成人弱视治疗和黄斑光相干断层扫描检查

目的探讨成人弱视治疗效果及成人视细胞仍具有可朔性的依据。方法对一组成人弱视患者43例50眼治疗前后做黄斑光相干断层扫描(OCT)检查,观察、比较治疗前后黄斑OCT像情况。弱视采取综合治疗方法。结果43例中38例患者OCT示黄斑结构正常,治疗前后无变化。另5例7眼OCT像示黄斑神经上皮层异常增厚,中心凹形成不良。其中的2例3眼经弱视治疗后黄斑神经上皮层变薄,中心凹明显,视力均有进步;3例4眼OCT像无变化,包括其中1例1眼视力有进步的情况。42例成人患者的弱视疗效观察,治愈24%,进步54%,无效22%,总有效率78%。结论成人视细胞仍具有一定程度可朔性,可根据OCT检查所显示黄斑情况试行弱视治疗。     

大龄儿童弱视69例疗效观察

目的探讨大龄儿童弱视治疗的方法及疗效。方法10～17岁弱视儿童69例（81眼）,经综合疗法治疗弱视,观察其治疗效果,并对年龄和弱视类型、弱视程度、注视性质等相关影响因素进行统计分析。结果69例81眼,基本治愈53眼（65.43%）,进步20眼（24.69%）,无效8眼（9.88%）,总有效率90.12%;按年龄分组,10～12岁组50眼,基本治愈34眼（68.00%）,13～17岁31眼,基本治愈19眼（61.29%）,两组间差异无统计学意义（P〉0.05）。不同程度弱视之间的疗效差异有非常显著意义（P〈0.01）;屈光不正性弱视疗效优于屈光参差性弱视和斜视性弱视（P〈0.01）;中心凹注视和中心凹旁注视患者的疗效明显优于黄斑旁注视和周边注视患者（P〈0.01）。结论大龄弱视儿童,只要坚持治疗,大部分治疗有效。其疗效与弱视类型、程度、注视性质密切相关。     

自制后像镜治疗儿童弱视疗效观察

我科应用自制后象镜对29例52眼弱视儿童的治疗结果,简要总结如下: 一般临床资料本文29例52眼,男15例,女14例。年龄:4岁1例,5岁10例,6岁10例,7岁7例,8岁1例。弱视类型:斜视性弱视7例,其中共同性内斜视6例,共同性非斜视1例,届光不正性弱视18例,届光参差性弱视4例。注视性质:中心注视者47眼,旁中心注视5眼。轻度弱视视力在0.6～0.8者13眼,中度弱视视力在0.2～0.5为36眼,重度弱视力≤0.1为3眼。     

弱视眼的视力性质与疗效

通常在眼科检查中视力是指中心视力而言,实际上存在有偏心视力,主要在视神经病、黄斑部疾病、弱视三大类眼病中。在弱视的检查中,过去仅有偏心注视的提法。本文用视力性质分析的方法对弱视进行了临床分析。     

远视性屈光参差性弱视儿童治疗前后黄斑区视网膜厚度的临床研究

目的:探讨远视性屈光参差性弱视儿童治疗前后黄斑各分区视网膜厚度、注视性质、最佳矫正视力(BCVA)、眼轴、等效球镜度数随着治疗时间延长发生的变化。方法:前瞻性纵向对照研究试验。选取2018-08/2019-08于我院确诊前未进行过弱视治疗的4~8岁单眼弱视的远视性屈光参差患儿共计40例(中心注视20例,旁中心20例),治疗前,治疗后6、12mo均行阿托品散瞳验光、眼底黄斑注视性质、眼轴、OCT视网膜厚度检查。用统计学分析远视性弱视眼的黄斑区视网膜厚度是否随治疗发生变化以及产生影响的相关因素,不同注视性质间是否存在差异。结果:治疗前,治疗后6、12mo中心注视组和旁中心注视组的中心凹视网膜厚度、内环鼻侧视网膜厚度均有差异(P<0.01),黄斑区其余视网膜厚度均无差异(P>0.05);随着治疗时间延长中心注视组和旁中心注视组的中心凹视网膜厚度、内环鼻侧视网膜厚度变薄(均P<0.05)。相同测量时间中心注视组的中心凹和内环鼻侧视网膜厚度比旁中心注视组薄(均P<0.05),黄斑区其余视网膜厚度无差异(均P>0.05)。治疗前后弱视眼的眼轴、BCVA、等效球镜度数有差异(均P<0.01);随着治疗时间延长眼轴长度增加,BCVA升高,等效球镜度数降低。远视性弱视眼黄斑各分区视网膜厚度厚于对侧正常眼,眼轴长度小于对侧正常眼(均P<0.01)。弱视眼与对侧正常眼治疗前后眼轴长度变化有差异(P<0.05),弱视眼眼轴短于对侧正常眼眼轴,随着治疗时间的延长弱视眼与对侧正常眼眼轴长度都变长。结论:中高度的弱视眼黄斑区视网膜各分区厚度均大于对侧正常眼,眼轴小于对侧正常眼。治疗后随着最佳矫正视力的提高,中心注视、旁中心注视组黄斑区中心凹和内环鼻侧的视网膜厚度均变薄。     

