LASIK治疗苏丹青少年难治性屈光参差性弱视(英文)

目的:评价准分子激光原位角膜磨镶术(LASIK)联合遮盖疗法治疗青少年屈光参差性弱视的疗效,并将其与传统光学矫正联合遮盖疗法的疗效进行比较。方法:回顾性病例对照研究,屈光参差性弱视患者19例,年龄10～17岁。A组包括患屈光参差性弱视的青少年10例,光学矫正联合遮盖疗法后,他们的视力不能改善。这些患者后接受LASIK联合遮盖疗法。B组包括年龄相匹配的屈光参差性弱视患者9例作为对照,他们适应光学矫正联合遮盖疗法。分析A组的术后视力,并与B组进行比较。结果:A组,术前平均球性屈光不正度数为-8.9±5.2D,术后为-1.9±2.0D;术前平均最佳矫正视力为0.25±0.18,治疗后提高至0.50±0.26。B组,治疗前平均最佳矫正视力为0.27±0.18,治疗后提高至0.50±0.28。两组治疗后最佳矫正视力相比较,无统计学差异。结论:对于经过传统的光学矫正联合遮盖疗法而不能提高视力的青少年屈光参差性弱视患者,LASIK为他们提供了一个可行的治疗方法,其治疗效果与传统疗法相当。     

LASIK治疗苏丹青少年难治性屈光参差性弱视

目的：评价准分子激光原位角膜磨镶术（LASIK）联合遮盖疗法治疗青少年屈光参差性弱视的疗效,并将其与传统光学矫正联合遮盖疗法的疗效进行比较。方法：回顾性病例对照研究,屈光参差性弱视患者19例,年龄10～17岁。A组包括患屈光参差性弱视的青少年10例,光学矫正联合遮盖疗法后,他们的视力不能改善。这些患者后接受LASIK联合遮盖疗法。B组包括年龄相匹配的屈光参差性弱视患者9例作为对照,他们适应光学矫正联合遮盖疗法。分析A组的术后视力,并与B组进行比较。结果：A组,术前平均球性屈光不正度数为-8．9±5．2D,术后为-1．9±2．0D;术前平均最佳矫正视力为0．25±0．18,治疗后提高至0．50±0．26。B组,治疗前平均最佳矫正视力为0．27±0．18,治疗后提高至0．50±0．28。两组治疗后最佳矫正视力相比较,无统计学差异。结论：对于经过传统的光学矫正联合遮盖疗法而不能提高视力的青少年屈光参差性弱视患者,LASIK为他们提供了一个可行的治疗方法,其治疗效果与传统疗法相当。     

传统遮盖法治疗儿童屈光性弱视的远期疗效

弱视是一种常见而严重影响儿童视功能发育的眼病。屈光不正、屈光参差是造成弱视的主要原因之一，采用传统遮盖法治疗儿童屈光性弱视的远期疗效观察报道较少，作者将随访２—１３年用传统遮盖法治疗的１５２例２７２眼屈光性弱视总结报告如下。对象与方法１．对象：屈光性...     

屈光性弱视的敏感期探讨

人类视觉发育的敏感期由于无法建立弱视模型只有一个模糊的界限。为探讨屈光性弱视即屈光不正性弱视与屈光参差性弱视的视觉发育规律与敏感期，本文观察了３１８例５４５眼屈光性弱视病人治疗年龄与疗效的关系。结果显示屈光不正性弱视的治疗效果与年龄密切相关，４岁组疗效最好，治愈率为９２％，有效率达９９％。随着年龄增长，疗效逐渐降低，１０岁仍能治愈。屈光参差性弱视的治疗效果亦与年龄有关，但１０岁年龄组９０％治疗有效，１例１５岁单眼屈光参差性弱视治疗后视力进步５行。提出屈光性弱视病人的视觉发育敏感期可延到１０岁以后。文中就弱视发生的神经生理机制进行了讨论。     

屈光手术在小儿眼科的应用

屈光不正是弱视发病的重要病因.儿童弱视的传统治疗方法是戴镜和遮盖,对于一些特殊儿童群体,如严重屈光参差无法耐受角膜接触镜患儿、神经行为异常疾病患儿、面部发育异常患儿,戴镜和遮盖治疗效果差,且患儿无法配合传统的戴镜及遮盖.近年来,屈光手术历经数次设备及手术技术的变革,已逐渐成为很多患者熟知的眼科手术.1995年Singh首次将准分子激光角膜切削术(PRK)应用于小儿眼科之后,一些学者陆续开始在此领域进行了探索式临床应用.根据解剖部位不同,屈光手术分为角膜屈光手术和晶状体屈光手术.本文就小儿眼科中不同屈光手术术式治疗儿童重度近视性屈光参差、重度远视性屈光参差及双眼近视进行综述,讨论适应证的选择及术后并发症,对手术进行展望,未来随着麻醉技术、手术材料及设备的革新发展,儿童屈光手术将更安全,预测性更好.     

