重度斜视性弱视32例的手术时机

目的:探讨重度斜视性弱视的手术时机,以寻求尽快提高视力,缩短弱视治愈时间。方法:对32例重度斜视性弱视患儿先行强化后像增视训练后,使其注视性质改善后,斜视度>20°以上,视力0.2～0.3之间尽早行眼位矫正术后,再进行弱视训练。结果:术后0.5a眼位正位23例(72%),欠矫7例(22%),过矫2例(6%);视力治愈10例(31%),有效18例(56%),无效4例(13%),总有效率87%;1a后眼位正位22例(69%),欠矫10例(31%),视力治愈14例(44%),有效18例(56%)。术后0.5a和1a的眼位正位率分别为72%和69%,经统计学处理无显著性差异(P>0.05),眼位控制稳定。结论:重度斜视性弱视,尽早手术矫正眼位,有利于视力恢复,同时眼位控制稳定。     

先天性特发性水平眼球震颤伴斜视21例手术疗效观察

目的 观察分析先天性特发性水平眼球震颤的手术治疗效果.方法 收集自2009年1月至2011年1月先天性冲动型眼球震颤伴斜视病例21例,既往无眼外伤史和眼部手术史,男15例,女6例,年龄8～25岁.手术方法采用Parks法联合斜视矫正术.结果 21例患者术后原在位双眼同时视视力均提高2行或2行以上;18例患者头位面转角完全矫正,3例存在15°以内的面转角,其中2例欠矫,1例过矫.19例眼位正位,1例欠矫,1例过矫.结论 对于伴有头位和斜视先天性水平性冲动型眼球震颤患者,手术治疗是首选,可以有效地提高视力,改善头位,同时矫正斜视.     

微小角度斜视与弱视、屈光参差相关性研究

目的通过对微小度斜视患者的临床治疗效果的观察，分析其与弱视、屈光参差的相关性。方法对2004年1月至2006年年1月，在本院门诊就诊的屈光参差性弱视患儿和斜视术后视力下降的患儿，采用4。底向外试验和Bagolini线状镜检查，确诊为微小角斜视后采用传统遮盖、红光闪烁、Corn后像仪等综合治疗。结果屈光参差性弱视52例，其中治愈19例（36．5％），进步22例（42．3％），无效11例（21．I％）；斜视术后微小角斜视22例（内斜视术后18例，外斜视术后4例），其中，治愈11例（50．O％），进步9例（40．9％），无效2例（9．1％），总有效率84．8％。结论屈光参差、斜视术后欠矫、过矫是引起微小度斜视性弱视的常见原因。针对病因采取综合治疗是有效的。远视性屈光参差和内斜视术后微小度斜视性者效果最佳。     

先天性冲动型眼球震颤合并水平斜视的临床处理

目的探讨先天性冲动型眼球震颤合并水平斜视的手术治疗方法与效果。方法27例病人，面转角矫正术后在注视眼上施行，斜视矫正术在斜视眼上施行。结果24例（88．89％）面转角完全矫正；3例面转角基本矫正，残留原方向10°以内头位扭转角；24例病人斜视矫正达到临床治愈，3例达到不完全功能治愈；所有病人原在位眼震减轻或消失，第一眼位双眼视力均得到改善，较术前提高超过2行。结论先天性冲动型眼球震颤合并水平斜视，在明确注视眼、面转角方向、斜视性质及其相互关系的前提下，可一次手术同时解决。     

水平斜视矫正术对眼屈光的影响

目的探讨水平斜视矫正术对眼屈光的影响及产生影响的可能因素。方法对63例水平斜视进行术前视力、角膜曲率、眼轴及眼的屈光度测量,进行术后1月、3月的视力、角膜曲率、眼轴及眼的屈光度测量,并进行对比分析。结果矫正视力,垂直角膜曲率、眼轴等术前术后无显著性差异（P〉0．05）,眼屈光度存在显著性差异（P〈0．05）。结论水平斜视矫正术对眼的屈光有影响,对角膜的影响是可以恢复的。大角度斜视眼单眼同时行两条直肌手术会导致近视度数加深。     