高度近视偏心注视优势位置的研究

目的 探讨高度近视眼因黄斑病理损害形成中心暗点以及丧失中心视力后偏心固视的形成规律,确定偏心注视点的优势位置.方法 应用微视野计(MP-1)对因黄斑病变形成偏心固视的40例高度近视患者的54只眼作固视检查.利用正常成人中心固视的90%置信椭圆,确定偏心固视相对于中心凹的位置.根据观察到的偏心固视的位置,将所有患眼分为preferred retinal locucs(PRL)优势组和PRL非优势组;并将两组视力作统计学比较.结果 54只高度近视眼中,中心视力丧失后偏心固视点形成在暗点下方视野者24只眼,占本组患眼的44.44%;左侧19只眼,占35.19%;上方6只眼,占11.11%;右侧5只眼,占9.26%.双眼均形成偏心固视者14例,其中13例双眼偏心固视模式一致,均为下方者7例,占双眼偏心固视者的50.00%;均为左侧者5例,占35.71%;均为上方者1例,占7.14%.偏心固视位于下方、左侧视野组与偏心位置位于右侧和上方的非优势组之间比较.其视力差异无统计学意义(F=0.144,P>0.05).结论高度近视患者偏心固视会形成在尽量靠近中心凹有功能的视网膜.下方视野是形成偏心固视的优势位置.     

高度近视偏心注视优势位置的研究

目的 探讨高度近视眼因黄斑病理损害形成中心暗点以及丧失中心视力后偏心固视的形成规律,确定偏心注视点的优势位置.方法 应用微视野计(MP-1)对因黄斑病变形成偏心固视的40例高度近视患者的54只眼作固视检查.利用正常成人中心固视的90%置信椭圆,确定偏心固视相对于中心凹的位置.根据观察到的偏心固视的位置,将所有患眼分为preferred retinal locucs(PRL)优势组和PRL非优势组;并将两组视力作统计学比较.结果 54只高度近视眼中,中心视力丧失后偏心固视点形成在暗点下方视野者24只眼,占本组患眼的44.44%;左侧19只眼,占35.19%;上方6只眼,占11.11%;右侧5只眼,占9.26%.双眼均形成偏心固视者14例,其中13例双眼偏心固视模式一致,均为下方者7例,占双眼偏心固视者的50.00%;均为左侧者5例,占35.71%;均为上方者1例,占7.14%.偏心固视位于下方、左侧视野组与偏心位置位于右侧和上方的非优势组之间比较.其视力差异无统计学意义(F=0.144,P>0.05).结论高度近视患者偏心固视会形成在尽量靠近中心凹有功能的视网膜.下方视野是形成偏心固视的优势位置.     

调节训练治疗矫正视力低下疑似弱视患儿的疗效分析

我院门诊2014年至2015年诊治患儿116例(232只眼),年龄7~11岁,患儿年龄均在视觉发育期,都有最佳矫正视力下降,眼部检查无器质性病变,但均无异常视觉经验,不能诊断为弱视,本研究称为矫正视力低下疑似弱视患儿.此类患儿不能按弱视治疗原则治疗,我们通过调节训练治疗该类患儿取得了非常好的疗效. 一、资料与方法 1.一般资料:门诊患儿116例(232只眼),其中男性52例,女性54例;初诊年龄7~11岁,平均8. 5岁. 2.入选标准:①视力低于相关年龄的最低下限;3 ~5岁为0. 5,6岁及以上为0. 7.②门诊行裂隙灯、眼位、屈光间质、注视性质,VEP,视野及OCT检查,排出眼部器质性病变后,③无引起弱视的异常视觉经验.     

