屈光参差性弱视患者LASIK术后矫正视力和立体视觉的变化

目的:探讨屈光参差性弱视患者在准分子激光原位角膜磨镶术(laser-assisted in situ keratomileusis,LASIK)治疗弱视中矫正视力和立体视觉的变化.方法:回顾性分析屈光参差性弱视患者84例84眼临床资料,分析不同性别、年龄、屈光参差性弱视类型患者治疗前和治疗后3、6mo,1a矫正视力和立体视觉的变化,分析矫正视力与立体视觉的相关性.结果:患者84 例84眼经LASIK术治疗3、6mo,1a后矫正视力较治疗前提高,立体视锐度值较治疗前降低(P<0.05).男性患者与女性患者治疗后3、6mo,1a矫正LogMAR视力和立体视锐度值差异无统计学意义(P>0.05).年龄<30岁组治疗后3、6mo,1a矫正视力明显高于年龄≥30岁组(P<0.05).远视性屈光参差性弱视患者治疗后3、6mo,1a立体视锐度值较近视性屈光参差性弱视患者显著下降(P<0.05),而两组患者治疗后矫正LogMAR视力比较无统计学差异(P>0.05).屈光参差性弱视患者在LASIK术治疗过程中矫正视力的提高与立体视力下降值无显著相关性(P>0.05).结论:LASIK术能有效改善屈光参差性弱视患者矫正视力及立体视觉,但患者治疗过程中矫正视力和立体视觉受年龄与弱视类型影响.     

准分子激光原位角膜磨镶术治疗儿童高度远视屈光参差性弱视的效果

目的评价准分子激光原位角膜磨镶术（LASIK）矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性,并探讨其对术后弱视治疗效果的影响。方法采用前瞻性自身对照法观察42例高度远视屈光参差性弱视儿童病例,年龄范围6～14岁。使用SVS Apex plus准分子激光系统（其中联合L型mask盘矫正单纯远视9例,联合P型mask盘矫正远视合并散光12例）及鹰视世纪波准分子激光系统（21例）,在局部麻醉或全身麻醉下对患儿高度远视眼行LASIK,术后进行弱视治疗。术后对视力、屈光度和双眼视功能进行分析。随访时间6～24个月。结果矫治屈光度数为＋3．00-＋7．50D,术后2年66．6％术眼残余屈光度数在预计矫正屈光度数±1．00D的范围内。术后随访发现睫状肌麻痹下等值球镜屈光度数波动范围为＋0．99～＋0．67D。最佳戴镜矫正远、近视力均不丢失。术后2年平均最佳戴镜矫正远视力为0．40±0．28,平均最佳戴镜矫正近视力为0．78±0．39。经规范弱视治疗,双眼不等像、同时视、融合、立体视及隐斜均得以改善。结论对患有高度远视性屈光参差且不能耐受戴镜矫治的儿童,采用LASIK矫治屈光参差是安全、有效的,具有良好的可预测性和稳定性,且这一手术有助于提高高度远视屈光参差性弱视的治愈率。     

LASIK矫治高度屈光参差性弱视儿童的立体视觉研究

目的观察儿童高度屈光参差性弱视患者接受LASIK后立体视觉的恢复情况及其矫治儿童高度屈光参差性弱视的疗效。设计前瞻性非随机自身对照观察。研究对象36例36眼行LASIK手术的6～12岁高度屈光参差性弱视儿童患者。方法患者在LASIK术前、术后3、6及12个月检查视力、屈光度,采用颜氏立体视觉检查图检查立体视觉。立体视锐度≤60”为有中央立体视;80＂-800”为有周边立体视;〉800”为立体视盲。按最佳矫正视力分为轻、中、重度弱视三组。主要指标立体视锐度。结果LASIK术后12个月裸眼视力、最佳矫正视力、屈光参差程度较术前均明显改善（P均〈0．05）。术前、术后6个月和术后12个月立体视盲分别占55．6％（20例）、33．3％（12例）和16．7％（6例）（P均〈0．05）。术后12个月轻度弱视组100％恢复了立体视,其中40．0％（8例）恢复了中央立体视;中度弱视组有10．0％（1例）恢复了中央立体视,70．0％（7例）恢复了周边立体视;而重度弱视组仅33．3％（2例）恢复了周边立体视（P均〈0．05）。术后12个月,年龄〈10岁者与≥10岁者分别有89．5％、76．5％恢复了立体视（P=0．351）。结论屈光参差性弱视儿童立体视建立与弱视程度、弱视治疗时间有关。对于不能耐受戴镜矫正的严重屈光参差性弱视患儿,LASIK手术是一种安全、有效的治疗手段,术后可能恢复正常或部分立体视。     

