrapolation level, the acuity was 0.57±0.186logMAR. No significant difference was found between the two acuity estimate techniques for all of the subjects (repeated measures ANOVA, p=0.16, F₂₀=2.131). The sVEP estimates of acuity to the 0V and noise levels were not significantly different from the logMAR acuity (paired t-test, all p values >0.05).Conclusions The results indicate that the sVEP acuity does not depend on the noise estimation technique. In agreement with prior studies, the sVEP acuity underestimates the logMAR acuity in normally sighted individuals by about an octave.     

弱视患者远、近视力差异的临床观察

目的  了解弱视儿童近视力和远视力是否存在差异。设计 回顾性病例系列。研究对象 弱视儿童81例（139眼）。方法 对81例初次就诊的弱视患者进行屈光矫正,分别运用标准对数远视力表和标准对数近视力表进行矫正后远、近视力的测量及分析。对所有接受检查的弱视儿童分别按年龄、屈光度和病因进行分组统计分析。主要指标 近视力,远视力。结果 不同病因弱视患者的远近视力比较：屈光不正性弱视、屈光参差性弱视、斜视性弱视患者的平均近视力分别为0.48±0.27、0.47±0.28、0.45±0.30,平均远视力分别为0.46±0.22、0.40±0.20、0.43±0.30,各组的远近视力差异均无统计学意义（P均＞0.05）。不同年龄弱视患者的远近视力比较：3岁～≤5岁组、＞5岁～≤7岁组、＞7岁～12岁组的平均近视力分别为0.41±0.23、0.56±0.29、0.46±0.31,平均远视力分别为0.39±0.18、0.52±0.22、0.42±0.23,各年龄组患者的远近视力差异均无统计学意义（P均＞0.05）。不同屈光度弱视患者的远近视力比较：≤+4.00 D组和＞+4.00 D组平均近视力分别为0.45±0.26、0.48±0.28,平均远视力为0.40±0.30、0.46±0.21,两组屈光度患者的近视力与远视力平均值差异均无统计学意义（P均＞0.05）。结论 本研究结果显示,不同病因、不同年龄段、不同屈光度的弱视患者其远、近视力无明显差异。 （眼科,2013,22： 266-268）     

Comparison of Applicability of Different Visual Acuity Charts for Pediatric Outpatient Visual Tests

Purpose： To evaluate the applicability of different visual acuity charts for outpatient pediatric visual tests.
Methods： Fifty-three children （53 eyes） aged 4-8 years undergoing visual acuity tests as outpatients were randomly selected for this study. The best corrected visual acuity （BCVA） of the eye with better visual acuity was measured for each child using the digital LogMAR visual chart, the ETDRS visual chart, and a new standard logarithm visual chart; all measurements were repeated twice and the BCVA was recorded. Paired comparisons were made between the LogMAR visual acuity chart and ETDRS chart measurements or between the ETDRS chart and logarithm visual acuity chart measurements for statistical analysis of the differences in measurement of visual acuity. The results of different measurements by the same chart were compared to evaluate the consistency of the measurement results. Bland-Altman analysis was employed to evaluate the most suitable chart for outpatient measurement of visual acuity in children.
Results： Bland-Altman analysis revealed that the mean visual acuity measured was （0.447±0.017 LogMAR）by the digital LogMAR chart, （0.301±0.024 LogMAR） by the standard logarithm visual acuity chart, and （0.309±0.018 LogMAR） by the ETDRS visual acuity chart. The BCVA was significantly lower when measured by the LogMAR visual acuity chart than by the ETDRS chart （P〈0.01）. The BCVA was slightly higher when measured by the logarithm visual acuity chart than by the ETDRS chart, but the difference was not statistically sig nificant（P〉0.05）. The Bland-Altman plot showed that the highest consistency was obtained with the digital LogMAR chart, with a difference between two repeated measurements of 0.068 LogMAR, compared to 0.090 and 0.072 LogMAR for the logarithm and ETDRS visual acuity charts, respectively.
Conclusion： All three types of visual acuity charts are appli-cable for outpatient measurement of pediatric visual acuity. The ETDRS and logarithm visual acuity ch     

