Emmetropisation in normal and strabismic children and the associated changes of anisometropia

The purpose of this study was to measure whether emmetropisation failed in children who had strabismus irrespective of their refraction in infancy, and to record simultaneous changes in anisometropia. We also report how often hypermetropia increased before these children presented with esotropia. A total of 2920 infants had a cycloplegic retinoscopy at age 5-7 months and again at 42 months or when defective vision was identified. Changes of refraction in 210 children with strabismus are compared with the remaining 2710 who did not. When the spherical equivalent of the fixing eyes was > +2.75 D in infancy, hypermetropia decreased less in both eyes of those who had microtropia (p <.001) and heterotropia (p <.001) than in normal children. When it was < +2.75 D, the spherical and/or cylindrical refraction more often remained outside the 'normal' range in both eyes of those who had microtropia and heterotropia (p <.05). Emmetropisation was deficient in both eyes of at least 80% of these strabismic children irrespective of their refraction in infancy. Furthermore, in the strabismic children, the mean change of refraction was less (p <.05) in their fellow eyes than in their fixing eyes, the difference between the two eyes being on average three times greater than that in those who had normal vision. Thus, anisometropia increased in 53% of those who had strabismus but remained within normal limits (< ca. 0.75 D spherical equivalent) in 94 % of those who did not. 'Abnormal' anisometropia in infancy did not, per se, permanently affect vision because 72% of all those who had it did not have strabismus. Finally, the spherical hypermetropia of fixing eyes increased in only 35% of the children with esotropia - similar to the incidence in those who had a microtropia (p =.36). This does not obviously support the concept that increasing hypermetropia causes accommodation to increase before convergence.     

A型肉毒毒素注射与手术治疗儿童共同性斜视的临床比较

目的比较A型肉毒毒素(BTA)注射与手术治疗儿童共同性斜视的疗效。 方法纳入2018年4月至2019年8月就诊于北京同仁医院眼科中心的共同性斜视患儿142例作为研究对象。其中,男性74例,女性68例;年龄3~15岁,平均年龄(7.2±2.6)岁。按照家属的选择意愿分为注射组和手术组。注射组患儿采用BTA眼外肌注射治疗,手术组患儿采用斜视矫正术治疗。检查并记录治疗前与治疗后6个月患儿的斜视度、双眼视觉功能以及并发症情况,治疗后6个月患儿的眼位正位率等指标。注射组和手术组患儿斜视度与双眼视觉功能的定量数据,用均数±标准差描述,采用独立样本t检验进行组间比较,采用配对样本t检验进行组内比较。患儿双眼视觉功能的定性数据,眼位正位率与并发症等指标的描述采用频数和百分率表示,采用卡方检验进行组间比较。 结果治疗后6个月,注射组患儿的眼位正位率为58.2%,手术组患儿的眼位正位率为69.3%。两组患儿眼位正位率的比较,差异无统计学意义(χ²＝1.90,P>0.05)。注射组患儿斜视度绝对值在注射前和注射后6个月分别为(35.23±6.69)△和(12.35±10.16)△;手术组患儿斜视度绝对值在手术前和手术后6个月分别为(35.40±8.74)△和(9.16±9.43)△。治疗前与治疗后6个月,两组患儿斜视度绝对值的比较,差异无统计学意义(t＝-0.13,1.92;P>0.05)。注射组和手术组患儿在治疗后6个月随访时,具有正常同视机Ⅰ级功能(同时视)的分别有25例(占39.1%)和38例(占50.7%);具有正常同视机Ⅱ级功能(融合视)的分别有43例(占67.2%)和70例(占93.3%);具有正常同视机Ⅲ级功能(立体视)的分别有26例(占40.6%)和37例(占49.3%);具有正常近立体视功能的分别有27例(占42.2%)和38例(占50.7%),与治疗前相比均有所增加。治疗后6个月,手术组具有同视机Ⅱ级功能(融合视)患儿的比例高于注射组,差异有统计学意义(χ²＝15.52,P<0.05),其余差异均无统计学意义(χ²＝1.88,1.06,0.99;P>0.05)。注射组所有患儿主诉出现复视,16例患儿表现出轻度上睑下垂和结膜下出血,均于随访1~3个月时消失。 结论对于斜视度为中低度数(15△~50△)的患儿,BTA注射与手术治疗儿童共同性斜视在治疗后6个月临床疗效相近,是一种安全有效的治疗方法。     

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。     

BOTULINUM TOXIN — THE RATIONALE OF ITS USE

Treatment with Oculinum, (Botulinum toxin, Type A), may induce three possible effects. These are a pharmacologic inhibitory effect, a mechanical effect and a sensory effect.     