豫东农村学龄前儿童弱视斜视调查

目的了解豫东农村学龄前儿童弱视斜视发病情况，以期早发现早治疗并为制定群体防治措施提供科学依据。方法国家标准视力表查视力，进行常规眼科检查，排除器质性病变。视力≤1．0者。用1％阿托品眼膏散瞳验光，视力≤0．8者定为弱视；采用Hirschberg角膜映光点测定法及遮盖去遮盖试验方法检查眼位。结果检查3136人，弱视64人，患病率为2．04％。斜视30人，患病率0．96％。结论定期对农村学龄前儿童进行弱视、斜视普查，督促患儿及早治疗，以免错过最佳治疗时机。农村幼儿弱视斜视的防治应引起全社会的高度重视。     

知觉性斜视的临床特点及手术效果

目的：分析知觉性斜视的临床特点及手术效果。方法：分析2012－01／2013－06我科收治的178例知觉性斜视患者的临床资料,包括知觉性斜视的类型,斜视眼视力障碍的病因,斜视度数分布,观察术后眼位及复视现象。结果：知觉性斜视178例中知觉性外斜视123例（69．1％）,知觉性内斜视55例（30．9％）,知觉性斜视中109例为屈光参差性弱视,123例知觉性外斜视的平均斜视度为69．32△,其中78例合并垂直斜视,55例知觉性内斜视的平均斜视度为56．45△,其中26例合并垂直斜视。术毕6例患者出现复视,均于2wk内消失。手术设计按内斜欠矫10△左右,外斜过矫10△左右,术后眼位±10△内为正位,所有患者均行斜视眼手术,超过60△者按超常量一截一退手术设计,术后1a随访,178例斜视患者中138例术后眼位达到正位。结论：知觉性外斜视较知觉性内斜视更为常见,知觉性斜视最常见的病因为屈光参差性弱视,通常斜视度数较大,且常合并垂直斜视,知觉性斜视手术可以较好的改善斜视外观,提高患者生活质量。     

手术治疗先天性眼球震颤合并斜视

目的 探讨先天性眼球震颤合并斜视的手术方法和效果.方法 回顾性分析先天性眼球震颤合并斜视手术24例.手术的设计根据中间带位置、代偿头位、斜视角度和主导眼的关系进行综合考虑,代偿头位矫正在主导眼上施行,斜视矫正在非主导眼上施行.结果 手术后随访3 ～12个月,平均（6.38±2.18）月.20例（83.33％）术后代偿头位消失,3例（12.50％）代偿头位明显改善,残留原方向15°以内头位扭转角,1例（4.17％）过矫.18例（75.00％）术后眼位达到正位,5例（20.83％）达到轻度欠矫或过矫,1例（4.17％）明显欠矫.所有病例原在位眼震减轻或消失,原在位双眼同时视视力均较术前提高2行或2行以上.术前术后双眼同时视视力及头位扭转角变化差异均有统计学意义（z=-5.83,-3.37,P ＜0.01）.结论 合并有斜视的先天性眼球震颤,手术既要矫正斜视又要解决代偿头位,合理的手术设计可以取得良好的治疗效果.     

弱视治愈行斜视矫正术后视力追踪观察

目的了解斜视性弱视及斜视性屈光参差性弱视患者在弱视治愈,行斜视矫正术后,弱视眼视力的变化.方法对1992～1997年在我院弱视治愈后行斜视手术矫正患者103例进行视力追踪观察.结果弱视治愈后行斜视手术后原弱视眼有50.49%存在不同程度视力减退,并且与开始治疗时弱视程度有关,即弱视开始治疗时的视力越低越易出现视力减退.结论弱视治愈行斜视术后的弱视眼,应密切监护,直到视力、眼位均巩固在正常范围为止.     

