186例共同性斜视儿童屈光状态分析

目的探讨儿童共同性斜视与屈光状态的关系。方法将共同性斜视186例分为两组,3～6岁为学龄前组,7～12岁为学龄组,进行眼屈光比较。结果共同性斜视儿童,内斜视多于外斜视。完全调节性和部分调节性内斜视为中、高度远视,非调节性内斜视以轻度远视为主。共同性外斜视以远视为多。结论儿童共同性斜视中内斜视与调节的关系较外斜视更为密切,近视性屈光参差可能是导致外斜视原因之一。     

儿童共同性斜视与屈光不正

共同性斜视多发生在儿童时期,特别是学龄前儿童,为了探讨共同性斜视与屈光不正的关系,现将我院127例儿童共同性斜视的屈光状态分析报告如下。临床资料本文127例共同性斜视儿童,内斜视103例,外斜视24例,均用1%阿托品眼膏散瞳,每晚涂眼一次,共3～5天由专人负责检影验光。远视散光和近视散光,分别按球镜     

手术治疗的共同性内斜视类型分布

目的 了解共同性内斜视各类型分布的情况.设计回顾性病例系列.研究对象共同性内斜视患者586例.方法 对586例欲行斜视矫正术的共同性内斜视患者的斜视类型、视力及斜视度进行统计和分析.主要指标共同性内斜视的类型,视力与矫正视力,AC/A比率,斜视度等.结果 586例共同性内斜视患者中,先天性者72例(12.29%),非屈光性调节性65例(11.09%),部分调节性55例(9.39%),非调节性189例(32.25%),知觉性79例(13.48%),连续性24例(4.10%),残余性41例(7.00%);共同性内斜视伴有非共同性垂直斜视55例(9.39%);急性共同性内斜视6例(1.02%).斜视度>60△者先天性内斜视占77.78%,知觉性内斜视者占59.49%,非调节性内斜视者占52.91%;斜视度≤40△者残余性内斜视占60.98%,连续性内斜视者占75.00%.共同性内斜视除外知觉性内斜视,视力或矫正视力≥0.9者367例,占62.26%.共同性内斜视屈光不正者357例(60.92%).其中远视性屈光不正257例(71.99%).结论 在共同性内斜视需手术治疗者中,非调节性内斜视占首位.先天性内斜视及知觉性内斜视斜视度显著大于其他类型的共同性内斜视.共同性内斜视的屈光状态主要是远视性屈光不正.(眼科,2008,17:130-133)     

兒童共同性斜視的屈光狀態分析

目的 探讨儿童共同性斜视与屈光不正的关系。方法 通过对320例儿童共同性斜视用1％阿托品眼膏散瞳验光后进行屈光状态分析。结果 320例儿童共同性斜视中,内斜278例,其中远视为265例(95.32％);外斜42例,其中远视为26例(61.90％),有显著差异性。结论 共同性内斜视与调节的关系较外斜更为密切,内、外斜中均以远视居多。     

儿童共同性斜视的屈光状态分析

目的 探讨儿童共同性斜视兴屈光不正的关系。方法 通过对320例儿童共同性斜视用1%阿托品眼膏散瞳验光后进行屈光状态分析。结果 320例儿童共同性斜视中，内斜278例，其中远视为265例（95.32%)；外斜42例，其中远视为26例（61.90%)，有显差异性。结论 共同性内斜视与调节的关系较外斜更为密切，内、外斜中均以远视居多。     

间歇性外斜视患者屈光参差的特点及其对视功能的影响

目的 探讨间歇性外斜视患者屈光参差的特点及其对视功能的影响.方法 对1149例间歇性外斜视患者中筛查出合并有屈光参差的285例患者资料进行回顾性总结和分析,根据屈光状态分为近视性、远视性、近视散光性、远视散光性和混合性屈光参差.观察项目包括患者的视力、屈光状态、Titmus立体视功能.结果 (1)间歇性外斜视合并屈光参差的检出率为24.80%,以近视性和近视散光性屈光参差所占比例较高,分别为11.31%和8.09%. (2)屈光参差类型和屈光参差度对视力的影响差异有统计学意义(P<0.05),远视和远视散光性屈光参差对视力的影响较大,屈光参差度越大对视力的影响越大. (3)屈光参差度对立体视功能的影响差异有统计学意义(P<0.005),立体视锐度损害程度与屈光参差度相关.结论 间歇性外斜视较多合并近视性和近视散光性屈光参差,屈光参差度与视力、立体视功能密切相关.     