斜视性弱视儿童多焦视觉诱发电位的研究

目的:研究斜视性弱视多焦视觉诱发电位特征,探讨弱视发病机制。方法:采用德国Roland公司的RETIscan3.15多焦视觉电生理仪,记录和分析了斜视性弱视儿童80眼,外斜43眼内斜37眼,并与正常对照组儿童60眼作比较。结果:弱视眼N1-P1波振幅密度平均值和P1-N2波振幅平均值较正常组儿童在中央视野有下降,随离心度增加,这种现象呈下降趋势。P1波潜伏期平均值无明显异常。正常组和各斜视性弱视组N1-P1波振幅密度平均值:颞侧<鼻侧,P1波潜伏期平均值:颞侧>鼻侧。结论:斜视性弱视mfVEP中心区损害重于周边区,波形异常程度与弱视程度无关。内斜性弱视波形异常程度大于外斜性弱视。     

Sustained improvement of reading symptoms following botulinum toxin A injection for convergence insufficiency

Introduction: We evaluated the use of botulinum toxin A in adults with convergence insufficiency in whom prior treatment had failed.

Methods: We studied 8 patients (median age 36 years, range 17 to 77 years) with reading symptoms due to convergence insufficiency defined as an exodeviation greater at near, not exceeding 10 PD in the distance measured by prism and alternate cover test, and either convergence near point >6?cm or reduced fusional amplitudes. All patients were still symptomatic after prior treatment by convergence exercises (n?=?8), base-in prism glasses (n?=?5) or strabismus surgery (n?=?2). Five patients received injection of 5?IU botulinum toxin in 0.1?ml saline to one lateral rectus muscle, two received 2.5?IU, and one received 2.5?IU to both lateral rectus muscles.

Results: At 1 month post injection, all patients had an initial reduction of exodeviation from baseline (median 9 PD, p?=?0.008) at near, although 2 patients had a temporary intermittent esotropia in the distance with diplopia associated with difficulty driving. At 6 months, when the pharmacological effect of botulinum toxin had completely worn off, patients still maintained a small reduction of exodeviation (median 4 PD, p?=?0.3) at near. Reading symptoms improved in 7 of 8 patients at 1-month post injection, and in all patients at 6 months. Two patients had health-related quality of life assessed with the Adult Strabismus 20 Questionnaire, showing improved Reading Function scores at 6 months. Interestingly, 3 patients reported improved reading despite returning to the baseline angle at 6 months, and 2 of 4 with 12-month follow-up still reported improvement.

Conclusions: In adult convergence insufficiency, botulinum toxin injection to a lateral rectus muscle improves reading symptoms beyond the duration of the pure pharmacological effect. Botulinum toxin injection may be useful in management of adult convergence insufficiency, although repeat injections may be needed.     

5-HT2c受体在正常发育和斜视猫视皮层17区的表达

目的观察在发育不同时限视皮层17区神经元5-HT2c受体(5HT2cR)的表达变化,从分子水平探讨斜视性弱视的发病机制。方法以5-HT2cR单克隆抗体分别检测发育不同时限8只正常发育猫、8只斜视猫视皮层17区5-HT2cR的表达。定量比较正常发育猫与斜视猫视皮层17区5-HT2cR在生后第3周、6周、9周和6月龄的表达差异。结果正常发育猫视皮层各层均可见5-HT2cR染色阳性细胞。其中,II~I V层信号相对较强,V~VI层表达信号较弱。5-HT2cR的表达在生后第6周达高峰,然后逐渐下降,6月龄猫5-HT2cR表达与9周龄猫接近。与正常猫相比,斜视猫5-HT2cR表达水平下降,6周、9周和6月龄斜视猫5-HT2cR表达水平的差异无显著性。结论5-HT2cR是调控视觉发育敏感期及其可塑性的重要因子。     

