屈光性调节性内斜视对儿童双眼立体视觉发育的影响

目的 探讨屈光性调节性内斜视对儿童立体视觉发育的影响.方法 通过观察79例屈光性调节性内斜视儿童不同发病年龄、不同戴镜年龄、不同斜视程度、戴镜及治疗前后的立体视功能、及与65名正常儿童立体视功能的比较,分析各种因素对儿童视觉发育的影响.结果 屈光性调节性内斜视儿童的双眼视觉较正常儿童比较明显异常;发病年龄越小,立体视功能越差;戴镜年龄越小,双眼视觉的发育与恢复越好;眼位偏斜程度对双眼视觉的影响差异不显著.结论 屈光性调节性内斜视严重影响儿童双眼视觉的发育:发病年龄越小,戴镜年龄越大对立体视功能影响越大;反之发病年龄越晚,及时佩戴合适的矫正眼镜,立体视功能恢复的就越好.显斜及屈光不正都会严重影响儿童立体视功能的发育.     

双眼内直肌后退术治疗高AC/A非屈光性调节性内斜视

目的对高AC/A的非屈光性调节性内斜视患者,进行双眼内直肌后徙术,观察手术疗效.方法选取15例高AC/A的非屈光性调节性内斜视患者进行双眼内直肌后徙术,后徙量依据斜视度数而定,术后观察眼位,AC/A值及双眼单视功能.结果15例患者术后视远斜视度数平均减少36.80棱镜度,视近斜视度数平均减少48.80棱镜度;9例患者术后双眼立体视锐度有不同程度的提高;13例患者术后不再需要双光镜.2例患者视近斜视度数没有得到改善,术后仍需戴双光镜.结论对高AC/A的非屈光性调节性内斜视患者进行双眼内直肌后徙术,是一种有效的治疗方法.     

屈光性调节性内斜视治愈后的远近立体视锐度测定

目的　探讨屈光性调节性内斜视的功能治愈情况和其远近立体视锐度的差异。方法　采用颜氏远用和近用随机点立体图测定正常儿童、屈光性调节性内斜视儿童和具有同样远视屈光度但不伴内斜视的儿童弱视治愈后的远近立体视锐度。结果　正常儿童的远近立体视锐度测定结果无差异。远视性弱视儿童的远近立体视锐度均优于屈光性调节性内斜视儿童的远近立体视锐度。屈光性调节性内斜视儿童和远视性弱视儿童的远立体视锐度均优于近立体视锐度。结论　屈光性调节性内斜视和远视性弱视治愈后远近立体视锐度的差异与其治疗前的屈光状态和眼位有关。儿童远视应尽早进行光学矫正。     

海口市学龄前儿童斜视与立体视锐度测定

目的了解海口市学龄前儿童斜视患病率及立体视发育情况,以便对斜视及立体视异常及时治疗提供客观依据.方法对海口市3～6岁8326名儿童进行远视力、眼位、近立体视等检查,双眼视力低于1.0或眼位异常者行阿托品散瞳验光.结果斜视患病率2.0%,其中89.7%为本次普查中首次发现.内斜视患者中93.5%发生于远视眼,外斜视及垂直性斜视患者中远视眼及近视眼构成比无明显差别.立体视锐度≤60"者占72.5%,≥100"者占27.5%.双眼视力及眼位正常者立体视锐度正常率为75.5%.随着视力的下降,立体视锐度下降;随着年龄增,加视力正常儿童立体视锐度正常者也呈增加趋势.影响立体视的常见病因是屈光不正、斜视、弱视等,而以斜视性弱视影响最大.结论本次调查显示,海口市3～6岁儿童斜视患病率、立体视锐度正常率与国内他人报告一致,但漏诊漏治情况严重.     