4D数字化弱视斜视矫治系统对远视性屈光不正性及屈光参差性弱视的疗效观察

目的:评估4D数字化弱视斜视矫治系统对远视性屈光不正性及远视性屈光参差性弱视儿童的疗效。方法:招募3~9岁远视性屈光不正性及远视性屈光参差性弱视患者48例(其中远视性屈光不正性弱视18例36眼,远视性屈光参差性弱视30例30眼),所有患者排除其他眼病,在屈光矫正、合理遮盖的基础上接受4D数字化弱视斜视矫治系统的训练。初期训练以提高视力为主,视力达0.6以上者加上脱抑制训练及双眼视功能训练。比较训练前、后的视力及双眼立体视变化情况。结果:远视性屈光不正性弱视患者共18例36眼,其中轻度弱视组13眼,中度弱视组19眼,重度弱视组4眼。远视性屈光参差性弱视患者共30例30眼,根据弱视程度分为轻度弱视组5眼,中度弱视组13眼,重度弱视组12眼。治疗60次后视力均有明显提高。治疗60次后立体视有明显提高,且与屈光度无关(P>0.05),与初始视力及治疗后视力均呈正相关(P<0.05),与屈光参差量呈正相关(P<0.05)。结论:4D数字化弱视斜视矫治系统联合传统的弱视治疗方法能有效提高3~9岁远视性屈光不正性弱视和远视性屈光参差性弱视儿童的视力并改善其双眼视功能。     

Laser in situ keratomileusis for myopic anisometropia in children.

PURPOSE: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK) in pediatric patients with myopic anisometropia and amblyopia, and to assess the predictability, safety, and efficacy of the procedure in children. METHODS: Fourteen patients aged 7 to 12 years with myopic anisometropia and amblyopia had LASIK in the more myopic eye (14 eyes) using the Chiron Automatic Corneal Shaper and the Chiron-Technolas Keracor 116 excimer laser. Preoperative spherical equivalent manifest refraction ranged from -4.62 to -12.50 D (mean, -7.87 D) and spectacle-corrected visual acuity ranged from 20/40 to 20/100 (median, 20/50). All patients completed a minimum follow-up of 12 months. RESULTS: One year after LASIK, spherical equivalent manifest refraction ranged from 0 to -1.50 D (mean, -0.55 D). Spectacle-corrected visual acuity improved in all eyes (range, 20/20 to 20/40; median, 20/25). Six eyes (42.9%) had a postoperative spectacle-corrected visual acuity of 20/20. Uncorrected visual acuity was 20/40 or better in 10 eyes (71.4%) (range, 20/20 to 20/70; median, 20/30). Uncorrected visual acuity exceeded preoperative spectacle-corrected visual acuity in all eyes by an average of 2 lines. There were no significant complications. CONCLUSION: LASIK was effective for correction of myopic anisometropia in this small group of children and reversed refractive amblyopia. LASIK in these children was safe, predictable, and provided good visual results.     