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.     

综合疗法治疗大龄屈光参差性弱视

弱视是青少年常见眼病,其治疗效果与治疗时的年龄密切相关,因此强调早发现、早治疗。但这并不意味着对年龄较大的弱视人群就不再有治疗意义。我们对46例13～16岁大龄屈光参差性弱视患者进行综合治疗,效果尚满意,现报告如下。一、资料与方法     

屈光参差性弱视的研究

双眼在一条或两条子午线上的屈光力存在差异时,称为屈光参差。屈光参差是导致儿童弱视的常见原因之一,且其发病率呈现随年龄逐渐上升的趋势。屈光参差的形成原因很多,不单是眼轴长度差异所致。屈光参差达到一定程度时造成融合困难,立体视下降,形成弱视。屈光参差性弱视的发病机制复杂,近年来通过磁共振来探讨其神经机制已取得一定成果。目前矫正屈光参差方法包括:框架眼镜、遮盖与药物治疗、硬性透氧性角膜接触镜(RGP)、屈光手术等,框架眼镜结合遮盖与药物治疗是最传统的治疗方法,但框架眼镜无法避免光学欠缺,RGP则克服了这一困难,而屈光手术直接作用于角膜,避免了光学像差,较框架眼镜和RGP更能改善立体视。     

RGP配戴综合疗法治疗大龄儿童及青少年屈光参差性弱视

目的：观察RGP配戴联合综合治疗大龄儿童及青少年屈光参差性弱视的临床疗效。

方法：选择2007-01/2010-10在我院确诊为屈光参差性弱视并已配戴框架眼镜辅以遮盖等其他方法治疗0.5a无效的8～15岁患者45例,均为单眼,设置RGPCL组(A组)配戴RGPCL 22例, 同期继续戴框架眼镜治疗的为B组共23例,两组均进行遮盖,红光闪烁,同视机脱抑制,口服左旋多巴及使用增视能双眼视觉和立体视觉综合治疗的方法进行治疗,随访30mo观察患者的视力恢复情况及远近立体视觉情况。

结果：综合弱视治疗30mo后,两组病例的矫正视力都有提高,A组基本治愈率为40.9%, B组基本治愈率为17.4%,A组疗效明显高于B组,两组有统计学意义(χ²=6.932,P<0.05); 经秩和检验,A组远近立体视明显高于B组(P<0.05)。

结论：对大龄儿童及青少年屈光参差性弱视应采取积极的弱视治疗,对于屈光参差性弱视,应建议患者戴RGPCL可以提高临床治愈率,最大可能地恢复立体视。     

全矫配镜加遮盖法治疗屈光不正性弱视疗效观察

目的：探讨用全矫配镜加遮盖法来治疗屈光不正性弱视。方法：对儿童屈光不正性弱视及屈光参差性弱视采用全矫配镜联合传统遮盖进行治疗。结果：屈光不正性弱视221眼,3～5岁74眼占33．5％,治疗有效率及治愈率最高;6～8岁组99眼占44．8％,有效率及治愈率居中：9～11岁组48眼占21．7％,治疗效果最差。说明年龄与疗效成正相关,6～8岁年龄组发病率最高。结论：治疗屈光不正性弱视方法很多,但全矫配镜加遮盖法仍是其中最简单有效的方法之一。     

Reversal of myopic anisometropic amblyopia with phakic intraocular lens implantation

PURPOSE: To report a case of reversal of myopic anisometropic amblyopia with phakic intraocular lens implantation. METHODS: A 6-year-old boy with anisometropic amblyopia with spherical equivalent refraction of right eye: -14.00 -3.00 x 100 degrees, left eye: -0.50 -3.25 x 90 degrees, was treated for 2 years with occlusion to the left eye, with poor results. Refractive surgery was planned because of contact lens intolerance at age 8 years. A -15.00-D iris claw Artisan intraocular lens (IOL) was implanted. RESULTS: Following surgery, treatment of the amblyopia and spectacle correction of -4.00 D cylinder at 85 degrees in the right eye and -3.50 D cylinder at 90 degrees in the left eye was necessary. Visual acuity 6 months after surgery was 20/25 in the right eye and 20/20 in the left eye, and has remained stable 18 months after surgery. CONCLUSION: Myopic anisometropic amblyopia in an 8-year-old boy was treated successfully with implantation of an Artisan iris claw phakic anterior chamber IOL, combined with occlusion therapy, and resulted in reversal of amblyopia.     