斜视术后再斜视的原因及治疗

斜视是眼科常见疾病,手术是治疗斜视的重要方法,斜视矫正术后欠矫、过矫、眼位回退问题一直是研究的热点,本文就斜视术后再斜视的相关原因及治疗做一综述.     

斜视性弱视手术后视功能恢复情况的短期疗效研究

目的:了解斜视手术后3mo内对斜视性弱视眼的视功能恢复情况的研究。方法:对2006-06/2008-03在我院行斜视手术的合并有弱视的98例患儿,年龄3.5～15(平均7)岁,其中共同性外斜76例,共同性内斜22例,手术前后用国际标准视力表进行视力的检测、同视机进行双眼视功能检查以及睫状肌麻痹下屈光状态的检查,采用自身对照的方法,将术后1wk;1,3mo的弱视眼视力、双眼视功能以及屈光状态与术前对比,统计学采用两因素方差分析(two-way ANOVA)。结果:术后1wk弱视眼视力较术前提高有显著性差异(P<0.05),双眼融合范围较术前提高有显著性差异。立体视觉的产生在术后1mo较术前有显著性差异。术后1mo的屈光状态与术前相比无统计学差异。结论:斜视性弱视经过斜视手术后可以迅速改善斜视性弱视眼的注视性质,使弱视眼视力和双眼视功能在术后1wk即可得到有效的提高,屈光状态无明显改变,眼位的正常是恢复视功能的关键。     

Decreased Binocular Summation in Strabismic Amblyopes and Effect of Strabismus Surgery

Purpose: Binocular summation (BiS) occurs when binocular visual function surpasses that of the better eye alone. We sought to evaluate whether strabismic amblyopia reduces BiS more than strabismus alone, and determine whether BiS improves in strabismic amblyopes after strabismus surgery. Methods: We prospectively recruited 15 patients with strabismic amblyopia who then underwent strabismus surgery. Thirty age-matched normal subjects and 30 non-amblyopic strabismic patients served as controls. Subjects underwent binocular and monocular visual acuity testing on high-contrast Early Treatment Diabetic Retinopathy Study (ETDRS) as well as 2.5% and 1.25% Sloan low contrast acuity (LCA) charts. BiS was calculated as the difference between better eye and binocular scores. Results: Strabismic amblyopes and strabismic controls did not significantly differ in preoperative BiS, but both had subnormal BiS preoperatively on LCA charts. Among 11 strabismic amblyopes with preoperative and postoperative BiS measurements, average postoperative BiS was not significantly different from preoperative. Improved LCA BiS postoperatively occurred in some patients and was associated with measurable preoperative stereoacuity (P=0.02), older age at strabismus onset (P=0.02), and larger preoperative angle of strabismus (P=0.0043).Conclusions: In this preliminary study, strabismic amblyopes experienced subnormal BiS, but amblyopia generally did not further impair BiS beyond that due to strabismus alone. Some strabismic amblyopes experienced improved low-contrast BiS after strabismus surgery. This suggests that further investigation in larger groups of patients should be undertaken to analyze a previously unrecognized functional benefit of strabismus surgery in strabismic amblyopes.     

Visual recognition time in strabismus: small-angle versus large-angle deviation.