LASIK in children with hyperopic anisometropic amblyopia

PURPOSE: To evaluate the results of LASIK for hyperopia in pediatric eyes with amblyopia resulting from anisometropia. METHODS: Thirty-two children with anisometropic amblyopia in whom conventional therapy was unsuccessful underwent unilateral LASIK between 1999 and 2005. Mean patient age was 10.3 +/- 3.1 years (range: 4 to 15 years), and mean follow-up was 20.1 +/- 15.1 months (range: 12 to 60 months). At the last follow-up examination, spherical equivalent refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications were recorded. RESULTS: Mean preoperative and postoperative manifest spherical equivalent refraction of the treated eyes was 5.17 +/- 1.65 and 1.39 +/- 1.21 diopters (D), respectively (P < .01). Mean UCVA was 0.06 +/- 0.09 (range: 0.01 to 0.5) preoperatively and 0.27 +/- 0.23 (range: 0.05 to 0.8) postoperatively (P < .01). Mean BSCVA was 0.20 +/- 0.17 (range: 0.01 to 0.8) preoperatively and 0.35 +/- 0.25 (range: 0.1 to 1.0) postoperatively (P < .01). Six eyes gained > or = 4 lines of BSCVA, 4 eyes gained 2 to 3 lines, 12 eyes gained 1 line, and 9 eyes were unchanged; only 1 eye lost 1 line of BSCVA due to haze in the flap-stroma interface. None of the patients reported halos or glare. There were no intraoperative or postoperative flap complications. CONCLUSIONS: LASIK seems to be an effective and safe procedure for the management of hyperopic anisometropic amblyopia in select cases. Visual acuity improved in the amblyopic eyes and was associated with decreased anisometropia. The refractive response to hyperopic LASIK in children appears to be similar to that of adults with comparable refractive errors.     

Laser-assisted subepithelial keratectomy for anisometropic amblyopia in children: outcomes at 1 year

PURPOSE: To assess the refractive, visual acuity, and binocular results of laser-assisted subepithelial keratectomy (LASEK) for anisomyopia, anisohyperopia, and anisoastigmatia in children with various levels of amblyopia secondary to the anisometropic causes. SETTING: Nonhospital surgical facility with follow-up in a hospital clinic setting. METHODS: This retrospective review was of 53 children with anisometropia who had LASEK to correct the refractive difference between eyes. All LASEK procedures were performed using general anesthesia. Patients were divided into 3 groups according to their anisometropia as follows: myopic difference greater than 3.00 diopters (D), astigmatic difference greater than 1.50 D, and hyperopic difference greater than 3.50 D. The children were followed for at least 1 year, and their refractive status, visual acuity, and binocular vision were assessed and recorded at 2 and 6 months as well as 1 year. RESULTS: The mean age at treatment was 8.4 years (range 10 months to 16 years). The mean preoperative anisometropic difference was 6.98 D in the entire group, 9.48 D in the anisomyopic group, 3.13 D in the anisoastigmatic group, and 5.50 D in the anisohyperopic group. One year after LASEK, the mean anisometropic difference decreased to 1.81 D, 2.43 D, 0.74 D, and 2.33 D, respectively, and 54% of all eyes were within +/-1.00 D of the fellow eye, 68% were within +/-2.00 D, and 80% were within +/-3.00 D. Preoperative visual acuity and binocular vision could be measured in 33 children. Postoperatively, 63.6% of children had an improvement in best corrected visual acuity (BCVA) and the remainder had no noted change. No patient had a reduction in BCVA or a loss in fusional ability after LASEK. Of the 33 children, 39.4% had positive stereopsis preoperatively and 87.9% had positive stereopsis 1 year after LASEK. CONCLUSION: Laser-assisted subepithelial keratectomy is an effective surgical alternative to improve visual acuity in anisometropic children unable to tolerate conventional methods of treatment or in whom these methods fail.     