Efficiency of occlusion therapy for management of amblyopia in older children

PURPOSE: To analyse results of full time occlusion therapy for amblyopia in children older than 6 years. MATERIALS AND METHODS: This was a retrospective consecutive case series analysis of children treated for amblyopia at a tertiary care center. All children received full time occlusion (FTO) for the dominant eye. RESULTS: Eighty-eight children older than 6 years at the time of initiation of therapy were included. Age at initiation of therapy ranged from 6 to 20 years (9.45 +/- 3.11 years). Forty-two children (47.7%) had strabismic amblyopia, 37 (42.0%) had anisometropic amblyopia and 9 (10.2%) had a combination of strabismic and anisometropic amblyopia. Eighty out of 88 eyes (90.0%) had improvement in visual acuity following FTO. Visual acuity (VA) improved from 0.82 +/- 0.34 at presentation to 0.42 +/- 0.34 (P < 0.001) after FTO. In children with strabismic amblyopia, VA improved from 0.81 +/- 0.42 to 0.42 +/- 0.39 (P <0.001). In children with anisometropic amblyopia, visual acuity of the amblyopic eye improved fron 0.82 +/- 0.24 to 0.36 +/- 0.29 (P< 0.001) following FTO. Out of 13 children older than 12 years, only 6 children (46.1%) had improvement in VA. Mean follow-up after complete stoppage of occlusion was 8.37 +/- 1.78 months. CONCLUSION: Occlusion therapy yields favorable results in strabismic and/or anisometropic amblyopia, even when initiated for the first time after 6 years of age. After 12 years of age, some children may still respond to occlusion of the dominant eye.     

Efficacy of occlusion treatment in amblyopia and clinical risk factors affecting the results of treatment

PURPOSE: To evaluate the factors influencing visual outcome in strabismic, strabismic-anisometropic and anisometropic amblyopia following occlusion treatment. METHODS: Records of 128 pediatric patients who had been treated for amblyopia by occlusion of the fellow eye between March 1992 and March 2003 were reviewed retrospectively. Age and level of visual acuity at initiation of treatment, occlusion time (full-time, part-time or minimal) and type of amblyopia were analyzed for the effect on visual outcome. RESULTS: The mean age of the patients was 5.69 +/- 2.01 years (3 to 12 years). Mean follow-up time was 3 years 2 months (6 months to 10 years). Mean visual acuity improvements were similar for the subtypes of amblyopia (strabismic amblyopia 0.38 +/- 0.29 logMAR units, strabismic-anisometropic amblyopia 0.46 +/- 0.40 logMAR units, anisometropic amblyopia 0.35 +/- 0.24 logMAR units). Level of initial visual acuity, age at initiation of treatment and type of occlusion correlated with the final visual acuity (p = 0.000, p = 0.035, p = 0.012, respectively). When the analysis was performed according to the subtypes of amblyopia, initial visual acuity was the only factor associated with the final visual acuity in all types of amblyopia (p < 0.05). CONCLUSION: The level of initial visual acuity is the most significant factor determining the success of treatment in amblyopia.     

Successful treatment of anisometropic amblyopia with spectacles alone.

BACKGROUND: The efficacy of treating anisometropic amblyopia with occlusion therapy is well known. However, this form of treatment can be associated with risks. Spectacle correction alone may be a successful and underutilized form of treatment. METHODS: The records of 28 patients treated successfully for anisometropic amblyopia with glasses alone were reviewed. Age, initial visual acuity and stereoacuity, and nature of anisometropia were analyzed to assess associations with time required for resolution, final visual acuity, and stereoacuity. Incidence of amblyopia recurrence and results of subsequent treatment, including patching, were also studied. RESULTS: Mean time to amblyopia resolution (interocular acuity difference 相似文献   

Factors affecting long term results of successfully treated amblyopia: initial visual acuity and type of amblyopia.