共同性斜视手术前后双眼单视功能的临床观察

目的　观察非调节性内斜视、恒定性外斜视和间歇性外斜视患者手术前后双眼单视功能的变化。方法　将 5 2例共同性斜视患者分为 3组 :非调节性内斜视、恒定性外斜视和间歇性外斜视组。用同视机测定远双眼单视功能 ,用《颜少明立体视觉检查图》测定看近立体视锐度。观察术前、术后5天、 1月、 3～ 6月的斜视角度、远双眼单视功能、近立体视锐度变化。结果　三组斜视的视远双眼单视功能无统计学差异 (P >0 0 5 )。非调节性内斜视与恒定性外斜视组近立体视觉无统计学差异 (P<0 0 5 )。间歇性外斜视组近立体视觉损害较远立体视觉轻 (P <0 0 5 )。结论　非调节性内斜视、恒定性外斜视对双眼单视功能的影响一致。间歇性外斜视组对远双眼单视功能的影响与非调节性内斜视、恒定性外斜视组一致 ,而近立体视觉破坏较轻。     

不同发病年龄非调节性内斜视患儿手术前后双眼单视功能的研究

目的观察分析不同发病年龄非调节性内斜视患者手术前后双眼单视功能的变化。方法将40例非调节性内斜视患者按照不同的发病年龄分为4组。用同视机测定双眼单视功能,用《颜少明立体视觉检查图》测定看近立体视锐度。分析比较不同发病年龄的患者手术前后的远双眼单视功能及近立体视锐度的变化。结果不同发病年龄患者术后获得立体视的情况不同,各组间差异有统计学意义(P<0．05)。结论非调节性内斜视发病年龄越小,术后获得立体视的可能性越小。     

手术疗法在屈光性调节性内斜视矫治中的应用

目的 探讨手术疗法在屈光性调节性内斜视矫治中的应用。方法对42例确定为完全调节性内斜视患儿,配载最佳矫正视力的最大度数的眼镜4周后,仍有斜视的患儿行手术矫正治疗。结果 术后眼位全部纠正,视力平均增加0.38,双眼同视功能恢复率100%,融合和立体视恢复率分别达到80%和76%。弱视治愈率89.5%。结论 屈光性调节性内斜视矫治中应用手术治疗可促进视力和视功能的迅速提高和恢复。     

斜视术后立体视锐度的测定

目的：探讨斜视矫正术后立体视恢复情况。方法：采用颜氏《立体视觉检查图》和《随机点同视机立体图》,进行远、近立体视锐度测定。结果：远、近立体视锐度无明显差异。立体视的恢复随发病年龄增长和视力的增加而上升,外斜视高于其他类型斜视。结论：斜视矫正术后,立体视锐度的恢复与斜视类型、发病年龄和视力有密切关系。发病早、视力低则立体视恢复差。     

儿童共同性斜视矫正术后功能治愈情况的研究和手术时机探讨

目的了解儿童共同性斜视矫正术后的功能治愈率及其影响因素,为斜视手术治疗的时机选择提供依据。方法选择在斜视矫正术后获得眼正位的113例共同性斜视儿童患者作为研究对象。使用同视机及颜少明远用和近用随机点立体图对其进行双眼视功能和远、近距离立体视锐度的检测。结果①113例中术后有111例(98．23％)获得Ⅰ级以上的双眼视功能,49例(43．36％)获得≤60″近立体视锐度,54例(47．79％)获得≤60″远立体视锐度。②外斜视组84例,术后近立体视锐度≤60″者46例(54．26％),远立体视锐度≤60″者49例(58．33％);内斜视组29例,术后近立体视锐度≤60″者3例(10．34％),远立体视锐度≤60″者5例(17．24％)。两组比较(P<0．001)。③间歇性外斜视50例,术后近立体视锐度≤60″者36例(72％);远立体视锐度≤60″者38例(76％)。两组比较(P< 0．001)。④内斜视组手术年龄与术后远、近立体视锐度秒角的相关关系:近立体视锐度r=0．472,P<0．01;远立体视锐度r=0．438,P<0．05。内斜视组病程与术后远、近立体视锐度秒角的相关关系:近立体视锐度:r=0．534,P<0．01;远立体视锐度:r=0．536,P<0．01。结论①儿童后天性共同性斜视患者在视力发育敏感期内得到正确的手术治疗,功能治愈率良好。②内斜视患者术后立体视重建率低于外斜视,间歇性外斜视的功能治愈率高于恒定性外斜视。术前有一定的双眼单视功能有利于术后获得更敏锐的立体视觉。③手术时机应取决于斜视类型,并参考术前双眼单视功能检查的结果。     