斜视儿童的屈光状态

本文介绍446例共同性斜视儿童用睫状肌麻痹剂后的屈光状态。446例中,383例为内斜视,63例为外斜视。98%以上的内斜视者为远视或远视散光。先天性和非调节性内斜视中,约一半病例为轻度远视,平均屈光度分别为+3.18和+3.35度。调节性内斜视中,93%的患者有3度以上远视,平均屈光度+5.99度。调节性内斜视的远视度比其他斜视的高(P<0.01)。本组病例中,约40%有屈光参差,最高者两眼相差7度,但80%相差不超过2度。连续2～9年观察136例屈光度的变化,其中55.51%无变化,但12.87%屈光度递增。85例调节性内斜视分为7岁以上和7岁以下两组,7岁以下组有15.85%的屈光度递减,而17.08%递增;7岁以上组则为51.14%递减,而5.68%递增。两组问的差异显著(P<0.001)。我们认为屈光度的变化和眼球的发育有关。有些先天性内斜视伴有较高远视,戴镜后可矫正至正位。作者提出可能是先天性和调节性的混合性内斜视,值得进一步观察。从本组内斜视病例的远视或远视散光占绝大多数,且远视度亦比普通儿童高。因此,远视和斜视发生的关系不容忽视。外斜视的屈光状态很分散,尚未能总结出其规律。     

儿童屈光不正性斜视分析

儿童共同性斜视 ,多数因调节因素、屈光不正和双眼屈光参差所引起的斜视。因此儿童屈光不正与斜视有着密切关系 ,现将我院眼肌科近几年来对 6 82例儿童屈光不正与斜视的关系分析报告如下。1　临床资料我院眼肌科诊治儿童共同性斜视患儿共 6 82例。检查前对所有患儿用 10 g· L- 1 阿托品眼膏散瞳 ,每日 2次 ,连续 3～ 5 d,充分散瞳后 ,进行检影验光 ,并以最高度数划分屈光程度 ,屈光度 <3.0 0 D为轻度 ,3.0 0～ 6 .0 0 D为中度 ,>6 .0 0 D为高度。近视及远视均包括散光。对调节性内斜视患者我们保持连续几年观察屈光度与斜视的变化 ,并每…     

共同性内斜视患者的屈光状态统计分析

目的 分析共同性内斜视患者的屈光状态，探讨共同性内斜视的发病原因。方法 对我院1990-2003年经住院治疗的774例共同性内斜视患者的屈光状态进行统计分析。结果 774例共同性内斜视患儿，平均年龄10．32岁。远视者483眼，构成比为62．40％；近视者131眼，构成比为16．93％；12岁以前年龄组中发生远视470眼（占87．69％），5岁以前219眼（占97．77％）；12岁以后年龄组中，发生远视13眼（占5．46％）；12岁以前组发生近视者25眼（占4．66％），12岁以后组的近视构成比为44．54％；重度内斜视组中，中、高度远视占58．13％。结论 （1）共同性内斜视患者，远视屈光不正者比正常人群远视患病率高；（2）内斜视斜视角大的中、高度远视比例明显高于中度和轻度内斜视组（P〈0．01）；（3）调节性内斜视伴发的远视屈光多为中、高度远视，较其他类型内斜视差异有非常显著性（P〈0．01）；平均屈光度为＋4，72D，明显高于非调节性内斜视（P〈0．01）；（4）先天性内斜视患者的远视屈光度平均为＋3．65D，明显高于非调节性内斜视组（P〈0．01）。且半数以上为中、高度远视，亦高于非调节性内斜视组（P〈0．01），推测屈光不正所引起的调节作用在先天性内斜视的病因中可能起一定的作用；（5）非调节性内斜视伴有远视者占41．17％，多为轻、中度远视，平均屈光度为＋1．96D；（6）共同性内斜视伴有近视者占22．54％，较正常人群近视患病率高，且中、高度近视超过半数，这一关系值得重视；（7）共同性内斜视12岁以前组远视屈光状态高于12岁以后组（P〈0．01）；近视屈光状态低于12岁以后组（P〈0．01）。     

调节性内斜视的临床疗效观察

调节性内斜视属于共同性斜视的内斜视之一，调节性内斜视又称屈光性内斜视，原因是由于远视性屈光不正的过度调节激起辐辏过强所形成的内斜视。多见于远视眼的幼儿，完全调节性者多在2-3岁时发生，80％伴有中度远视（＋3．00-＋7．00D），因为中度远视经加强调节即能看清，而高度远视由于程度太深，即使加强调节，也很难达到看清的目的，故多不发生内斜。但远视并不是引起调节性内斜视的唯一因素，因为远视患者中92％没有内斜而4％的内斜又为近视患者。     