LASIK治疗近视性屈光参差性弱视

目的 评价准分子激光原位角膜磨镶术(laser in situ keratomileusis;LASIK)治疗近视性屈光参差性弱视的临床疗效.方法 用LASIK手术矫正8位近视性屈光参差性弱视患者,比较手术前后屈光不正的度数和立体视锐度的改变,并将术前的最佳矫正视力和术后第1天,第3天,第10天的裸眼视力以及6～9个月随访的裸眼视力和最佳矫正视力进行比较和分析.结果 术前屈光度数高眼的屈光不正的等效球镜平均为(-10.06±1.50)D,术后该眼屈光不正的等效球镜平均为(0.19±0.32)D.手术前后立体视锐度差别有统计学意义(z=-2.207,P=0.027).术前屈光度数高眼矫正视力和术后该眼矫正视力相比,差别有统计学意义(F=11.431;P=0.000).结论 LASIK手术能安全,有效地减少近视性屈光参差,提高患者的视力和立体视功能.     

Laser-assisted subepithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children

PURPOSE: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK) for high myopic anisometropia with amblyopia and contact lens (CL) intolerance in children. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: This prospective comparative study comprised 27 children with high myopic anisometropia and amblyopia. The mean age of the children was 5.4 years (range 4 to 7 years). Multizonal PRK (13 eyes) or LASEK (14 eyes) was performed in the more myopic eye under general anesthesia using the Nidek EC-5000 excimer laser. After surgery, the dominant eye was patched. The postoperative visual and refractive outcomes were analyzed; all children had a 2-year follow-up. The 27 children (Group A) were compared with a control group of 30 children (mean age 5.1 years) (Group B) in whom myopic anisometropia and amblyopia were treated conventionally by CLs and patching the dominant eye. The visual acuity and binocular vision outcomes in both groups were analyzed and compared. RESULTS: In Group A, the mean spherical equivalent refraction was -8.25 diopters (D) +/- 2.37 (SD) (range -6.00 to -11.25 D) preoperatively and -1.61 +/- 0.73 D (range +0.50 to -2.25 D) postoperatively. The mean best corrected visual acuity (BCVA) was 0.23 +/- 0.21 preoperatively and 0.78 +/- 0.19 at 2 years. In Group B, the mean BCVA was 0.16 +/- 0.19 at the start of CL correction and amblyopia therapy and improved to 0.42 +/- 0.15 after 2 years. The mean BCVA at the final examination was significantly better in Group A (P<.05). Binocular vision improvement expressed by the proportion of patients who gained fusion and stereopsis was better overall in Group A (78%) than in Group B (33%) (P<.05). There were no complications postoperatively. CONCLUSIONS: Photorefractive keratectomy and LASEK were effective and safe methods for correcting high myopic anisometropia and improving amblyopia in children aged 4 to 7 years who were CL intolerant. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of anisometropia than in those who were treated conventionally by CLs.     

儿童屈光参差与弱视、立体视相关性的研究

目的　探讨屈光参差对儿童视力和立体视功能的影响以及屈光参差、弱视、立体视三者之间的相关关系。方法　选择不伴有斜视的 4 5～ 13 8岁屈光参差儿童 186例 ,无屈光参差和弱视的同龄正常儿童 2 0例。对以上所选病例 ,测定裸眼视力、屈光状态、最佳的矫正视力及矫正后Tit mus立体视 ,并对测量数据进行统计学分析。结果　①当远视参差 >1D ,近视参差 >2D ,散光参差 >1 0D ,弱视的发生率分别为 43 %、 43 %、 3 6% ;立体视异常百分比分别为 43 %、 2 9%、 3 6% :屈光参差 >3D ,弱视及异常立体视发生率均 10 0 %。②屈光参差与弱视的相关性及立体视与弱视的相关性均大于屈光参差与立体视的相关性。结论　儿童屈光参差可严重损害患儿的视力及双眼视功能 ,随着屈光参差程度的增加 ,弱视及异常立体视的发生率明显增多 ,并且 ,立体视功能的下降与弱视相伴行 ,二者之间存在显著相关性     

