主视眼对民航招飞隐斜检查结果的影响

目的:探索便携式隐斜计放置眼别(主视眼或非主视眼)对民航招飞隐斜检查结果的影响。方法:南航2012年度广东地区招飞上站眼科第一轮通过650例学生,卡孔法判断被检者主视眼眼别,将便携式隐斜计分别放置在主视眼(主视眼组)与非主视眼(非主视眼组)前测量隐斜值,用Von Graefe法测量值作为对照,外隐斜为负值、内隐斜为正值,垂直隐斜取绝对值。分别对主视眼组与非主视眼组、主视眼与Von Graefe法组、非主视眼组与Von Graefe法组隐斜值进行统计学分析。结果:Von Graefe法组外隐斜平均为-2.21±0.35△,内隐斜平均为+3.87±1.20△,上隐斜为+0.44±0.12△;主视眼组外隐斜平均为-2.68±0.55△,内隐斜平均为+6.22±2.55△,上隐斜为+0.46±0.15△;非主视眼组外隐斜平均为-2.16±0.40△,内隐斜平均为+3.22±1.65△,上隐斜为+0.45±0.14△。水平隐斜(外隐斜和内隐斜):主视眼组与非主视眼组有统计学差异(P<0.05),主视眼组与Von Graefe法组有统计学差异(P<0.05),非主视眼组与Von Graefe法组无统计学差异(P>0.05);垂直隐斜:Von Graefe法组与主视眼组、非主视眼组无明显统计学差异(P>0.05)。结论:民航招飞隐斜检查时便携式隐斜计放置在被检者非主视眼前结果更为可靠。     

眼位正常、外隐斜及间歇性外斜视儿童的近视患病率比较

目的 通过观察眼位正常、外隐斜视及间歇性外斜视儿重的近视患病率和等效球镜屈光度,探讨三组儿重的近视患病率及程度的差异.方法 临床回顾性研究.收集6 ～14岁眼位正常儿童151人、外隐斜视儿童180例及间歇性外斜视儿童168例的验光结果,均使用睫状肌麻痹剂(托吡卡胺滴眼液)使睫状肌充分麻痹放松调节后客观验光3次,取平均值为客观验光结果.并将间歇性外斜视组分为基本型、集合不足型和分开过强型,观察三种类型间歇性外斜视患者等效球镜屈光度的差异.结果 不同年龄的间歇性外斜视组近视患病率均显著高于眼位正常组和外隐斜视组,差异均有统计学意义(均为P＜0.05).不同年龄的眼位正常组近视患病率和外隐斜视组差异均无统计学意义(均为P ＞0.05).间歇性外斜视组总体近视患病率与眼位正常组和外隐斜视组差异均有统计学意义(均为P =0.000);眼位正常组总体近视患病率与外隐斜视组差异有统计学意义(P=0.034).眼位正常组、外隐斜视组、间歇性外斜视组等效球镜屈光度分别为(0.08±0.99)D、(-0.16±1.16)D、(-1.23±1.57)D,三组间差异有统计学意义(P=0.000).眼位正常组与外隐斜视组(P=0.015)、眼位正常组与间歇性外斜视组(P=0.000)及外隐斜视组与间歇性外斜视组(P=0.000)的等效球镜屈光度差异均有统计学意义.间歇性外斜视组中,集合不足型等效球镜屈光度(-1.68±1.61)D、基本型(-1.14±1.44)D、分开过强型(-0.85±1.50)D,三种类型组间差异有统计学意义(P =0.000).集合不足型等效球镜屈光度明显低于基本型(P =0.000)和分开过强型(P =0.041).结论 间歇性外斜视儿童近视患病率及近视程度均高于眼位正常组及外隐斜视组儿童.     