应用下加压贴球镜治疗小角度高AC／A调节性内斜视

目的探讨小角度高AC／A调节性内斜视的治疗方法。方法给14例小角度高AC／A调节性内斜视儿童长期佩戴下加压贴球镜的双焦点眼镜,并观察眼位变化及近立体视功能。结果戴镜后所有患者视近眼位正位,AC／A值2—4;14例Titmus检查获400″-40″立体视锐度,11例随机点图片检查获800″-60″立体视锐度。结论8岁前儿童长期佩戴压贴膜球镜制做的双焦点眼镜,可以替代双焦点眼镜治疗小角度高AC／A调节性内斜视。     

Early-onset refractive accommodative esotropia.

INTRODUCTION: We studied the natural history of pure refractive accommodative esotropia after spectacle correction in patients with onset before 1 year old to determine whether their outcomes and characteristics were different from those of patients with more typical age at onset of refractive accommodative esotropia. METHODS: We retrospectively reviewed the charts of 17 children with onset of refractive accommodative esotropia before 1 year old. Records of 26 children with onset after 2 years old were reviewed as controls. RESULTS: The mean ages at diagnosis were 9 months and 48 months for the study and control groups, respectively. All 17 study patients and all 26 control patients were initially well aligned with spectacles at distance and near. Follow-up averaged 34 months for study patients and 41 months for control patients. Three study patients (17.6%) and 1 control patient (3.8%) had eventual deterioration and required strabismus surgery (P = .28). None of the study patients developed amblyopia, whereas 42% of control patients did (P = .001). Seven of 15 (47%) of the study patients with known birth history were born prematurely, whereas only 3 of 24 (12%) control patients were born prematurely (P = .03). CONCLUSIONS: Refractive accommodative esotropia was diagnosed at as early as and age 4 months. Prematurity appeared to be a risk factor. Amblyopia was not detected in any patient with early-onset refractive accommodative esotropia. Treatment with full hyperopic spectacle correction led to long-term stable alignment, with relatively few patients requiring surgery.     

部分调节性内斜视屈光状态与双眼单视功能的相关性研究

目的研究部分调节性内斜视患儿的屈光状态与双眼单视功能的相关性。 方法回顾性分析36例部分调节性内斜视患儿，对患儿裸眼视力、矫正视力、阿托品散瞳后的屈光度数、戴镜半年的远近残余斜视度及双眼单视功能等进行记录和统计学分析。左右眼等效球镜用配对秩和检验比较，右眼等效球镜与视力、斜视度和视功能的相关性采用Spearman分析。 结果36例部分调节性内斜视患儿年龄3~14岁，平均(79.39±31.21)个月，右眼等效球镜(+4.45±1.73)D，左眼等效球镜(+4.75±1.68)D；33 cm裸眼斜视度(+53.19±18.05)△，6 m裸眼斜视度(+47.50±19.00)△；33 cm残余斜视度(+30.36±12.03)△，6 m残余斜视度(+25.53±9.59)△。右眼等效球镜与同视机Ⅰ级、Ⅱ级和Ⅲ级视功能无相关性(r＝-0.012，-0.058，-0.016；P>0.05)。右眼等效球镜与33 cm裸眼斜视度呈正相关(r＝0.344，P<0.05)，与裸眼视力呈负相关(r＝-0.456，P<0.05)。33 cm裸眼斜视度与同视机Ⅰ级、Ⅱ级和Ⅲ级功能均呈负相关(r＝-0.378，-0.678，-0.482；P<0.05)，与Titmus立体图亦呈负相关(r＝-0.477，P<0.05)。6 m裸眼斜视度与同视机Ⅰ级、Ⅱ级和Ⅲ级功能均呈负相关(r＝-0.453，-0.610，-0.430；P<0.05)。33 cm残余斜视度与同视机Ⅱ和Ⅲ级功能均呈负相关(r＝-0.651，-0.600；P<0.05)，与Titmus立体图、立体动物和立体圆圈亦呈负相关(r＝-0.688，-0.625，-0.462；P<0.05)。6 m残余斜视度与同视机Ⅱ和Ⅲ级功能均呈负相关(r＝-0.587，-0.543；P<0.05)，与Titmus立体图、立体动物和立体圆圈亦呈负相关(r＝-0.644，-0.514，-0.492；P<0.05)。 结论部分调节性内斜视患儿的屈光状态与双眼单视功能不相关，与裸眼视力负相关。影响双眼单视功能的是残余斜视度。     