屈光参差性弱视儿童视力与立体视的关系

目的探究相同屈光参差范围内不同类型屈光参差性弱视儿童的视力与立体视情况,以及视力、屈光参差类型对拥有立体视与否的影响。方法回顾性研究。收集56例屈光参差性弱视儿童和52例伴有斜视的屈光参差性弱视儿童以及20例正常儿童相应检查数据,检查包括矫正视力、屈光程度、随机点动态2阶粗糙立体视。采用多元方差分析3类儿童的视力差异,统计立体视分布情况,运用非条件logistic回归分析视力与屈光参差类型对拥有立体视与否的影响。结果单纯屈光参差性弱视儿童与伴有斜视的屈光参差性弱视儿童的视力差异无统计学意义（F=3.58,P=0.0314,校正α=0.016）。单纯及伴有斜视的屈光参差性弱视儿童粗糙立体视拥有率分别为96%,71%。在双眼视力一致的条件下,伴有斜视的屈光参差性弱视与单纯屈光参差性弱视儿童相比,拥有2阶立体视的OR估计值为0.132（95%CI：0.034~0.503）。在屈光参差类型一致的条件下,高、中双眼视力平衡度与低双眼视力平衡度相比,拥有2阶立体视的OR估计值分别为5.161（95%CI：0.868~30.675）和3.939（95%CI： 0.920~16.858）。结论相同屈光参差程度范围中不同类型屈光参差性弱视儿童的视力差异不明显;伴有斜视的屈光参差性弱视儿童立体视缺损的可能性更高,并且双眼不平衡度越高引起的立体视下降越明显。     

Improvement of visual acuity following refractive surgery for myopia and myopic anisometropia

PURPOSE: To test the hypothesis that anisometropic adults without significant amblyopia suffer from mild visual impairment probably due to aniseikonia, which might be improved by corneal refractive surgery. METHODS: Fifty-seven patients presenting with myopic anisometropia > or = 3.25 diopters (D) and 174 myopic controls appropriate for refractive surgery were included. Photorefractive keratectomy (PRK) or LASIK was performed on 57 anisometropic eyes. As 43 of the 174 myopic control patients had bilateral surgery, PRK or LASIK was performed on 217 myopic control eyes. Best spectacle-corrected visual acuity (BSCVA), refraction, and refractive correction were measured preoperatively and at 1, 3, 5 to 7, 8 to 13, and 25 months following surgery. RESULTS: Preoperative mean spherical equivalent was -7.20 +/- 2.40 D for anisometropic patients and -6.40 +/- 1.90 D for myopic patients. At 8 to 13 months postoperatively, when 23 (40%) anisometropic eyes and 94 (43%) myopic eyes were examined, the mean spherical equivalent refractions were -0.80 +/- 1.60 D and -0.30 +/- 0.60 D, respectively. Preoperatively, the mean BSCVA on a logMAR scale was -0.0143 +/- 0.0572 (Snellen 0.98 +/- 0.12) in the anisometropic group and 0.0136 +/- 0.0361 (Snellen 1.04 +/- 0.09) in the control group (P = .001). Eight to 13 months postoperatively, these values were 0.0076 +/- 0.0659 (Snellen 1.03 +/- 0.15) and 0.0495 +/- 0.0692 (Snellen 1.13 +/- 0.18) and this difference remained statistically significant (P = .012). For the myopic patients, the improvement in BSCVA reached almost maximum at 3 months, and this improvement was found to be highly significant 3 months after surgery (P = .001). The improvement in BSCVA was significantly slower for anisometropic patients and became statistically significant only after 8 to 13 months postoperatively (P = .041). CONCLUSIONS: Anisometropia reduces visual acuity in the more myopic eye and can be at least partially reversed by refractive correction. The slower improvement in BSCVA for anisometropic patients suggests plastic changes in the visual cortex following refractive surgery.     