视觉噪声双视力表在弱视检查中的临床应用

目的 探讨视觉噪声双视力表在弱视视觉敏感度检测中的临床应用价值.方法 弱视门诊随机选择100例弱视患者作为弱视组,同时随机抽取100例屈光不正患者作为对照组,使用视觉噪声双视力表分别检测2组患者在有、无视觉噪声条件下视力.然后分别将2组中有、无视觉噪声条件下的视力求差后进行对比研究,以明确视觉噪声双视力表在弱视检查中的应用价值.结果 2组中所有患者在有视觉噪声下的视力均低于无视觉噪声条件下的视力,其中弱视组有、无视觉噪声条件下测得的视力相差(1.62±1.11)行,对照组的视力相差(0.97±0.61)行,2组之间差异有统计学意义(t=5.355,P<0.05).结论 视觉噪声双视力表能够提示弱视者的视觉噪声加工缺陷,借此将弱视者和其他视觉异常者区分开来;可作为常规枧力检查的有益补充,用于弱视的临床检测和诊断.     

两种回归方法推算扫描视觉诱发电位客观推断视力的比较

背景扫描视觉诱发电位（SVEP）是一种客观视力的检测方法,虽然SVEP客观推断视力与主观视力之间存在着明显的相关性,但是两者之间并不完全吻合。研究显示,改进SVEP客观推断视力的推算方法可以提高推断视力的准确性。目的研究SVEP客观推断视力两种推算方法,即振幅-空间频率（A—SP）回归方法与振幅一视角对数（A-logVA）回归方法在客观视力评估中的准确性,探讨影响SVEP客观推断视力准确性的因素。方法对64例具有不同视力的113眼进行SVEP检测、主观小数视力和LogMAR视力检测,分别计算A—SP回归方法推算出的小数视力和LogMAR视力及A．10gVA回归方法推算出的小数视力和LogMAR视力,并对检测结果行相关性分析。使用重庆国特公司GT-2000n型视觉电生理仪检测SVEP,选用0．99～12．89cpd的10个空间频率水平正弦光栅连续刺激视网膜,经离散傅里叶分析获得A—SP回归曲线和A—logVA回归曲线,并将相关直线外推至0振幅处,获得SVEP客观推断视力。结果在小数视力评价系统中,A—SP回归方法和A-logVA回归方法推算出的回归线相关指数分别为0．663和0．705,主观小数视力与由A-SP回归方法推算所得的小数视力间呈正相关（r=0．620,P〈0．01）,主观小数视力与由A—logVA回归方法推算所得的小数视力间呈正相关（r=0．540,P〈0．01）。SP小数视力与VA小数视力间差异有统计学意义（Z=-8．688,P〈0．01）;在LogMAR视力评价系统中,A-SP回归方法和A—logVA回归方法推算出的回归线相关指数分别为0．733和0．715,主观LogMAR视力与由A-SP回归方法推算所得的LogMAR视力间呈正相关（r=0．710,P〈0．01）,主观LogMAR视力与由A-logVA回归方法推算所得的LogMAR视力间呈正相关（r=0．700,P〈0．01）。两种推算方法获得的LogMAR视力间差异有统计学意义（Z=-8．748,P〈0．01）。不同性别、眼别、病种以及年龄段中VALogMAR视力测试值的偏差差异均无统计学意义（χ2=2．171,P=0．338;χ2=0．976,P=0．614;χ2=6．032,P=0．420;χ2=14．720,P=0．257）。结论SVEP是检测客观视力较为有效的方法。但SVEP变异较大,就目前检测技术的稳定性与准确性而言,A—logVA回归方法推算出的客观视力较A—SP回归方法准确。