知觉性内/外斜视与视力障碍发病年龄关系的研究

目的 研究知觉性内斜视或外斜视的发生与视力障碍发病年龄的关系。方法 回顾性分析169例知觉性斜视的临床资料,包括视力障碍的发病年龄、病因和知觉性斜视的类型等。结果 169例知觉性斜视中34例先天性视力障碍(20％),其中20例(59％)发生知觉性内斜视,14例(41％)发生知觉性外斜视;135例(80％)获得性视力障碍,其中21例(16％)发生知觉性内斜视;114例(84％)发生知觉性外斜视。两组间有显著性差异,x~2=27.67,P<0.01。86例视力障碍(51％)因白内障所致,其中无晶状体者64例(74％)。结论 先天性视力障碍(发病年龄≤6个月)主要发生知觉性内斜视,获得性视力障碍(发病年龄>6个月)主要发生知觉性外斜视。白内障是导致知觉性斜视最常见的原因。     

调节性内斜视儿童双眼屈光差值的变化趋势及其对立体视的影响

目的研究调节性内斜视患者屈光差值的变化趋势和立体视的发展变化。方法回顾性研究。对有完整病历资料的屈光调节性内斜视儿童进行回顾性研究和总结。根据初始双眼屈光差值分为低度屈光差异组（双眼SE差≤1.0 D）、中度屈光差异组（1.0 D<双眼SE差<2.5 D）和高度屈光差异组（双眼SE差≥2.5 D）;根据初始视力情况分为双眼视力相等组和弱视组。对初始视力与初始屈光差值的关系进行独立样本t检验,对初始屈光差值随戴镜治疗时间的变化采用重复测量混合线性模型进行分析,对初始屈光差值与末次立体视进行卡方检验。结果在平均（6.8±2.8）年后,末次随访时87例（82.1%）屈光差值为低度,14例（13.2%）为中度,5例（4.7%）为高度。①不同视力组别间屈光差值差异有统计学意义（t=9.787,P<0.05）;②不同的屈光差异组间的末次立体视差异有统计学意义（χ2=18.785,P<0.01）;③戴镜后,随着年龄的增加3组屈光差值均有下降的趋势（F=142.913,P<0.01）。结论初始就诊时,调节性内斜视伴远视性屈光差异者,初始屈光差值越大,初始弱视眼视力越差,末次随访时获得的立体视越差。随戴镜时间增加,双眼屈光差值逐渐趋减。     

儿童远视眼的屈光演变

目的：探讨儿童远视服的屈光演变规律。方法：观察197例(394眼)3～8岁远视儿童，按首诊年龄分6组，按有无斜视分2组，按远视程度分3组。每年扩瞳孔验光1次，连续5年观察远视度数的发展规律。结果：3～8岁年龄组儿童远视眼的远视球镜部分和远视散光部分，每年平均降低的幅度相邻组比较差异无显著性；斜视组和屈光不正组，远视平均每年降低的幅度比较差异无显著性；轻度、中度、高度远视服，远视平均每年降低的幅度比较，差异有高度显著性。结论：儿童远视服远视屈光度(球镜)部分逐年降低，平均每年降低幅度相近，远视散光部分变化较小；斜视和屈光不正儿童，远视度数逐年降低的幅度相近；屈光程度越高远视度数逐年降低的幅度越多；儿童远视散光95％为顺规性散光。     

Long term effect of hypermetropic anisometropia on the visual acuity of treated amblyopic eyes

AIM—To evaluate the effect of the extent of hypermetropic anisometropia on the long term visual acuity results in amblyopic eyes following their treatment by occlusion.
METHODS—The visual acuity of 86 patients, who had been treated for unilateral amblyopia by occlusion of the fellow eye and followed up at least to the age of 9 years, was examined 6.4 years, on average, after cessation of treatment. Patients were divided into two groups—those with a small amount of hypermetropic anisometropia, where the spherical equivalent difference between the eyes ranged between 0 and +1.50 dioptres, and those with a large amount of hypermetropic anisometropia, where the difference was +1.75 dioptres or greater.
RESULTS—Deterioration of visual acuity after cessation of occlusion treatment occurred in 51% of the patients in the group with a small amount of anisometropia and in 75% of the patients in the group with a large amount. At cessation of treatment, the average visual acuity in both groups was 20/40+. At the long term follow up examination, however, the average visual acuity was 20/40− and 20/70, respectively. This difference was statistically significant.
CONCLUSIONS—Hypermetropic anisometropia greater than 1.50 dioptres appears to be a risk factor for deterioration of visual acuity in the long term, following treatment of amblyopic eyes by occlusion of the fellow eye.