Refractive surgery for unilateral high myopia in children

PURPOSE: To evaluate the safety and efficacy of refractive surgery in children. METHODS: Pediatric patients with unilateral high myopia who were 9 years of age or older were offered refractive surgery to supplement optical correction. The patients and families were informed that the operation may not improve their best-corrected visual acuity. Photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) was performed on the more myopic eye with the use of topical anesthesia. Cycloplegic refraction, stereopsis, motility, and best-corrected visual acuity were measured before the procedure and at 2 months and 20 months after the procedure. All patients had completed amblyopia therapy before surgery. RESULTS: Fourteen eyes of 14 patients aged 9 to 14 years received refractive surgery. Average age at the time of surgery was 11.9 years (+/-1,6). Average corrected preoperative visual acuity was 20/147 (+/-0.065 in decimals). Average preoperative refraction was -7.96 D (+/-2,16) spherical equivalent. Twenty months after refractive surgery, the uncorrected visual acuity averaged 20/129 (+/-0.08 in decimals) and best-corrected vision averaged 20/121 (+/-0.08 in decimals). Average refraction was -0.46 D (+/-0,58) at 2 months and -0.67 D (+/-0,68) D at 20 months. An average myopic shift in refraction of -0.22 D was found in treated eyes during the 20 months of follow-up; this was not statistically significant (P =.69). Three patients had LASIK and 11 patients had PRK. LASIK patients averaged -0.875 D of myopic shift over 20 months of follow-up. Those with PRK averaged -0.025 D. This difference was not statistically significant (P =.10). The vision of 5 of 14 patients improved 1 or 2 lines after refractive surgery. Two patients who had 20/80 vision preoperatively improved to 20/60. No patients lost any lines of vision. Only 4 patients demonstrated stereopsis preoperatively, and all retained stereopsis postoperatively. No patient gained stereopsis. CONCLUSIONS: LASIK and PRK can be performed safely and effectively in children who are cooperative enough to undergo the procedures with topical anesthesia. Refractive surgery does not improve vision in densely amblyopic eyes but may give modest improvement in those that are mildly amblyopic. No significant complications were encountered aside from a myopic shift over time.     

青少年远视屈光参差性弱视LASIK效果观察

目的探讨准分子激光原位角膜磨镶术（LASIK）矫治青少年重度远视屈光参差性弱视的效果与安全性。方法56例（56眼）平均矫正视力为0．38±0．09的9—17岁远视屈光参差性弱视纳入观察,常规行围手术期检查。术后进行双眼训练和弱视治疗。结果术后3个月弱视眼平均裸眼视力由术前的0．07±0．03提高到0．65±0．15;术后6个月平均裸眼视力为0．68±0．14。术后矫正视力较术前明显提高;术后屈光度较术前明显降低（P〈0．05）;52例（92．86％）同时视和融合功能改善,其中36例（64．29％）建立完整立体视功能。结论青少年远视屈光参差性弱视的LASIK安全有效,有助于改善双眼单视功能。     

Laser in situ keratomileusis for treated anisometropic amblyopia in awake, autofixating pediatric and adolescent patients

PURPOSE: To establish the safety and efficacy of laser in situ keratomileusis (LASIK) in pediatric and adolescent patients with anisometropic amblyopia who completed amblyopia therapy and had a visual acuity of 20/30 or better bilaterally. SETTING: Department of Ophthalmology and Visual Science, University of Texas-Houston Medical School, Houston, Texas, USA. METHODS: From August 2000 to March 2002, LASIK was performed in 21 eyes of 19 consecutive patients meeting eligibility requirements. The procedure was performed with the Summit Autonomous LADARVision 4000 excimer laser (Alcon Laboratories, Inc.) in the amblyopic eye for the correction of anisometropia or in both eyes. All patients were awake and autofixating during the procedure. RESULTS: The mean patient age was 13.14 years (range 8 to 19 years). Seventeen patients were treated in the amblyopic eye only to correct anisometropia; treatment was performed in both eyes of 2 patients who were older than 18 years. Patients were followed for a mean of 18.0 months (range 8.6 to 26.5 months). Anisometropia was greater than 2.00 diopters (D) in all cases (mean 4.43 D, range 13.25 to 2.25 D). The percentage deviation from the attempted correction in the myopic group was 4.0% +/- 4.0% (SD) (range 2.0% to 10.0%) and 38.0% +/- 13.0% (range 5.0% to 58.0%) in the hyperopic group. Anisometropia decreased uniformly to less than 2.00 D in all patients (mean 1.52 D). The percentage of patients with stereo acuity increased from 63.0% preoperatively to 84.0% postoperatively. CONCLUSIONS: Laser in situ keratomileusis safely and effectively reduced anisometropia in these patients. If stereo acuity is not possible preoperatively, it may be obtained postoperatively.     

