Amblyopia of the fellow eye in assumed unilateral congenital fibrosis syndrome

BACKGROUND: Amblyopia of the ptotic eye in spite of head posturing and of the fellow eye in ptosis with motility disorders are well known. We emphasize the importance of exact ophthalmological and orthoptic examinations to avoid amblyopia in both ptosis and fellow eye, even in cases of mild ptosis, especially if they are combined with motility disorders. PATIENT: A 5 year-old girl presented to our outpatient clinic because of ptosis of the left eye and hypertropia of the right eye. Visual acuity of the right eye was 0.32 and of the left ptotic eye 1.0. Cycloplegic retinoscopy showed + 2.0 sphere in both eyes. Ocular motility showed a mild reduction of elevation of the left eye in ad- and abduction. This led to the diagnosis of congenital fibrosis syndrome of the inferior rectus muscle of the left eye. Due to the preferred fixation with the left ptotic eye and the consecutive deviation of the fellow eye amblyopia of the right eye had developed. Occlusion therapy of the left eye resulted in an improvement of visual acuity of the right eye to 0.9 and centralisation of fixation within one month. CONCLUSION: Even children with mild ptosis, especially in combination with motility disorders, require a complete ophthalmological and orthoptic examination to avoid amblyopia also of the fellow eye.     

Outcome after treatment of congenital unilateral cataract

PURPOSE: To evaluate long-term functional outcome after treatment of congenital unilateral cataract. METHODS: The records of 30 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. The patients were followed until 4-9.5 years of age. Linear Snellen visual acuity (VA), occlusion therapy compliance, and the presence of nystagmus, strabismus and other complications are reported. RESULTS: Six children achieved VA of 0.1 or better. They were all operated on before 3 months of age. Of the 12 infants operated on before 6 weeks of age, four have VA between 0.3 and 0.4 and eight have VA of finger counting or less. Four developed severe secondary glaucoma within 6 months of cataract extraction. Two of these had persistent fetal vasculature. Three eyes developing glaucoma became amaurotic. Occlusion therapy was abandoned before the age of 2.5 years in 21 children. CONCLUSION: Good levels of VA were achieved only in children who underwent cataract surgery before 3 months of age and who adhered to the occlusion therapy schedule. Severe secondary glaucoma developed in four out of 12 children operated on within 6 weeks. Full compliance with the occlusion therapy programme was uncommon.     

单眼先天性白内障术后弱视的治疗

目的探讨完全遮盖疗法及完全压抑疗法、单镜及双镜矫正对单眼先天性白内障术后弱视患儿的治疗效果。方法将58例患儿随机分为4组A组采取完全压抑疗法,对弱视眼行双镜矫正;B组采取完全压抑疗法,弱视眼给予单镜矫正;C组及D组均采用遮盖疗法,C组弱视眼以双镜矫正,D组以单镜矫正。结果治疗后视力提高≥2行者,A组75%,B组36%,C组73%,D组31%;双镜矫正与单镜矫正比较差异有显著性(P<005);而完全压抑疗法与完全遮盖疗法比较差异无显著性(P>005)。结论无论何种方法,只要达到解除主导眼对弱视眼的抑制,视力就可能提高;双镜矫正更符合人工晶体眼的生理特点,故治疗效果更为明显。     

Stereopsis after congenital monocular cataract extraction.

Congenital monocular cataract extraction was performed on a 1-day-old baby girl and a hydrophilic contact lens was fitted. A progressive regimen of part-time occlusive therapy was then instituted. Eight years later, the girl has a visual acuity of 20/25 in the operated-on eye and 50 seconds of arc of stereoacuity that has been confirmed by an independent pediatric ophthalmologist. This patient demonstrates the potential for high-grade stereopsis in congenital monocular aphakia.     

婴幼儿先天性白内障术后视功能评价

目的 综合评价婴幼儿先天性白内障术后的视功能发育情况.方法 为回顾性系列病例研究.将先天性完全白内障患儿41例(62只眼)按年龄分为4组.A组:＜0.5岁,13例(20只眼);B组:≥0.5且＜1岁,11例(16只眼);C组:≥1岁且＜2岁,9例(15只眼);D组:≥2岁,8例(11只眼).均施行白内障吸除及双撕囊联合前段玻璃体切除手术,术后3 d使用Mini刺激器行闪光视觉诱发电位(F-VEP)检查,术后1周用维视顿视功能治疗和检查系统评价视力情况,随后配戴合适框架眼镜,遮盖健眼进行增视训练,12周后再次使用Mini刺激器行F-VEP检查以及视力检查.结果 4组患儿增视功能训练12周后的P100潜伏时分别为(90.28±1.59)、(111.30±1.59)、(125.28±1.97)、(147.87±1.46)ms,与术后3 d[(144.61±2.25)、(150.05±1.92)、(153.89±1.12)、(164.15±1.48)ms]比较明显缩短(t=43.75,32.77,31.61,65.04;P＜0.01).4组患儿增视功能训练12周后P100振幅分别为(12.65±0.25)、(10.56±0.05)、(9.06±0.40)、(8.71±0.02)Μv,与术后3 d[(3.41±0.06)、(4.60 ±0.10)、(4.70±0.27)、(5.00±0.01)Μv]比较明显增加(t=-376.05,-91.64,-507.77,-399.41;P＜0.01).视力检查亦显示,增视功能训练12周后视力(0.471 ±0.021、0.462 ±0.033、0.410±0.027、0.390 ±0.033)较术后1周(0.112±0.0127、0.107 ±0.013、0.117 ±0.014、0.120±0.014)明显提高(t=20.983,10.607,15.036,7.488;P＜0.05),且年龄段越小其视功能恢复越好,以A组患儿视功能恢复情况最好.结论 先天性白内障患者应尽早行手术治疗,术后配戴合适眼镜以及合适的增视功能训练,对于患者视功能的发育及重建具有重要意义.     