Keywords: amblyopia; hypermetropic anisometropia; strabismus     

Results of re-operation on the deviated eye in patients with sensory heterotropia

Purpose

To evaluate the result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after surgery.

Methods

The medical records of 11 patients who had received second strabismus operation on the deviated eye due to recurred, consecutive or undercorrected sensory strabismus were studied retrospectively.

Results

Among the 11 patients, five patients were operated for recurred exotropia after surgery of sensory exotropia (group 1), two for consecutive exotropia after surgery of sensory esotropia (group 2), and four for undercorrected esotropia after surgery of sensory esotropia (group 3). Re-operation was performed 19.2±12.6 years after the first operation and the mean preoperative deviation before re-operation was 30.0±8.66 prism diopters (PD), 32.5±10.6PD, and 32.5±8.66PD, respectively. In all cases, a small amount of recession or resection compared with the usual surgical dosage was applied in re-operation on the deviated eye. The mean follow-up period after re-operation was 12.3±14.2 (1-48 months). Among the 11 patients, postoperative deviations less than 10PD were achieved postoperatively in 8 (72.7%) at 1 month and of the 8 patients with follow-up data beyond 6 months, 5 (62.5%) showed orthotropia within 10PD at 6 months or later.

Conclusions

The surgical result of re-operation on the deviated eye of recurred, consecutive or undercorrected sensory strabismus after the first surgery was satisfactory in spite of the reduced amount of surgical correction compared with the surgical dosage recommended for the non-operated eye.     

肉毒毒素治疗眼睑、面肌痉挛的临床疗效

目的 肉毒毒素治疗眼睑、面肌痉挛的临床疗效及其应用。方法 应用肉毒毒素对眼睑、面肌痉挛患者进行局部肌肉多点注射法。结果 21例眼睑、面肌痉挛经注射肉毒毒素，大部分完全缓解或明显缓解，仅少部分为部分缓解，有效率达100％。全部病例均未出现全身毒副作用，局部并发症有轻微上睑下垂，均于治疗后3～4周自然恢复。结论 肉毒毒素局部注射为眼睑、面肌痉挛患者提供了一个安全、有效、可靠的治疗方法，值得临床推广使用。     

间歇性外斜视病人与正常人眼外肌肌酶组织化学染色的比较

目的研究间歇性外斜视病人与正常人眼外肌的肌酶组织化学染色的结果,探讨间歇性外斜视的可能发病机制。方法分别取间歇性外斜视病人和正常人近附着点处的内直肌进行HE染色和mATPase组织化学染色,光镜下观察并定量比较慢肌和快肌纤维的比例和分布。结果间歇性外斜视病人和正常人的慢肌纤维和快肌纤维的比例无差异。结论1.间歇性外斜视病人内直肌的慢肌和快肌纤维比例的改变不是间歇性外斜视的可能病因。2.人眼外肌肌球蛋白ATP酶染色酸性前孵育液的最适pH值是4.3～4.4,碱性前孵育似乎无法区分两型肌纤维。3.人眼外肌内直肌慢肌纤维所占的比例是随位置而变化(从肌附着点向后其比例增加)。     