Acute acquired comitant esotropia simulating late onset accommodative esotropia

Acute acquired comitant esotropia in the older child, adolescent, and young adult may represent uncorrected accommodative esotropia. Three young patients developed spontaneous diplopia associated with acute comitant esotropia. In all cases, cycloplegic refraction revealed high uncorrected hyperopia suggesting late onset accommodative esotropia. However, for one patient an intracranial neoplasm precipitated the strabismus and for the other patients the hyperopic correction did not alter the deviation. Clinicians confronted with older children or adolescent patients with acute comitant esotropia associated with large uncorrected hyperopia should not hastily classify the deviation as being accommodative in etiology. Although the latter is possible, the hyperopia may be coincidental and masking an underlying mechanism.     

儿童远视性弱视与屈光状态的关系分析

目的探讨远视性弱视儿童远视度数与弱视、斜视的关系。方法对远视性弱视儿童300例（550眼）使用阿托品散瞳验光,检查结果进行统计学处理。结果远视性弱视儿童的远视度数由低至高依次为外斜视组、无斜视组、内斜视组。球镜度数越高,弱视程度越高,无斜视组中度弱视比轻度弱视球镜度数高,差异有高度显著性,轻度弱视比中度弱视的柱镜度数高,差异有显著性;重度弱视只有1例。内斜视组中度弱视比轻度弱视的球镜度数高,差异有高度显著性;重度弱视球镜度数比中度弱视低,与斜视和注视性质有关;外斜视组中度弱视比轻度弱视球镜度数高,差异有显著性。结论远视性弱视儿童远视度数与弱视程度有一定关系,但重度弱视还与视觉抑制和中心旁注视关系更为紧密;中高度远视是内斜视的主要原因;远视散光是弱视的重要原因。     

Comitant strabismus

This article briefly overviews the recent literature regarding comitant strabismus. The evaluation and management of esodeviations and exodeviations, which are still topical questions today, are discussed. Several relevant basic studies focus on the prevalence and the role of sensory mechanisms in the clinical findings of essential infantile esotropia. Data reported on by the authors reinforce the validity of early surgery in congenital strabismus. Other articles deal with the accommodative esotropia. The beneficial effect of adequate corrective eyeglasses in accommodative esotropia is emphasized, in both children and adult patients. A major informative review of intermittent exotropia and a worldwide survey of current management of intermittent exotropia are also presented.     

Comitant strabismus

This article reviews 14 of the past year's important published works on comitant strabismus, referring to the most interesting developments related to subjects such as epidemiology of comitant strabismus and prevalence of esotropia and exotropia in pathologic conditions like cerebral palsy, Down syndrome, and prematurity-factors influencing the surgical success in strabismus and functional outcomes of early surgery in essential infantile esotropia. Relevant anatomic and physiologic findings on extraocular muscle function are also discussed, which may contribute to our knowledge on the pathophysiology of congenital strabismus.     

Comitant strabismus

This review reports on articles written on comitant strabismus during the past year. Congenital esotropia was a recurring theme in these publications. Included in this review are articles that provide an insight into the basis for motor epiphenomena such as optokinetic nystagmus asymmetry and latent nystagmus. The optimum window of opportunity to achieve quality binocular vision by surgical alignment in congenital esotropia is discussed. We also report on articles that address various aspects of the management of comitant strabismus including the amount of medial rectus recession for esotropia, the target angle for best results in accommodative esotropia with high accommodation convergence/accommodation ratio, and issues related to comitant exotropia.     

Clinical characteristics of sibling patients with comitant strabismus

AIM: To investigate the clinical characteristics of sibling patients with comitant strabismus. METHODS: Sibling patients who were diagnosed with comitant strabismus from January 2005 to December 2014 were retrospectively reviewed. Factors including age, sex, types of strabismus, refractive errors, angle of deviation, and coexistence of other strabismus were analyzed. RESULTS: A total of 62 patients (31 pairs of siblings) were included. Of these, 26 pairs had intermittent exotropia, 3 had accommodative esotropia, and 2 had infantile esotropia. There were no pairs with different subtypes of strabismus. The age at first visit was 3.7±2.6y and the mean follow-up period was 30.5±24.1mo. In siblings with intermittent exotropia, there was no difference in age of onset, age at operation, or refractive errors between the first and second-born children. The 20 (77%) pairs of siblings with exotropia showed more than 80% concordance of maximum angle of deviation during follow-up. In the 9 pairs in which both siblings had an operation, the final angle of deviation after the operation was 8.2±8.1 prism diopters (PD) in first-born children and 8.6±6.5 PD in second-born children. CONCLUSION: The subtypes of strabismus are the same in all pairs of siblings and clinical characteristics of strabismus are similar between the first and second-born children. This similarity could be an indicator for the diagnosis of second-born children. Further prospective study including a larger number of sibling patients is needed.     