Accommodative esotropia following surgical treatment of infantile esotropia: frequency and risk factors

Purpose: We aimed to examine the frequency of and risk factors for the development of accommodative esotropia following surgical treatment for infantile esotropia. Methods: A total of 29 children were recruited. Potential risk factors for the development of accommodative esotropia included: sex; angle of deviation at initial and final visits; cycloplegic refractive error at initial and final visits; increase in hyperopia; amblyopia; amblyopia treatment; age at surgical treatment; pre‐ and postoperative latent nystagmus; dissociated vertical deviation or inferior oblique muscle overaction; additional surgical procedures; unstable alignment, and binocular sensory status. Results: Overall, 14 (48.2%) of 29 children developed accommodative esotropia during the 36‐ to 132‐month postoperative follow‐up period. Twelve (85.7%) of the 14 patients developed refractive accommodative esotropia and two developed non‐refractive accommodative esotropia. The onset of accommodative esotropia occurred at a mean of 8.8 months (range 6–24 months) after the initial surgical alignment. This corresponded to a mean age of onset for accommodative esotropia of 43.2 months. We determined that, among children with infantile esotropia, those who had hyperopia of ≥ 3.0 D and increasing hyperopia after surgery and those who did not develop dissociated vertical deviation during the follow‐up period were more likely to develop accommodative esotropia. Conclusions: Children who have the established risk factors should be followed closely for the development of accommodative esotropia. The treatment of these children with appropriate glasses may prevent the development of adverse effects of accommodative esotropia on sensory and motor functions.     

Changes in deviation following correction of hyperopia in children with fully refractive accommodative esotropia

Changes in deviation may occur following the correction of hyperopia in children with accommodative esotropia. We analyzed possible factors involving the development of changes in deviation. We examined 49 children (23 boys and 26 girls) who had fully refractive accommodative esotropia at the age of 3 or 4 years. All children wore glasses to correct the fully cycloplegic refractive errors. At the age of 10 or 11 years, 28 (57.1%) of these children had good alignment, 12 (24.5%) developed partial accommodative esotropia and 9 (18.4%) developed consecutive exotropia. The age at onset of esotropia, age at initial visit, and refraction, deviation and presence of stereopsis, as determined by the Titmus test using a fly at the initial visit, were similar among the three groups. In the consecutive exotropia group, amblyopia at the initial visit was significantly higher (89%) than that of the good alignment group (50%). The age at the start of the correction, and the refraction, amblyopia and presence of fusion (10 or 11 years) were almost equal among the three groups. We conclude that some children with fully refractive accommodative esotropia associated with amblyopia at the age of 3 or 4 years may be predisposed to developing consecutive exotropia.     

Risk factors for the development of accommodative esotropia following treatment for infantile esotropia.

