弱视治愈后的巩固治疗及临床意义

为了降低弱视的复发率，作者对已治愈的３１３例５３５只弱视眼采取了：①保持两眼视力平衡。②建立稳固的注视性质。③加强立体视训练。④进行眼位和矫正。⑤坚持门诊随访等措施，使弱视治愈后的巩固率高达９８．６９％。     

Dynamics of Interocular Suppression in Amblyopic Children during Electronically Monitored Occlusion Therapy: First Insight

Purpose: Interocular suppression is assumed to be the mechanism leading to impaired visual acuity, especially in strabismic amblyopia. Little is known about the dynamics of suppression during treatment. The aim of our study was to assess the development of the depth of suppression and its relation to changes in visual acuity during electronically monitored occlusion treatment.

Methods: In a prospective pilot study, 15 amblyopes (8 with and 7 without strabismus) aged 5 to 16 years (mean 10.24 years) were examined before initiation of patching and then every 3 to 6 weeks for 4 months. To quantify suppression, a red filter ladder (Sbisa bar) was used, attenuating the image of the dominant eye until the patients reported a binocular perception (diplopia, rivalry, color mixture) or a change in eye dominance. Acuity was assessed with crowded Landolt rings. Daily occlusion was recorded using occlusion dose monitors.

Results: The depth of interocular suppression showed a biphasic change: it increased significantly during the first month (P=0.02), while visual acuity improved (mean 0.14 log units ±0.13; P<0.01). During the following 3 months, median suppression decreased back to the initial values. This reduction in suppression was more pronounced in anisometropic patients without strabismus than in amblyopes with strabismus. The average visual acuity steadily improved (P<0.01) during the 4 months of treatment. Mean recorded patching dose rate was 3.91 h/d. The correlation between mean daily occlusion and suppression changes was not statistically significant.

Conclusions: This first insight into the functional changes during electronically monitored patching suggests a complex relationship between visual acuity and interocular suppression that seems to be influenced by the presence of strabismus. Knowledge of the dynamics of interocular suppression is crucial for enhancing the outcome of occlusion treatment and also for the evaluation of its future role compared to emerging dichoptic treatments.     

Evaluation of Occlusion Treatment Outcomes for Unilateral Amblyopia Using Different Definitions of Outcome

We studied 87 cases of children aged 3 to 10 with unilateral amblyopia (with types of anisometropia, strabismus, or both) who received good recovery after occlusion therapy. The proportional improvement had moderate positive correlation with amblyopic eye improvement (p?p?p?p?相似文献   

Final Visual Outcomes and Treatment Received for Children Referred from a UK Primary School Visual Screening Program: A Comparison of An Orthoptic-led Program with Orthoptic-delivered Services

There is little published evidence relating to the final visual acuity of children who are identified as having reduced vision at a school screening program. The school vision screening program in Leeds (led by an orthoptist but delivered by health care support workers within the school nursing team) is examined.

Results: 7807 children were screened in school between November 1, 2013, and September 1, 2014. Of these, 319 (4%) failed the screen and were referred to the general optometry service and 547 (7%) were referred to the Children’s Community Eye Service (CCES). Of the children who were referred to the CCES, 79.4% attended their first appointment and 86.4% were positive referrals. Of the children with reduced vision, 31 (8.3%) were found to have a manifest strabismus or eye movement disorder; 75 (20% of the positive referrals) required occlusion therapy for amblyopia; 52.6% of those with initially reduced vision obtained good visual acuity following spectacle correction alone within an 18- to 24-week refractive adaptation period. Of those who completed their treatment, 92.9% had vision within normal limits for their age in both eyes at discharge. Of children referred from vision screening who were found to have a defect, 64.6% had that treatment completed within three visits.

Conclusion: Vision screening identifies individuals with treatable vision defects who have a greater than 90% chance of achieving normal visual acuity with good compliance to treatment. Vision screening programs led by an orthoptist but delivered by well-trained and monitored screeners can be of as good quality as a screening program delivered by orthoptists.     

Clinical Manifestations,Complications and Treatment of Ocular Sarcoidosis: Correlation between Visual Efficiency and Macular Edema as Seen on Optical Coherence Tomography

Sarcoidosis is a chronic systemic autoimmune disease which belongs to a group of systemic granulomatous diseases. It can be confirmed through characteristic systemic and ocular manifestations and histological findings. Biopsy is the golden standard for diagnosing sarcoidosis. Ocular sarcoidosis can be confirmed, probable, or possible. Over a two-year period, ocular manifestations were studied on a sample of 52 patients, each followed for four months and diagnosed with some form of systemic sarcoidosis. Most frequent systemic manifestations in patients with ocular sarcoidosis were pulmonary, skin, glandular, and systemic generalized sarcoidosis. The disease was diagnosed four times more frequently in females than males (42:10, respectively; p < 0.05). Most frequent, and statistically significant, manifestation of ocular sarcoidosis is anterior uveitis (64.61%; p < 0.01). Macular edema and periphlebitis associated with periarteritis were frequent, and statistically significant (43.90% and 29.26%, respectively; p < 0.05). Overall, with regards to gender and location (right eye; left eye), visual acuity was >0.5 and of statistical significance (76.92%; p < 0.01). The most common therapy consisted of systemic corticosteroids (26.67%) and/or a combination of corticosteroids and immunosuppressive drugs (23.33%). In 16 eyes treated with repeated doses of sub-Tenon’s injections, both initial and control visual acuity correlated with average thickness. There was positive correlation between several optical coherence tomography findings before and after treatment.