Against-the-rule (ATR) astigmatism as a predicting factor for the outcome of amblyopia treatment

PURPOSE: To evaluate whether with-the-rule (WTR) or against-the-rule (ATR) astigmatism influences the treatment outcome of anisometropic amblyopia. DESIGN: A cohort study. METHODS: Retrospective study of patients with unilateral amblyopia due to anisometropia without strabismus. Ninety-eight patients with simple, compound, mixed, oblique myopic, and hyperopic astigmatism were divided into seven groups based on the type of astigmatism. The groups were reviewed as to the amount of anisometropia, duration of occlusion, and best-corrected visual acuity (BCVA) before and after treatment. RESULTS: There was statistically significant longer duration of occlusion and less lines gain of BCVA among patients with hyperopic ATR astigmatism compared with patients with hyperopic WTR astigmatism (P =.0143 and P =.0000, respectively) and myopic ATR patients compared with myopic WTR patients (P =.0392 and P =.0192, respectively). For the same parameters, group differences were also statistically significant when all hyperopic or myopic simple/compound/mixed ATR patients were compared with all hyperopic or myopic simple/compound/mixed WTR patients (P =.0015 and P =.0000, respectively). CONCLUSION: The outcome of amblyopia treatment seems to be less favorable in patients with either hyperopic or myopic ATR astigmatism. Near vision impairment may be more amblyogenic than distance vision impairment during visual development.     

近视性屈光参差患者LASIK术后双眼视功能评估

目的 观察近视性屈光参差患者接受准分子激光原位角膜磨镶术（LASIK）后双眼视功能的变化,探讨LASIK手术矫治近视性屈光参差对三级视功能的影响,从双眼视觉的变化评价其临床应用价值。设计 前瞻性病例系列。 研究对象 36例（72眼）行LASIK手术的近视性屈光参差患者（双眼屈光参差 ≥ 2.50 D）。 方法 对36例行LASIK手术的近视性屈光参差患者分别于手术前和手术后3个月进行裸眼视力、最佳矫正视力、屈光状态和同视机双眼视功能的检测,并对双眼视功能的变化进行随访研究。 主要指标 手术前后裸眼视力、最佳矫正视力、屈光度、同时视、融合功能、远立体视和近立体视。 结果 术前72眼的裸眼视力在0.01~0.2之间,术后3个月时均达到1.0。双眼屈光参差由术前的（5.01±1.96）D（ 2.50~9.00 D）,降低到术后3个月的（0.28±0.22）D（0.00~0.75 D）。手术前后的屈光参差度的改变,差异均有显著统计学意义（P＜0.01）。26例屈光参差量≥2.50 D且≤6.00 D的高度屈光参差者术前戴框架眼镜下近立体视正常的12例,术后3个月增至22例,差异有统计学意义（P＜0.05）;16例屈光参差量>6.0 D的重度屈光参差者手术前后均没有正常近立体视。术前戴框架眼镜下三级视功能（同时视、融合功能、远立体视）正常的分别为33例、18例、13例,LASIK术后3个月三级视功能正常的分别为34例、33例、23例,手术后获得融合功能和远立体视者较术前明显增加（P均＜0.05）。结论 LASIK矫治近视性屈光参差,不仅可提高患者裸眼视力,而且可通过减小患者双眼间的屈光差异,增加双眼物像的融合,改善立体视功能。     