间歇性外斜视的研究进展

间歇性外斜视是介于外隐斜与恒定性外斜视之间的一种斜视.起病较早,发病年龄通常为1岁到4岁.与其他类型的斜视不同,间歇性外斜视的儿童在很长一段时期内仍可维持正常眼位及双眼视功能,因此如何选择合适的干预时机及治疗方式对临床医师是个挑战.本文旨在回顾近年来间歇性外斜视的最新研究进展,重点对间歇性外斜视的严重度分级、非手术治疗方式、手术时机及手术方式、过矫及欠矫处理等方面的研究进展进行简要介绍,为间歇性外斜视的治疗提出改善化建议.     

外斜视伴有假性斜肌功能亢进

目的分析外斜视患者伴有上、下斜肌功能亢进现象的临床特点、机制和治疗效果。设计回顾性病例系列。研究对象13例外斜视伴上、下斜肌功能亢进的患者。方法回顾分析该类患者的斜视患病时间、眼球运动功能、眼球主客观旋转、手术治疗方法和治疗效果。主要指标斜视程度、斜视患病时间、眼球运动功能、双眼视功能。结果13例患者外斜视患病时间平均(19.5±5.9)年,视远外斜视度平均(35.0±5.2)°,视近外斜视度平均(45.4±6.2)°,术前双眼内转功能不足-2～-3,双眼上、下斜肌功能同时亢进 1～ 2,眼球主观和客观旋转正常。2例行单眼内直肌缩短联合外直肌后退术,11例行双眼内直肌缩短或联合外直肌后退术。术后1周双眼内转功能正常,上、下斜肌功能亢进现象消失,1例患者术后2个月时复查有单眼下斜肌功能亢进 2。结论部分患病时间较长的大度数外斜视患者伴有内转功能不足,可表现为假性斜肌功能亢进,建议行内直肌缩短术或联合外直肌后退术。(眼科,2007,16:330-333)     

共同性外斜视眼外肌病理研究

目的：探讨共同性外斜视内直肌的病理变化与斜视发现时间的关系。
　　方法：对30例共同性外斜视患者行斜视矫正手术,术中将截除的内直肌用4%甲醛固定后送病理,在显微镜下观察眼外肌的组织结构,并进行HE和Masson染色。
　　结果：共同性外斜视30例中,内直肌纤维大小不一、形态异常,数量减少,肌肉不同程度的纤维化,经Masson染色后发现,发现斜视较久患者组眼外肌肌纤维含量明显少于发现时间较短患者组(P<0.05) 。
　　结论：斜视的发生与眼外肌的结构异常有关,发现斜视时间较久的共同性外斜视比发现时间较短的共同性外斜视其眼外肌发生明显的纤维化,说明内直肌纤维化可能是外斜视形成的原因之一。随着斜视时间的延长,眼外肌纤维化程度加重。     

间歇性外斜视患者眼外肌的超微结构研究

目的 研究间歇性外斜视患者眼外肌的超微结构,以期探讨间歇性外斜视的发病机制.方法 取8例间歇性外斜视患者、8例恒定性外斜视患者(间歇性外斜视恒定化)及8例同期角膜移植供体的健康人眼内直肌,常规HE染色后在光镜下观察并计算每例标本每100倍视野下肌纤维的含量;利用透射电镜观察8例间歇性外斜视患者与5例同期角膜移植供体的健...     

合并小度数垂直斜视的共同性外斜视眼外直肌MRI研究

目的:观察共同性外斜视合并小度数垂直斜视患者眼外4条直肌Pulley位置、肌肉体积及水平直肌上、下两部分肌肉体积比值的特点。方法:横断面研究。收集2018年1月至2019年12月在天津市眼科医院确诊为共同性外斜视患者,其中第一眼位不合并垂直斜视的患者为A组,第一眼位合并小角度垂直斜视（<5三棱镜度）的患者为B组;健康志...     