PURPOSE: One aim of the study was to determine whether accommodative esotropia after surgical alignment in infantile esotropia occurs because a pre-existing accommodative component is unmasked at the time of surgery or whether it occurs as a sequela of infantile esotropia. A second aim of the present study was to examine risk factors for accommodative esotropia after surgery for infantile esotropia. METHODS: A total of 80 consecutive patients who were enrolled in a prospective study of infantile esotropia had been followed for more than 4 years and had achieved orthoposition were included. Twelve potential risk factors were examined: age at onset, initial esodeviation, initial refractive error, age at alignment, delay in alignment, presurgical glasses, amblyopia, additional surgical procedures, unstable alignment, increase in hypermetropia, peripheral fusion, and stereopsis. Mantel-Haenszel odds ratios were computed for each factor and were corrected to relative risks. RESULTS: Overall, 48 of 80 children (60%) developed accommodative esotropia at a mean age of 33 months. Increasing hypermetropia, delay in alignment, and poor stereopsis posed significant risks for accommodative esotropia. The remaining 9 factors were not associated with increased risk for accommodative esotropia. CONCLUSIONS: Accommodative esotropia is unlikely to be a pre-existing condition in most cases because the mean age of onset was 23 months postoperative and the prevalence of preoperative hypermetropia greater than +3.00 D was low. Both delay in alignment and stereopsis risk factors may reflect compromised binocular sensory status that allows accommodative esotropia to occur at low to moderate levels of hypermetropia. Identification of children treated for infantile esotropia who are at risk for accommodative esotropia may allow for prevention or early treatment.     

Update on accommodative esotropia

PURPOSE: The aim of this study was to present an update on accommodative esotropia. METHODS: The diagnosis, clinical features, etiology, treatment, prognosis, and clinical course for the 3 types of accommodative esotropia are presented. RESULTS: Accommodative esotropia is the most common pediatric strabismus and must be differentiated from other pediatric esotropias. Although its average age of onset is 2.5 years, it can begin during the first year of life and is seen rarely in older children and teenagers. Refractive accommodative esotropia and nonrefractive accommodative esotropia have a better prognosis for achieving normal binocular vision and high-grade stereopsis with appropriate and timely treatment than partly accommodative esotropia. Children with successfully treated accommodative esotropia need to be followed up with to prevent possible deterioration and development of a superimposed nonaccommodative esotropia, which in some cases may require extraocular muscle surgery. Emmetropization and spontaneous resolution of the esotropia occur rarely and may take many years. CONCLUSION: Approximately 50% of all pediatric esotropias are either entirely or partly accommodative. Proper care is long term and includes monitoring the refractive error and binocular vision status over the years.     

急性共同性内斜视的临床特征分析和手术 治疗体会

目的：分析101例急性共同性内斜视患者的临床特征、手术方式及治疗效果。方法：回顾性系列病例 研究。连续纳入2018年11月至2020年11月于武汉爱尔眼科医院就诊的急性共同性内斜视患者101例, 其中男71例,女30例,年龄5~76（20.7±11.3）岁。收集患者的临床资料包括患者基本资料、眼部情 况以及头颅影像学检查等。采用配对t检验对看近和看远斜视度及手术前后斜视度进行比较。采用 χ2检验分析不同年龄段、不同性别的患者屈光状态的差异。结果：101例患者中近视81例,远视19例, <12岁组以远视为主,12~30岁组以中高度近视为主,>30岁组以低中度近视为主。发病年龄12~30 岁有71例,占比70.3%（71/101）。其中学生有63例,近距离用眼时长大于8 h的占比46.5%（47/101）。 裸眼看近斜视度（+42.0±18.3） △,裸眼看远斜视度（+43.7±17.2） △,裸眼看远斜视度大于看近斜视 度（t=2.82, P=0.011）;戴镜看近斜视度（+41.6±18.6） △,戴镜看远斜视度（+43.2±17.7） △,戴镜看远 斜视度大于看近斜视度（t=2.61, P=0.007）。裸眼与戴镜看远斜视度数大于看近斜视度数患者占总人 数24.8%,裸眼与戴镜看近斜视度数大于看远斜视度数患者占总人数7.9%。83例内直肌止端距角膜 缘的距离平均为4.74 mm,小于正常值的5.50 mm。最常用的手术方式为内直肌后徙联合外直肌缩 短术,所有患者手术均一次成功,术后患者看近看远的斜视度的均数为0 △。结论：急性共同性内斜 视患者多为青少年和20多岁的年轻人,可能与近距离用眼时长过长有关。不同屈光状态患者均有出 现急性共同性内斜视的可能。内直肌止端前移解剖异常。急性共同性内斜视患者中裸眼和戴镜看远 斜视度数大于看近斜视度数占比高于看近斜视度数大于看远斜视度数。采用内直肌后徙联合外直肌 缩短术治疗的患者术后均有良好的手术效果。     