Visual rehabilitation of adult patients after unilateral cataract extraction

The influence of correcting soft contact lenses and pleoptic-orthoptic exercises on the improvement of the visual acuity and acquiring of binocular vision was analyzed in 22 patients aged 17-65 years after unilateral cataract extraction. Visual acuity of between 5/5 and 5/16 was attained in 88.6 p.c. of patients, binocular vision in 85.9 p.c. Poorer results were observed in persons with a diminished transparency of the ocular media caused by injury as well as in younger individuals after congenital cataract surgery.     

Vision in the "good" eye of children treated for unilateral congenital cataract.

PURPOSE: The authors examined linear acuity and contrast sensitivity in the "good" (fellow) eye of children treated for unilateral congenital cataract to determine (1) whether there were subtle deficits like those described for the good eye of patients with strabismic amblyopia and (2) whether any deficits were related to the degree to which the good eye had been patched. METHODS: The authors tested patients treated for unilateral congenital cataract who had a well-documented history of patching. The good eye was physically normal with minimal refractive error. The measures were linear acuity at far (n = 15) and contrast sensitivity (n = 9). RESULTS: Compared with age-matched control subjects, the good eyes of patients had subtle deficits in linear acuity and in contrast sensitivity at high spatial frequencies. These deficits occurred even in eyes that had received minimal patching, and their severity was not related systematically to the duration of patching, which varied widely across the group. CONCLUSION: The visual sensitivity of the good eye of children treated for unilateral congenital cataract is, on average, slightly reduced, even in cases of minimal patching. Consequently, any deficits discovered after aggressive patching may not have been caused by occlusion amblyopia.     

Amblyopia treatment of unilateral and bilateral cataract with visual acuity result

Treatment strategies of congenital cataract provide evidence of recent improvement in the visual prognosis. This trend is likely to be accounted for by a combination of improved management of amblyopia occurring in parallel with advances in surgical techniques, instrumentation, and materials. Compliance with occlusion is the factor most strongly associated with visual outcome: to support, to encourage, to comfort, to explain, to require (demand) to put in front of the responsibilities, here are the other missions of the therapist which are not less important than the surgical gesture. Progress, in this "educational" care of the visual function remains to make but the way is drawn.     

白内障术后干眼的研究进展

白内障手术后，部分患者会主诉术眼出现干燥感、异物感、灼热感等不适，即出现干眼，本文将白内障术后干眼的发生原因、预防和治疗作一简要综述。     

双眼先天性白内障同时手术的评价

目的 评价双眼同时手术治疗双眼先天性白内障的疗效。方法 通过对6例先天性白内障施行双眼同时手术,术后联合弱视训练进行分析。包括手术方式、手术操作、术后炎症反应、后囊膜浑浊、术后视力情况、脱盲、脱残情况等。结果 手术方式分单纯白内障吸出术、白内障吸出加人工晶状体植入、白内障囊外摘除加人工晶状体植入术。所有手术眼术后视力较术前均有提高,5例7眼术后出现前房纤维素样渗出、1例1眼出现人工晶状体前后膜,全部发生后囊膜混浊,但程度不等。需激光后囊切开的有3例6眼。经过手术前后对比,术后眼球震颤的程度都有减轻。结论 双眼先天性白内障同时手术是可行的,有利于避免遮盖导致的剥夺性弱视,利用双眼视的建立,减少全麻手术的风险。如果双眼先天性白内障视力均低于0.1,双眼无明显的差别,可以选择同时手术。     

婴儿先天性白内障摘除一期人工晶状体植入的研究进展

近年来,婴儿先天性白内障摘除后一期植人人工晶状体受到越来越多眼科医生的认可,并在临床实践中逐步开展。25G玻璃体切除系统在婴儿白内障手术中的应用,大大降低了术后并发症的发生;新型屈光度计算公式和近视漂移预测公式的发展,提高了人工晶状体屈光度选择的准确性;更适合婴幼儿的人工晶状体和弱视训练方法的发展,提升了术后视功能重建的效果。     

白内障摘除联合后囊连续环形撕囊治疗先天性白内障

目的：观察先天性白内障摘除术中行后囊连续环形撕囊（PCCC）防治后发性白内障的疗效及可能出现的并发症。 方法：采用小切口先天性白内障单纯囊外摘除或联合人工晶状体植入术，对58例97眼先天性白内障患者进行后囊连续环形撕囊，使晶状体后囊中央形成约3～5mm的囊膜缺损区，行前部玻璃体切除术，以避免后发性白内障的发生。 结果：Ⅰ期植入人工晶状体50眼：术后1mo矫正视力≥0．6者18眼，0．5以下42眼；术后3mo矫正视力≥0．6者20眼，0．5以下46眼；术后6～12mo矫正视力≥0．6者21眼，0．5以下50眼。术后lmo第1次复查，无1眼发生后发性白内障，3mo周边部后囊膜浑浊40例，撕囊区清亮。6～12mo16眼发生新生膜，10眼少量玻璃体脱出于前房，玻璃体轻度浑浊，瞳孔不圆18眼，人工晶状体偏位10眼，无1眼发生视网膜脱离。 结论：后囊连续环形撕囊是一种经济、安全、高效的防止先天性白内障术后后发性白内障的手术方式，适用于不能配合激光治疗的儿童，但存在一定的复发率。