不同类型间歇性外斜视斜视角不同测量方法的比较

目的:比较不同类型间歇性外斜视使用注视6m示标三棱镜检查、注视30m示标、注视户外示标、1h遮盖试验四种测量方法测量斜视角结果的差别。方法:前瞻性研究。收集2013-06/2014-06在青岛大学医学院附属医院被确诊为间歇性外斜视的患者65例,其中男37例,女28例,平均年龄12.5±6.2岁。分别对患者行注视6m示标斜视度测量、注视30m示标斜视度测量、注视户外示标斜视度测量、1h遮盖试验斜视度测量。根据测量远近斜视角差值大小,将患者分为基本型、集合不足型、分开过强型。对各型中测量的视远斜视度进行单因素方差分析,采用LSD-t方法进行两两比较。结果:注视6m示标、注视30m示标、注视户外示标、1h遮盖试验四种检测方法测得的视远斜视度在三型中分别为:基本型45.4±21.0,55.0±15.0,64.68±17.7,68.75±16.6PD;集合不足型33.3±14.0,44.9±12.9,43.6±11.8,54.6±11.2PD;分离过强型55.6±17.4,66.3±18.8,76.9±16.4,78.1±15.6PD,三型中四种方法测得的视远斜视度进行比较,结果均有统计学意义(F基本型=9.649,P=0.00;F集合不足型=6.886,P=0.001;F分离过强型=7.989,P=0.00)。两两比较,注视户外示标(P基本型=0.044,P分离过强型=0.048)及1h遮盖试验(P基本型=0.04,P分离过强型=0.027)与注视30m示标检查比较时,在基本型与分离过强型两型中差异均有统计学意义;注视户外示标检查与1h遮盖试验(P基本型=0.353,P分离过强型=0.815)在基本型与分离过强型两型中的比较差异无统计学意义。而在集合不足型中,与其它三种检查方法相比,1h遮盖试验检查结果明显更大,差异有统计学意义。结论:注视户外示标与1h遮盖试验可以测出基本型与分离过强型更大的斜视角,在集合不足型1h遮盖试验可以测出更大斜视角。     

空军招飞体检中健康青少年人群视网膜非压迫变白分布规律

目的：初步探究视网膜非压迫变白(white without pressure,WWOP)在健康青少年人群中的分布规律,为空军招飞和健康体检提供理论支持。

方法：选取参加2018年空军招收飞行学员医学选拔的高中毕业学员461名和青少年航校入校选拔的初中毕业学员71名作为研究对象。利用超广角激光眼底扫描系统配合直接眼底镜及三面镜检查,对WWOP等眼底病变进行筛查。

结果：本研究纳入的健康青少年人群中WWOP检出率高达2.63%,初中毕业和高中毕业学员WWOP检出率差异无统计学意义(P>0.05)。本研究检出的WWOP病变以颞侧象限为主,尤其以颞下象限多见。高中毕业学员存在WWOP的眼合并其它周边部视网膜变性的比例高达18.18%,较无WWOP眼显著增高。

结论：WWOP在健康青少年人群中并不罕见,病变以颞侧多见,病变区域内合并其它视网膜变性的比例显著增高,体检过程中发现WWOP体征时需对周边视网膜进行仔细检查,避免漏诊、误诊。     

Adjustable suture strabismus surgery

Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of 'no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach.     

先天性内斜视合并下斜肌功能亢进的早期手术治疗

目的：探讨先天性内斜视合并下斜肌功能亢进的早期手术治疗效果。方法：通过获取先天性内斜视患者的数码图像,观察患儿的双眼水平、垂直眼位,对眼球运动检查的结果进行记录,分析垂直肌功能异常的类型。采用特殊电脑软件,分析得出水平斜视度数。根据检查结果,设计斜视矫正手术。结果：6例先天性内斜视合并下斜肌功能亢进病人术前容易发现代偿头位,歪头实验（ ）。本组病人水平斜视角度24-43度,合并单眼或双眼下斜肌功能亢进。全部病人在手术后,4例病人水平斜视与垂直斜视获得矫正。2例病人术后残留内外斜。结论：引入数码影像分析手段,有助于先天性内斜视合并下斜肌功能亢进的诊断。先天性内斜视合并下斜肌功能亢进病人,早期手术时,垂直斜视与水平斜视可以一并进行。     

Semistructured Observation of Population-based Eye Screening in The Netherlands

Background: In the Netherlands, youth-healthcare (YHC) physicians screen children 7 times for vision disorders between the ages of 1 and 60 months. Examination consists of inspection of the external structures of the eye, fundus red reflex, Hirschberg test, pupillary reflexes, cover-uncover test, alternating-cover test, eye motility, monocular pursuit, and, from 36 months onwards, visual acuity (VA). We observed how well these tests are done.