屈光参差性弱视与斜视性弱视临床疗效的比较

目的:分析比较屈光参差性与斜视性弱视的治疗效果。方法:前瞻性研究。2018-07/2020-01在我院门诊确诊的并首次接受治疗的单眼弱视患者46例,平均年龄9±3岁,其中男26例,女20例,按照临床诊断分为斜视性弱视组(无屈光不正),共23例,平均年龄9±3岁,其中男12例,女11例。以及屈光参差性弱视组,共23例,平均年龄9±3岁,其中男14例,女9例。对两组患者采用遮盖及精细训练治疗弱视,于治疗前及治疗后采用国际标准视力表检测视力、用Titmus图谱行立体视锐度的检测。比较两组患者经弱视治疗前后最佳矫正视力及立体视恢复的差异。结果:治疗前两组患者弱视眼的最佳矫正视力无差异(t=-0.475,P>0.05),但斜视性弱视患者的立体视功能明显低于屈光参差性弱视患者(t=-3.919,P<0.001);通过2mo的治疗,两组患者最佳矫正视力提高值有明显差异(t=-2.946,P<0.01),而两组患者立体视提高值无差异(t=1.305,P>0.05);通过6mo的治疗,两组患者最佳矫正视力提高差值有明显差异(t=-2.353,P<0.05),两组患者立体视提...     

单眼LASIK矫正近视性屈光参差疗效分析

目的探讨单眼准分子激光原位角膜磨镶术（LASIK）治疗单眼近视所致屈光参差的效果。方法采用对单跟等效球镜度-2．50D以上的近视性屈光参差42例，进行单眼LASIK手术前后平均屈光度、屈光参差度数、最佳矫正视力和裸眼视力进行评价，术后随访6～12月。结果术前平均等值球镜度数为-4．66D（-2．50D--9．25D），术后减少至-0．62D（0～-1．70D），LASIK对平均等值球镜改变为-4．38D（-2．00D～-8．00D）。术前两眼平均屈光参差为-5．23D（-2．5D～-9．25D），术后减少至-0．50D（0～-1．25D）。术前术后BCVA（最佳矫正视力）范围均为0．6～1．0，平均最佳矫正视力从术前1．0提高到1．04；术后裸眼视力≥1．0者39跟，平均裸跟视力从术前的0．13术后提高至1．0。结论单眼LASIK治疗近视性届光参差不仅能提高患眼的最佳矫正视力和裸眼视力，解除单眼近视、散光所致的屈光参差对眼镜或角膜接触镜不能耐受的痛苦，而且对恢复双眼单视功能具有积极意义。     

The burden of pure anisometropic amblyopia: a cross-sectional study on 2800 Iranians

Purpose

To assess the proportion of pure anisometropic amblyopia in a sample Iranian (white) population.

Methods

A total of 2800 consecutive individuals who presented at a referral eye clinic for any reason were examined for the presence of pure anisometropic amblyopia. Anisometropia was reported when a spherical equivalent refraction difference of at least 1.0 D with or without a cylinder refraction difference of at least 1.0 D was present between the two eyes. Amblyopia was defined as the best-corrected visual acuity of 20/30 or worse or a two-line interocular visual acuity difference between eyes that could not be attributed to any structural ocular pathology or visual pathway abnormality.

Results

Subjects were 1528 females and 1272 males with a mean age of 30.25 ± 14.93 years (range, 5–65). Amblyopia was diagnosed in 192 cases (6.9%), significantly more frequent among females (7.9 vs. 5.7%, p = 0.02). Pure anisometropic amblyopia was present in 6.1% of the study population, significantly more common in patients with spherical hyperopic anisometropia (37.7%) compared to patients with spherical myopic anisometropia (21.3%), cylindrical myopic anisometropia (4.1%), and cylindrical hyperopic anisometropia (15%) (p < 0.001).

Conclusions

Pure anisometropic amblyopia is a common finding in Caucasians seeking eye care, particularly when anisometropia is of spherical hyperopic subtype.