Haidinger刷联合后像及红光闪烁治疗偏心注视性弱视的疗效观察

目的:观察Haidinger刷联合后像及红光闪烁法对偏心注视性弱视的治疗效果。方法:242例偏心注视性弱视患者随机分成两组,治疗组116例116眼,采用Haidinger刷联合后像及红光闪烁法;对照组126例126眼,采用后像及红光闪烁法。连续在门诊治疗2mo。结果:治疗组有效率86.2%,对照组42.9%,两组之间的差异具有统计学意义(P<0.01)。结论:Haidinger刷联合后像及红光闪烁法对偏心注视性弱视有显著的增视作用。     

学龄儿童单眼弱视的疗效分析

目的:探讨学龄期儿童单眼弱视的治疗效果。方法:我院门诊治疗的6～18岁单眼弱视患者71例,采用综合疗法,观察其治疗效果,并对患者的年龄、弱视类型、弱视程度及注视性质与疗效的相关性进行分析。结果:学龄期儿童单眼弱视71例71眼的治愈率为63%(45/71),进步24%(17/71),无效13%(9/71)。结论:学龄期儿童单眼弱视治疗效果较好,应予积极治疗,疗效与患儿年龄、弱视类型、弱视程度及注视性质关系密切,6～12岁患儿,屈光参差性弱视、轻度弱视、中心注视者疗效好。     

On the relationship between strabismic amblyopia and eccentric fixation.

Landolt C and grating acuity are compared with that normally expected of the eccentric fixation region for 10 strabismic amblyopes. The findings suggest that 2 populations of amblyopes exist. For some amblyopes visual function is that predicted of the eccentric region used for fixation, whereas for other amblyopes there is a further pathological reduction in visual function. These findings may have an important bearing on the type of orthoptic treatment used for amblyopia.     

A preliminary report of acuity and contour interactions across the amblyope's visual field

Acuity and contour interactions were assessed across the visual field of representative strabismic amblyopes. Acuity profiles display large variations between amblyopes who exhibit the same degree of eccentric fixation; however, in no case was foveal acuity significantly better than that found eccentrically. The acuity abnormality for most amblyopes is visual field locus dependent. Contour interactions are abnormal in both form and magnitude for some amblyopes. This abnormality does not depend upon the acuity deficit, is field locus dependent and cannot be easily accounted for by optical, oculomotor or eccentric fixation factors.     

Amblyopia in 4-year-old children treated with grating stimulation and full-time occlusion; a comparative study.

We have compared the effects on visual acuity and binocular functions of grating stimulation (CAM therapy) and full-time occlusion in 38 4-year-old, previously untreated amblyopic children. The patients were divided into subgroups with regard to amblyopia type and fixation pattern. We found that grating stimulation was slightly better than occlusion in improving visual acuity of anisometropic amblyopes with central fixation, but that both types of therapy were equally effective in strabismic amblyopia with central fixation and in amblyopia with eccentric fixation. However, maximal treatment effects were not reached with grating stimulation alone, as shown at follow-up after continued conventional therapy. Grating stimulation may be regarded as a valuable method at the initiation of treatment, particularly in anisometropic amblyopia, but it has to be supplemented with occlusion, which still must be regarded as the prime form of amblyopia therapy.     

Pattern of amblyopia and fixation after keratoplasty.

Forty cases of clear corneal grafts in 2 groups of patients who developed corneal opacities either before or after 5 years of age were investigated for the pattern of amblyopia and fixation. A severe irreversible form of amblyopia with eccentric fixation was observed in cases of unilateral corneal opacity when the anomaly occurred before the age of 5 years and corneal grafting was delayed until the second or third decade of life. If the opacity was bilateral, although the onset was before the age of 5 years, the improvement in visual acuity after corneal grafting occurred in the relatively better eye with foveal fixation. Good visual results were seen after corneal grafting when the offending opacity occurred after the age of 5 years. Foveal fixation was also observed in most of these cases. None of the patients who had a squint preoperatively lost their angle of strabismus. Four cases in group B, however, developed an alternating squint postoperatively.     

Evaluation of visual acuity in a historical cohort of 137 patients treated for amblyopia by occlusion 30-35 years ago