共同性斜视患儿手术前后三级视功能的临床观察

目的观察共同性斜视患者手术前后双眼视觉功能的变化,探讨手术矫正在共同性斜视患者双眼视觉功能重建中的重要性。方法收集了37例共同性斜视患者,手术前后分别进行眼部常规检查,屈光检查和三棱镜加交替遮盖法测定远、近斜视度;同时视、融合功能采用同视机检测,立体视功能采用颜少明编绘的《立体视觉检查图》检测。有屈光不正的患者须戴眼镜矫正后进行检测。记录术前、术后1、3、6个月各项检查数据,并对数据资料进行统计分析。结果术前所有患者中,有同时视功能者8例,占21.6%,有融合功能者7例,占18.9%,平均融合范围1.90°±4.15°,有立体视功能者0例;术后1个月同时视功能较术前有明显恢复（P〈0.05）,融合功能及融合范围、立体视无明显恢复（P〉0.05）;术后3、6个月同时视、融合功能及融合范围、立体视均较术前有明显改善（P〈0.05）。结论 （1）共同性斜视患者视觉三级功能都受到了严重损害。（2）术后视觉三级功能较术前均有明显提高,手术矫正眼位是双眼视觉功能恢复和重建的前提因素。（3）我国斜视患者手术年龄偏大,病程较长,应加强科普宣传,加大全国斜弱视的普查,尽可能做到早发现、早诊断、早治疗。     

三棱镜与视野弧检查法在斜视手术设计中的应用

目的：：探讨三棱镜、视野弧检查法在斜视手术设计中的应用。方法：共同性内、外斜视患者145例,年龄2~50岁,术前均用三棱镜、视野弧法检查斜视度,根据检查结果及眼轴长度设计手术量,评估斜视术后眼位正位率。结果：在共同性内、外斜视轻度、重度组中,远、近距离三棱镜与视野弧法所测的斜视度,经统计检验差异均有显著性(P<0.05);而在中度斜视组,两种方法所查斜视度经检验差异无显著性(P>0.05);共同性内、外斜视组眼轴长度比较差异有显著性(P<0.05)。斜视术后共同性内、外斜视组功能治愈率分别为70.83％,67.01％;临床治愈率分别为20.84％,24.74％;无效分别为8.33％,8.25％。结论：三棱镜、视野弧两种检查法在斜视度检查中应相互补充,同时参考眼轴长度,有利于提高斜视术后眼位正位率降低二次手术的风险。     

斜视性弱视猫视皮层17区神经元眼优势及空间特性的改变

目的　从单细胞功能角度探讨斜视性弱视的可能机制。方法　以扫描正弦光栅刺激 ,应用微电极检测 8只正常猫组、9只斜视性弱视猫组纹状皮层细胞的放电水平 ,研究斜视性弱视猫皮层细胞的双眼性、眼优势及其空间特性的改变。结果　斜视性弱视组细胞数为 76 ,正常组为 83,斜视性弱视组皮层双眼细胞较正常组减少 (P <0 .0 5 ) ,眼优势未发生转移。与对侧眼相比 ,斜视性弱视弱视眼驱使皮层细胞的最优空间频率 (正常2 4 9± 0 .4 5 ,斜视组 0 .90± 0 .12 )、高端截止空间频率 (分别为 6 .19± 1.0 7,3.4 9± 0 .5 1)下降 (P <0 .0 0 1) ,两眼时间频率调谐无显著差异 (P >0 .0 5 )。结论　斜视性弱视可能与两眼间异常相互作用以及弱视眼驱使皮层细胞的空间特性发生改变有关。     

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...     

高频超声引导下A型肉毒杆菌毒素注射在甲状腺相关眼病限制性斜视中的应用

目的:探讨高频超声引导下注射A型肉毒杆菌毒素(botulinum toxin A,BTXA)治疗甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)限制性斜视的临床效果。方法:选择32例TAO限制性斜视患者,在眼科高频超声引导下注射BTXA。观察注射前后的斜视度及复视的变化情况。结果:患者32例经重复注射2～4次BTXA后,其斜视度及复视情况有不同程度的减轻。总体显效率占47%,有效率占44%,无效率占9%。结论:高频超声引导下注射BTXA治疗TAO限制性斜视,定位准确,是一种有效缓解眼外肌痉挛和减轻复视症状及斜视度的方法。     

Spasm of the near reflex associated with head injury

Spasm of the near reflex is characterized by intermittent miosis, convergence spasm and pseudomyopia with blurred vision at distance. Usually, it is a functional disorder in young patients with underlying emotional problems. Only rarely is it caused by organic disorder. We report a patient who developed convergent spasm associated with miosis after head trauma at the age of 84 years.