Methods: Screening test performance was assessed with semistructured observations. Two orthoptic students developed a semistructured observation form. In addition to extensive instructions from an orthoptist and YHC-physicians instructor, they attended 2 one-day courses for YHC physicians. Tests were assessed using criteria based on the Dutch Child Vision Screening Guideline version 2010 and the Dutch Manual for Orthoptic Examination. Type of chart, testing distance, and starting eye were recorded for VA measurements. The observations in the first week were done simultaneously by the two observers and checked for concordance.

Results: Concordance between the two observers was good. Twenty-five YHC physicians were observed during 100 days in total. Two physicians were excluded because they examined few children. The remaining 23 physicians examined 329 children, of whom 82 were aged 1-4 months, 157 aged 6-24 months, and 90 aged 36-45 months of age. Fundus red reflex was performed in 89% of children, Hirschberg test in 88%, pupillary reflexes in 14%, cover-uncover test in 65%, alternating-cover test in 62%, eye motility in 68%, monocular pursuit in 23%, and VA at 36-45 months in 94%. Forty-eight percent of cover-uncover tests, 36% of alternating-cover tests, and 7% of eye motility tests were performed correctly. VA was measured at 3 meters in 2%, others at 5 meters in accordance with the guideline. A picture chart was used instead of the Landolt-C at the age of 45 months in 23%. VA measurements were performed correctly in 89%, fundus red reflex in 89%, and Hirschberg test in 87%.

Conclusion: Hirschberg test, fundus red reflex, and VA were adequately tested in most cases. Cover-uncover test, alternating-cover test, and eye motility were often performed inadequately. Pupillary reflexes were skipped often as room lights could not be dimmed.     

Early American Strabismus Surgery: 1840–1845

Abstract

The discovery of effective surgical therapy for strabismus was one of the outstanding triumphs of the first half of 19th-century ophthalmology, just prior to the invention of the ophthalmoscope in 1850. Although priority for the development of strabismus surgery belongs to Johann Friedrich Dieffenbach of Germany, who first reported his surgical results in 1839, 4 cases of tenotomy of the medial rectus muscle had been performed in the United States by William Gibson in 1818 but never published. By 1840, the reports of surgery in Europe had rapidly spread to America where surgeons immediately began using these procedures. The first American surgeon to perform eye muscle surgery and publish his results was John Dix of Boston, and other surgeons were soon reporting their cases as well. We discuss 8 American pioneers in this field during the time (1840–1845) of the first burst of enthusiasm for this surgery. Although these surgeons were active in performing a large number of cases and carefully reporting their experiences and results, they did not make any major advances in the field.     

水平肌肉移位术治疗间歇性外斜视合并小度数垂直斜视

目的：观察水平肌肉移位术对间歇性外斜视合并小度数垂直斜视的矫正效果。方法：总结7例9眼间歇性外斜视伴小度数垂直斜视的病例,手术矫正水平斜视的同时,对水平肌肉止端垂直移位,矫正并存的小度数垂直斜视;术后随访3~18（平均6）mo,观察其疗效。结果：水平斜视矫正的同时,垂直眼位也得到满意矫正,5例7眼患者垂直眼位消失,1例1眼患者术后由R/L8^△变成R/L2^△,1例1眼患者术后由原来R/L6^△变成L/R2^△。随访期间全部患者均未出现医源性A-V现象,无复视,无代偿头位。结论：在解决水平斜的同时进行水平肌肉垂直移位可兼顾到小度数垂直斜的矫正。\"     