PURPOSE: To measure the possible differences in monocular detection time of a threshold visual acuity stimulus (recognition time [RT]) between patients with small-angle and large-angle strabismus. METHODS: Ten patients with free alternating esotropia were tested (10 to 18 years old): five with small-angle esotropia (< or = 7 degrees), five with large-angle esotropia (15 degrees to 20 degrees). Six age-matched normal subjects served as controls. The RT of the threshold stimulus was measured in both eyes sequentially for stimuli presented in the center of a computer monitor (RT 1). Moreover, we measured the time necessary for identifying the same threshold visual acuity stimulus generated on the computer screen in the moment in which fixation is taken up by one eye after occlusion of the second eye (RT 2). Using the same setting, RT was also measured monocularly in all strabismic and normal subjects who were originally looking at a luminous fixation point positioned horizontally at 6.5 and 15 degrees from the center of the monitor (RT 3). RESULTS: The multivariate analysis of variance for repeated measures indicated that there was no statistical difference in RT 1 between groups. The mean RT 2 was significantly longer (p<0.001) in large-angle strabismic eyes when compared with that of normal control eyes. The mean RT 2 in small-angle strabismic eyes did not differ significantly from that of normal eyes. Finally, RT 3 (both at 6.5 degrees and 15 degrees of eccentricity) did not show any significant difference in the three different study groups. CONCLUSIONS: The authors hypothesized that alternating strabismus patients may have a significant advantage in maintaining a small-angle deviation, as a large-angle deviation would require longer RT in the moment the deviated eye takes up fixation. It can be speculated that the extension of re-fixation movement, obviously shorter in small-angle strabismus patients, is the main factor responsible for longer RT occurring in large-angle strabismus patients.     

Occlusion therapy for strabismic amblyopia

Objective : To assess the outcome of occlusion therapy in strabismic amblyopia. Methods : The case notes of 369 children requiring strabismus surgery were reviewed. Results : Of 369 children requiring surgical correction for strabismus, 109 had strabismic amblyopia. All of these patients were treated with occlusion. Seventy-eight per cent (85 of 109) had improvement of their visual acuity to within one Snellen line of the other eye. Another 11% (12 of 109) of patients genuinely failed to achieve equal acuity in both eyes despite occlusion and 11% (11 of 109) failed to improve due to poor compliance. Conclusions : Occlusion for six hours per day, every day, produced an effective and rapid response in most patients. There was no occlusion amblyopia. Admission to hospital for occlusion was effective in some refractory cases.     

The contrast sensitivity function and childhood amblyopia

We measured contrast sensitivity function and visual acuity in both eyes of strabismic and anisometropic amblyopic patients. There was a linear relationship between contrast sensitivity function and visual acuity in the amblyopic eye. As visual acuity decreased, the contrast sensitivity function decreased along the contrast sensitivity axis, and peak sensitivity shifted to lower spatial frequencies. After patching therapy, when visual acuity reached 20/20 in each eye, suggesting that the amblyopia was cured, there continued to be statistically significant difference in the contrast sensitivity functions between the eyes. The contrast sensitivity function from the previously amblyopic eye was depressed compared to the nonamblyopic eye. A comparison between patients with strabismic and anisometropic amblyopia showed that, when matched for visual acuity, the contrast sensitivity functions were similar for both the nonamblyopic and amblyopic eyes. However, a large difference was found between the amblyopic and nonamblyopic eyes of each group.     

Increased drift in amblyopic eyes.

Reports are conflicting on the presence of increased drift in amblyopic eyes. Furthermore, the individual effects of either amblyopia or strabismus alone on ocular drift have not been systematically investigated. We therefore used a photoelectric method to record horizontal eye position during monocular and binocular fixation in patients having amblyopia without strabismus, intermittent strabismus, or constant strabismus amblyopia. Our principal finding was increased drift amplitude (up to 3.5 degree) and velocity (up to 3.0 degrees per second) in amblyopic eyes during monocular fixation. While increased drift was found 75% of the time in amblyopia without strabismus and 50% of the time in constant strabismus amblyopia, it was found only 20% of the time in intermittent strabismus. Amblyopic drift could be either error-producing or error-correcting in nature. Increased drift was not present during monocular fixation with the dominant eye or during binocular fixation in any of our 16 patients. We therefore conclude that amblyopia and not strabismus is a necessary condition for the presence of markedly increased fixational drift. Increased drift amplitude but not velocity may adversely affect visual acuity in the amblyopic eye.     