Clinical characteristics of sibling patients with comitant strabismus

AIM: To investigate the clinical characteristics of sibling patients with comitant strabismus. METHODS: Sibling patients who were diagnosed with comitant strabismus from January 2005 to December 2014 were retrospectively reviewed. Factors including age, sex, types of strabismus, refractive errors, angle of deviation, and coexistence of other strabismus were analyzed. RESULTS: A total of 62 patients (31 pairs of siblings) were included. Of these, 26 pairs had intermittent exotropia, 3 had accommodative esotropia, and 2 had infantile esotropia. There were no pairs with different subtypes of strabismus. The age at first visit was 3.7±2.6y and the mean follow-up period was 30.5±24.1mo. In siblings with intermittent exotropia, there was no difference in age of onset, age at operation, or refractive errors between the first and second-born children. The 20 (77%) pairs of siblings with exotropia showed more than 80% concordance of maximum angle of deviation during follow-up. In the 9 pairs in which both siblings had an operation, the final angle of deviation after the operation was 8.2±8.1 prism diopters (PD) in first-born children and 8.6±6.5 PD in second-born children. CONCLUSION: The subtypes of strabismus are the same in all pairs of siblings and clinical characteristics of strabismus are similar between the first and second-born children. This similarity could be an indicator for the diagnosis of second-born children. Further prospective study including a larger number of sibling patients is needed.     

Strabismus management

In this article, three topics of current interest in strabismus are covered. These include strabismus after glaucoma implant surgery, management of accommodative esotropia, and the timing of treatment for strabismic amblyopia. Glaucoma implants have improved our results with difficult glaucoma syndromes, however, a high incidence of postoperative strabismus has been associated with this procedure. The mechanism of the strabismus has not been clearly defined in previous literature, but in this article we describe three mechanisms that cause strabismus after glaucoma implant surgery and describe methods for managing this problem. The standard management of accommodative esotropia has historically resulted in a large number of undercorrections. Patients with accommodative esotropia have good fusion potential as the strabismus is acquired and binocular visual development occurred during the critical period. Recent studies indicate that we should increase our surgical numbers when managing patients with accommodative esotropia. Various treatment strategies are covered in the section on accommodative esotropia. Finally, a discussion on the management of strabismic amblyopia is presented. The importance of treating amblyopia first, then secondarily correcting the strabismus is emphasized.     

Accommodative convergence in hypermetropia

We compared the clinical characteristics of esotropic, hypermetropic children whose strabismus was fully corrected with spectacles (refractive accommodative esotropia) with those who remained orthotropic (that is, had no manifest strabismus on the cover test) in the presence of uncorrected hypermetropia. In addition to a standard ophthalmologic and orthoptic examination, we determined the stimulus accommodative convergence/accommodation (AC/A) ratio by using the gradient method over a range of 6 diopters, the near point of accommodation, and random dot stereopsis. Hypermetropic patients without esotropia or significant esophoria were found to have a low AC/A ratio in contrast to those patients with refractive accommodative esotropia. This finding explains why esodeviations may be absent in some hypermetropic patients with uncorrected vision. We found a high prevalence of abnormally low near points of accommodation and defective or absent stereopsis in both groups of patients.