BACKGROUND: Opinions differ on the course of the visual acuity in the amblyopic eye after cessation of occlusion therapy. This study evaluated visual acuity in a historical cohort treated for amblyopia with occlusion therapy 30-35 years ago. MATERIALS AND METHODS: Between 1968 and 1975, 1250 patients had been treated by the orthoptist in the Waterland Hospital in Purmerend, The Netherlands. Of these, 471 received occlusion treatment for amblyopia (prevalence 5.0%, after comparison with the local birth rate). We were able to contact 203 of these patients, 137 were orthoptically re-examined in 2003. We correlated the current visual acuity with the cause of amblyopia, the age at start and end of treatment, the visual acuity at start and end of treatment, fixation, binocular vision and refractive errors. RESULTS: Mean age at the start of treatment was 5.4 +/- 1.9 years, 7.4 +/- 1.7 years at the end and 37 +/- 2.7 years at follow-up. Current visual acuity in the amblyopic eye was correlated with a low visual acuity at the start (p < 0.0001) and end (p < 0.0001) of occlusion therapy, an eccentric fixation (p < 0.0001), and the cause of amblyopia (p = 0.005). At the end of the treatment, patients with a strabismic amblyopia (n = 98) had a visual acuity in the amblyopic eye of 0.29 logMAR +/- 0.3, and in 2003 0.27 +/- 0.3 logMAR. In patients with an anisometropic amblyopia (> 1 D, n = 16) visual acuity had decreased from 0.17 +/- 0.23 logMAR to 0.21 logMAR +/- 0.23. In patients with both strabismic and anisometropic amblyopia (n = 23), visual acuity had decreased from 0.52 logMAR +/- 0.54 to 0.65 logMAR +/- 0.54. Overall, acuity had decreased in 54 patients (39%) after cessation of treatment. Of these, 18 patients had an acuity decrease to less than 50% of their acuity at the end of treatment. In 15 of these 18 patients anisohypermetropia had increased. CONCLUSIONS: A decrease in visual acuity after cessation of occlusion therapy occurred in patients with a combined cause of amblyopia or with an increase in anisohypermetropia.     

The prognostic value of visual evoked response latency in the treatment of amblyopia caused by strabismus

Visual evoked response alterations and especially P100 latency were studied in 60 patents with amblyopia caused by strabismus. Patients were divided in two groups according to the mode of fixation of the strabismic eye. Group A included patients with eccentric fixation, and group B, patients with central fixation of the strabismic eye. In all cases visual evoked responses were recorded before and after a 6-month period during which the patients had full-time occlusion of the sound eye. In case with eccentric fixation of the strabismic eye, P100 latency was more abnormal than in cases with central fixation. In cases where latencies are clearly abnormal before treatment, the prognosis is poor and the results after occlusion of the sound eye are unstable. In contrast, in the cases with normal or nearly normal visual evoked response latencies, the prognosis is better, and these eyes show satisfactory improvement of visual acuity.     

青年和成人弱视视觉系统可塑性的临床研究

目的　研究青年和成人弱视的治疗方法和效果 ,进一步探讨人的视觉系统可塑性。方法　按照全国统一弱视诊断标准 ,收集 15～ 17岁弱视患者 4 7例 (5 7只眼 )和 18～ 4 5岁弱视患者5 5例 (6 8只眼 )。治疗前进行矫正视力、激光干涉条纹视力 (IVA)、弱视类型和程度、注视性质检查 ,采用准确验光配戴矫正眼镜法和光学药物压抑疗法 (远、近距离压抑和微量压抑 )联合遮盖疗法 ,同时辅以后像红光法进行综合治疗。随访时间 1～ 5年 ,平均 2 9年。结果　治愈 5 5只眼 (44 0 % ) ,其中痊愈 2 3只眼 ,基本痊愈 32只眼 ;进步 37只眼 (2 9 6 % ) ,无效 33只眼 (2 6 4 % ) ;治疗总有效率为73 6 %。不同年龄患者疗效比较 ,差异无显著意义 (P >0 0 5 ) ;中心注视和中心凹旁注视患者的疗效明显优于黄斑旁注视和周边注视患者 (P <0 0 1) ;不同弱视程度患者的疗效差异有非常显著意义 (P<0 0 1) ;屈光不正性和屈光参差性弱视患者的疗效明显优于斜视性和形觉剥夺性弱视患者 (P <0 0 1)。IVA预测疗效的准确率为 92 8% ,IVA与患者治疗后视力呈显著正相关 (r =0 886 2 ,P <0 0 1)。结论　人的视觉系统可塑性可能终身存在。采取压抑联合遮盖并辅以其他疗法综合治疗青年和成人弱视行之有效 ,其疗效与患者的弱视程度和类     