水平肌移位术治疗水平斜视并伴垂直斜视

目的 探讨水平肌移位量与矫正垂直斜视度的关系.方法 对我院58例(80眼)诊断为水平斜视并垂直斜视者施行水平肌移位术,在做内外直肌手术时,在后徙或缩短的同时将其附着点向上或向下移位0结果 j.5g例(,80眼)中有36例(47眼),行内外直肌止端上下移位量5～7 mm,平均矫正垂直斜视度4.58°±0.78°;22例(33眼)移位小于3mm,平均矫正垂直斜视度1.75°±0.46°;10例(15眼),未行内外直肌移位,平均矫正垂直斜视度1.25°±0.36°.结论 水平肌移位术治疗水平斜视并小度数垂直斜视效果佳,而且水平肌移位量不少于5mm.     

中国东北某医院2014─2017年间斜视住院患者斜视类型分布变化

目的：根据中国东北地区某医院眼科收集的数据,评估所有年龄阶段斜视住院患者的斜视类型和数量变化趋势。方法：回顾性分析2014年1月至2017年12月在哈尔滨医科大学附属第一医院眼科住院的斜视患者3 661例的资料。收集患者基本信息、斜视类型以及各种斜视的数量等信息,并观察分析斜视类型分布及斜视数量的变化趋势。组间数据比较采用方差分析、χ2 检验或Fisher确切概率法。 结果：最终纳入3 555例患者,年龄为1～79岁（15.5±11.6）岁,其中3 536例患者行斜视手术治疗。患者数量呈逐年递增趋势,且在每年1、2月份及7、8月份大致达到峰值（χ2 =956.67,P<0.001）。外斜视患者数量（71.8%）明显多于内斜视患者数量（16.0%）,差异有统计学意义（χ2 =31.41,P<0.001）, 其中间歇性外斜视是最常见的斜视类型。非调节性内斜视（77.6%）是所有内斜视中最常见的斜视类型。其他特殊类型斜视虽然患者数量较少,但依然有小幅度的上升趋势。在所有年龄阶段患者中, 12岁以下的患者最常见,占总数的56.0%,其中外斜视（71.5%）是最主要的斜视类型。结论：中国东北地区某医院2014─2017年外斜视患者比内斜视患者更常见,且外斜视患者的比例逐年增加,其中间歇性外斜视是最主要的斜视类型。此外12岁以下患者是最常见的患病人群。     

Panel D-15检查法在招收飞行学员中的应用

目的:探讨PanelD-15检查法在招收飞行学员中的应用。方法:随机选取2012-12-01/12-10南航招收飞行学员400例为测试对象,应用俞自萍色盲检查图和PanelD-15对学生的色觉能力进行评估,以俞自萍色盲检查图判断色盲、色弱和正常学生;用PanelD-15比较学生色相子排列的次序,以正常、小错和按跨线判断学生对不同色调的辨色能力。结果:色盲本检查,正常386例,全色盲4例,红绿色盲5例,红绿色弱5例;PanelD-15检查,正常384例,小错5例,跨线11例。结论:PanelD-15能够客观评价招飞学生的色觉能力,可减少漏诊率,保证招飞质量,保证飞行安全。     

儿童斜视手术治疗与临床分析

目的：评价儿童各种斜视手术的疗效。方法：对102例患者施行手术,随访1－2年,手术方法包括双侧外直肌缩短术,双侧内直肌徒后术;单眼内直肌徒后和外直肌缩短术,双眼内直肌徒后并附着点下移,或行双眼外直肌缩短并附着点上移,或单眼内直肌徒后并附着点下移加外直股缩短附着点上移,双眼外直肌徒后并附着点上移,或行单眼外直股起诉一并附着点上移加内直股缩短并附着点下移,如伴有下斜肌功能亢进者,则行下斜肌徒后术。结果：术后95例斜视均明显改善,随访1－2年的102例斜视患者占,78例（76．47％）,斜视得到治愈,17例（16．675）斜视得到美容治愈,7例（6．86％）手术失败。结论：各种类型斜视通过各种手术方法后,均能得到良好的矫正而无严重并发症。