共同性斜视立体视觉的临床检测与分析

目的:研究不同检查方法检测斜视患者立体视锐度的一致性,以及不同类犁斜视立体视损害的差异.方法:对4-25岁双眼视正常组76例及共同性斜视组89例(间歇性外斜39例,恒定性外斜22例,非调节性内斜28例),采用TNO及Randot立体图于40 cm处检查近距离立体视,采用Optec3500视觉检查仪检查远距离立体视,比较3种方法测定的立体视锐度的一致性及不同类型斜视的立体视差异.结果:随机点立体图(TNO)的立体视锐度高于非随机点立体图(Randot与Optec3500)的立体视锐度(P＜0.01);恒定性外斜及内斜TNO近立体视丧失达90%以上,3种方法检查的立体视分布无显著性差异;间歇性外斜的远、近立体视均存在,但其分布有显著性差异(P＜0.05),远立体视的中心凹立体视比例明显降低.结论:立体视损害与斜视偏斜性质无关;随机点及图形立体图对斜视者的检查结果在中心凹立体视一致性好,在黄斑及周边立体视差异较大,故不能仅凭一种检查方法来判断斜视者是否存在立体视.     

斜视手术前后双眼视觉的临床研究

目的探讨斜视对双眼视觉的影响及不同双眼视检查方法的评价。方法89例共同性斜视分为间歇性外斜、恒定性外斜及恒定性内斜3组。定量测量斜视度；检查双眼视觉状态及视网膜对应情况；测定远近立体视锐度。并观察斜视手术前及手术后1周、1月的斜视度、双眼视觉状态及远、近立体视锐度变化。结果3组术后双眼视功能较术前均有明显改善（P〈0．05），术后1周与1月双眼视功能的差异无统计学意义（P〉0．05）；恒定性斜视术后立体视恢复好于间歇性外斜视，且近立体视恢复好于表视；立体视检查非随机点画片（Titmus与Optec3500）与随机点画片（TNO）检查结果的差异有统计学意义（P〈0．05）；线状镜较Worth四点检测阳性率高；大于9岁患者术后双眼视觉较术前增加32％。结论斜视手术是恢复、重建双眼视觉的有效方法，不同检测方法结果不一致，需综合考虑。     

Treatment of acute comitant esotropia in Chiari I malformation

PURPOSE: To explore the appropriate treatment of acute comitant esotropia in patients with Chiari I malformation. DESIGN: Interventional case reports and literature review. PARTICIPANTS: Two patients with Chiari I malformation presenting with acute comitant esotropia are described. INTERVENTION: Strabismus surgery, then neurosurgical decompression of the Chiari I malformation was performed. MAIN OUTCOME MEASURE: Both patients were evaluated for resolution of esotropia and other ocular motility problems. RESULTS: After initially successful strabismus surgery, both patients developed recurrent esotropia with diplopia, which resolved on suboccipital decompression. CONCLUSION: Comitant esotropia may recur and other eye movement disorders may develop after initially successful strabismus surgery in patients with Chiari I malformation. The data suggest that the appropriate sequence of treatment should first be suboccipital decompression, then strabismus surgery if spontaneous realignment does not occur, but further studies are needed to confirm this impression.     

间歇性外斜视合并调节性内斜视：附8例报告

本文对我院3年2158例初诊斜视者中遇到的8例间歇性外斜视合并调节性内斜视进行分析讨论.归纳本型斜视病人的临床特征为:(1)发病年龄较早.(2)先发现内斜视.(3)患者常有中或高度远视(6/8).(4)AC/A 比率正常或偏低.(5)其斜视度变化大,外科30～15°(?)正位(?)内科15～30°.(6)内斜视可戴镜矫正.3例患者做了视觉电生理的眼球运动检查,但没获规律性的结果.最后讨论了本病的发病情况(0.4%,8/2158)和治疗问题.