Positional uncertainty in peripheral and amblyopic vision

Three experiments were performed to examine positional acuity and the role of spatial sampling in central, peripheral and amblyopic vision. In the first experiment, 3-line bisection acuity was compared to grating acuity. In normal foveal vision bisection acuity represents a hyperacuity. In anisometropic amblyopes, bisection acuity is reduced in rough proportion to their grating acuity. In strabismic amblyopes, and in the normal periphery, bisection acuity is reduced to a greater extent than grating acuity. This result implies that reduced contrast sensitivity of the spatial filters is not sufficient to account for the increased positional uncertainty found in peripheral vision and in strabismic amblyopia. In order to test the hypothesis that the high degree of positional uncertainty evident in these visual systems is a consequence of sparse spatial sampling, bisection thresholds and width discrimination thresholds were measured with stimuli comprised of discrete samples. The results showed that normal foveal vision and the vision of anisometropic amblyopes show little benefit from adding discrete samples to the stimulus. In contrast, the normal periphery, and the central field of strabismic amblyopes demonstrate marked positional uncertainty which can be efficiently reduced in proportion to the square root of the number of samples (up to about 10) comprising the stimulus in the direction orthogonal to the discrimination cue. In aggregate the results suggest that anisometropic and strabismic amblyopia are fundamentally different. The positional uncertainty in anisometropic amblyopia is consistent with the reduced sensitivity of the spatial filters. The data of the normal periphery and of the central field of strabismic amblyopes suggest that the cortical sampling grain imposes a fundamental limit upon their positional acuity.     

Contrast sensitivity and acuity relationship in strabismic and anisometropic amblyopia.

The contrast sensitivity function (CSF) and visual acuity were determined in children and adults with unilateral amblyopia due to strabismus or anisometropia with central fixation. The preschool children were examined repeatedly during occlusion treatment. All amblyopes had CSF deficits. The CSF was characterised by its peak value (the maximal sensitivity, Smax, and the spatial frequency at which Smax occurs, Frmax) calculated by a single peak least-square regression method. The two amblyopic groups showed discrepancies in relationship of both Smax and Frmax versus visual acuity both initially and during treatment. The strabismic cases had a more marked visual acuity deficit in relation to the contrast sensitivity losses, whereas these parameters are affected similarly in anisometropic amblyopes. The relationship between recovery of visual acuity and CSF during the initial month of occlusion treatment was of prognostic significance for the outcome of visual acuity improvement.     

Long-term changes in visual acuity and refractive error in amblyopes.

PURPOSE: To report long-term changes in visual acuity and refractive error for strabismic, anisometropic, and isoametropic amblyopes. METHODS: Records of patients with strabismic amblyopia, anisometropic amblyopia, and isoametropic amblyopia who were treated from 1983 to 1993 were reviewed. Excluded were patients having ocular or neurological diseases, developmental delay, and follow-up <4 years after treatment cessation. Data included best-correctable visual acuity and spherical equivalent refractive error of the amblyopic and the nonamblyopic eye at pretreatment, posttreatment, and long-term follow-up. RESULTS: Records for 61 patients met the inclusion criteria. For strabismic amblyopia (n = 22), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.36 and 0.05 logarithm of the minimum angle of resolution (logMAR) units after a mean treatment time of 1 year. At long-term follow-up (mean = 9.3 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR and visual acuity in the nonamblyopic eye improved 0.10 logMAR units. For anisometropic amblyopia (n = 26), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.30 and 0.02 logMAR units, respectively, after a mean treatment period of 1.1 year. At the long-term follow-up visit (mean = 7.1 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR unit and in the nonamblyopic eye improved 0.03 logMAR unit. Repeated-measures analysis of variance showed no significant effect of type of amblyopia on visual acuity of the amblyopic eye and a significant effect of visit due to treatment but not regression. The changes in visual acuity in the nonamblyopic eye from the pretreatment to the follow-up visit were significant and interacted with type, the changes being larger in strabismic amblyopia. For strabismic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +2.15 D and +1.85 D, respectively, initially to +0.45 D and +0.58 D, respectively, at the follow-up visit. For anisometropic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +1.04 D and +0.12 D, respectively, initially to +0.23 D and -0.94 D, respectively, at the follow-up visit. The effect of visit on amblyopic and nonamblyopic refractive errors was significant. For isoametropic amblyopia (n = 13), visual acuity in both right and left eyes initially was 0.39 logMAR unit and improved to 0.14 logMAR unit in each eye after a mean follow-up of 8.9 years. Refractive error in the right and the left eyes changed from -1.22 D and -1.14 D, respectively, to -2.68 D and -2.56 D, respectively, at follow-up. These differences were all significant. CONCLUSIONS: After treatment and with long-term follow up, visual acuity regresses but not significantly in the amblyopic eye in strabismic amblyopia and anisometropic amblyopia. At the same time, visual acuity in the nonamblyopic eye improves slightly. Visual acuity also improves significantly over time in isoametropic amblyopia. The refractive error of both amblyopic and nonamblyopic eyes tends to show a myopic shift regardless of the type of amblyopia.