Vernier acuity, crowding and amblyopia

When a vernier target is flanked by a pair of optimally positioned flanks, offset discrimination is strongly degraded. Spatial interference with vernier acuity was studied in each eye of observers with unilateral amblyopia associated with strabismus, anisometropia or both, and were compared to the functions obtained in the normal periphery (Levi et al., 1985). The results showed that: (1) For both strabismic and anisometropic amblyopes, as in normal central and peripheral vision, the extent of spatial interference was proportional to the unflanked vernier threshold. (2) For anisometropic amblyopes, grating and vernier acuity are affected similarly. (3) For strabismic amblyopes, like the normal periphery, vernier and grating acuity are decoupled, with vernier falling off faster than grating acuity. (4) The preferred eyes of strabismic but not anisometropic amblyopes have poorer vernier acuity than the normal controls. A conceptual framework for amblyopia based upon spatial filtering and spatial sampling is discussed.     

【In Press】 Clinical features of strabismus and nystagmus in bilateral congenital cataracts

AIM: To evaluate the prevalence, clinical features, and the factors affecting onset of strabismus and nystagmus in patients with bilateral congenital cataracts. METHODS: This study evaluated 116 eyes of 58 patients who underwent lens removal for the treatment of bilateral congenital cataracts between January 1999 and January 2011. The presence and type of strabismus and nystagmus were determined before and after surgery. Type of strabismus and final visual acuity were compared in patients with and without nystagmus. Patients were divided into three groups (orthotropia/orthotropia, orthotropia/strabismus, and strabismus/strabismus) according to their preoperative and postoperative ocular alignment. Age at cataract surgery and associations of nystagmus and primary intraocular lens (IOL) implantation with strabismus were analyzed. RESULTS: Six patients (10.3%) had strabismus preoperatively and an additional 11 (19.0%) developed postoperative strabismus. Exotropia was more common than esotropia both preoperatively and postoperatively. Eighteen patients (31.0%) had postoperative nystagmus, with sensory nystagmus being the most common type. Of the 18 patients with nystagmus, 10 had strabismus, with exotropia being more common than esotropia. Postoperative visual acuity was poor in patients with nystagmus. Age at cataract surgery and rate of primary IOL implantation were significantly lower, and postoperative nystagmus was more common, in the orthotropia/strabismus group than in the other two groups. CONCLUSION: Exotropia and sensory nystagmus are common in patients with bilateral congenital cataracts. Age at cataract surgery and rate of IOL implantation were lower and nystagmus more common in patients with postoperative onset of strabismus. Nystagmus was associated with poor visual prognosis.     

Clinical features of strabismus and nystagmus in bilateral congenital cataracts

AIM: To evaluate the prevalence, clinical features, and the factors affecting onset of strabismus and nystagmus in patients with bilateral congenital cataracts. METHODS: This study evaluated 116 eyes of 58 patients who underwent lens removal for the treatment of bilateral congenital cataracts between January 1999 and January 2011. The presence and type of strabismus and nystagmus were determined before and after surgery. Type of strabismus and final visual acuity were compared in patients with and without nystagmus. Patients were divided into three groups (orthotropia/orthotropia, orthotropia/strabismus, and strabismus/strabismus) according to their preoperative and postoperative ocular alignment. Age at cataract surgery and associations of nystagmus and primary intraocular lens (IOL) implantation with strabismus were analyzed. RESULTS: Six patients (10.3%) had strabismus preoperatively and an additional 11 (19.0%) developed postoperative strabismus. Exotropia was more common than esotropia both preoperatively and postoperatively. Eighteen patients (31.0%) had postoperative nystagmus, with sensory nystagmus being the most common type. Of the 18 patients with nystagmus, 10 had strabismus, with exotropia being more common than esotropia. Postoperative visual acuity was poor in patients with nystagmus. Age at cataract surgery and rate of primary IOL implantation were significantly lower, and postoperative nystagmus was more common, in the orthotropia/strabismus group than in the other two groups. CONCLUSION: Exotropia and sensory nystagmus are common in patients with bilateral congenital cataracts. Age at cataract surgery and rate of IOL implantation are lower and nystagmus more common in patients with postoperative onset of strabismus. Nystagmus is associated with poor visual prognosis.     

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.