AIMS--The study aimed to assess the effect of initial visual acuity and type of amblyopia on the long term results of successfully treated amblyopia. METHODS--The visual acuity of 94 patients, who had been successfully treated for unilateral amblyopia by occlusion of the good eye and followed up to the age of 9 years, was examined 6.4 years, on average, after cessation of treatment. Patients were divided into two groups according to the depth of amblyopia before occlusion therapy was started: those with visual acuity between 20/60 and 20/100 and those with visual acuity of 20/100 or worse. RESULTS--Deterioration of visual acuity was observed in 42% of patients in the first group and in 63% of patients in the second group. Their average deterioration, as measured by the Snellen chart, was 0.58 and 1.54 lines, respectively. The results were also assessed by the division of patients into three groups according to the type of amblyopia: strabismic, strabismic anisometropic, and anisometropic. Deterioration of visual acuity occurred in 46%, 79%, and 36% of patients in these three groups, with an average deterioration on the Snellen chart of 0.70, 2.04, and 0.64 lines, respectively. CONCLUSION--It is concluded that low initial visual acuity and strabismic anisometropic amblyopia are risk factors for deterioration of visual acuity in the long term, following the successful earlier treatment of eyes with amblyopia.     

传统弱视治疗方法联合视功能训练治疗远视性屈光参差性弱视的疗效

目的　评价传统弱视治疗方法联合视功能训练治疗远视性屈光参差性弱视的疗效。方法　收集2016年3月至2017年5月就诊于天津市眼科医院弱视训练室的50例远视性屈光参差性弱视患者,年龄（7.57±2.65）岁。所有患者均排除其他眼部疾病、危险因素和全身性疾病。在屈光矫正、遮盖健眼的基础上对弱视眼进行治疗,分析治疗前后的视力、立体视变化情况。结果　根据筛选最终纳入31例远视性屈光参差性弱视患者,其中轻度弱视10例,中度弱视15例,重度弱视6例。31例患儿治疗前及治疗后3个月、6个月视力差异有统计学意义（F=48.591,P=0.000）;中、重度弱视组治疗前后3个时间点差异均有统计学意义,轻度弱视组治疗后与治疗前视力相比,差异有统计学意义,但治疗后6个月与治疗后3个月视力相比差异无统计学意义（P=0.223）。轻度弱视组与中、重度弱视组治疗后视力进步情况差异均有统计学意义（χ²=6.005,P=0.022;χ²=5.760,P=0.026）;治疗后立体视比治疗前明显提高,与视力呈负相关（r=-0.537,P=0.002;r=-0.885,P=0.000）。结论　传统弱视治疗方法联合视功能训练不仅可以提高远视性屈光参差性弱视患者视力,而且有助于双眼视功能的恢复。     

Contact lenses in the management of high anisometropic amblyopia

Poster at College Congress, Birmingham 2001.Oral presentation at European Strabismus Association, Florence 2001. PURPOSE: Anisometropia of more than one dioptre during the sensitive visual period may cause amblyopia. Its management requires refractive correction, and occlusion. Compliance with treatment is critical if visual improvement is to obtained. High anisometropia, poor initial acuity and mixed strabismic/anisometropia amblyopia are predictive factors for a poor outcome. We evaluated contact lens use in the management of high anisometropic amblyopia. METHODS: Retrospective analysis of anisometropic amblyopia managed in a paediatric contact lens clinic (July 1996-July 2000), after standard amblyopia therapy of spectacles and occlusion therapy had been tried. Presenting age, acuity and refraction, duration of lens wear and occlusion, and final visual outcomes were noted. RESULTS: Seven children (four male, three female) presented at age 3.5-6 years (mean 4.5). Six had myopic anisometropia 6.0-18.4 dioptres (mean 10.4 dioptres) and one 6.75 dioptres hypermetropic anisometropia. The initial corrected acuities of the amblyopic eyes were 6/18 to 1/60. Five patients used contact lenses with a range from 5 months to 4 years. Final acuities were 6/12-1/60. Two myopes with 6 dioptres anisometropia improved three to four Snellen lines, one with 8.8 dioptres improved one line. Three with >10 dioptres anisometropia did not improve. The hypermetropic patient improved part of one Snellen line. CONCLUSIONS: High anisometropic amblyopia is challenging to treat. In our study contact lenses improved visual acuity in myopic anisometropia of up to 9 dioptres.     

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。     

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.