两种方法测定间歇性外斜视远随机点立体视的差异

目的 比较同视机随机点立体视检测和单屏显示计算机随机点立体视检测系统对间歇性外斜视远方随机点立体视测定的异同.方法 对30名正常人和94名间歇性外斜视患者用同视机随机点立体视和单屏显示计算机随机点立体视检测系统(single monitor distance stereopsis test SMDST)检测远方随机点立体视.检查结果记录有或无.将94例间歇性外斜视患者从年龄,近方立体视和远近方斜视度分别进行分组后,对两种不同检测方法的结果给予比较.结果 30例正常人,两种检查方法检出率为100％,94例间歇性外斜视同视机随机点立体视(14/94) 14.89％,SMDST(58/94) 61.7％.两种检查方法检出率的差异明显(P＜0.001),有统计学意义.≤8岁和＞8岁两组的同视机随机点立体视没有差别(P=0.635),SMDST有差异(P=0.005).近方立体视＜200″和≥200″两组的同视机随机点立体视有差异(P=0.038),SMDST有明显差异(P=0.001).近方斜视度＜40△和≥40△两组的同视机随机点立体视有差别(P=0.049),SMDST没有差别(P=0.822).远方斜视度＜40△和≥40△两组的同视机随机点立体视有差别(P=0.001),SMDST没有差别(P=0.083).结论 评价间歇性外斜视远方立体视要考虑检测的方法,SMDST是间歇性外斜视远方立体视检出率较高的方法.间歇性外斜视年龄≤8有远方立体视的可能性要大;有＜200″近方立体视的间歇性外斜视远方立体视存在的可能性大.     

Distance stereoacuity in intermittent exotropia

BACKGROUND: Studies of distance stereoacuity in intermittent exotropia suggest that normal stereoacuity corresponds to good control of the deviation and that reduced or negative stereoacuity signifies poorer control. AIM: : To evaluate distance stereoacuity in intermittent exotropia using the Frisby Davis Distance stereo test (FD2). METHODS: Children with intermittent exotropia where the near angle was less than or equal to distance were eligible for recruitment. Standardised prospective data collection included FD2 distance stereoacuity. This was a longitudinal study in which outcomes are reported for baseline, last follow-up (> or =6 months before any surgery) or preoperative and last postoperative visits for those undergoing surgery. RESULTS: 110 children with intermittent exotropia had FD2 stereoacuity tested at baseline: 70 comprehended the test. Mean (standard deviation (SD)) age was 4.6 (1.7) years (range 2-10 years). 41/70 (59%) showed positive responses: mean (SD) stereoacuity 30 (12) s of arc. The mean follow-up period before any surgery was 13 months (range 6-27 months). At follow-up, mean (SD) stereoacuity was 24 (11) s of arc. Preoperative and postoperative stereoacuity were not significantly different from those not undergoing surgery. CONCLUSION: This study was the first to report distance stereoacuity in intermittent exotropia using the FD2 stereo test: patients with intermittent exotropia can achieve normal levels of distance stereoacuity, but a considerable proportion, despite comprehending, showed a negative response. This suggests that using the FD2, distance stereoacuity in intermittent exotropia is either absent or normal rather than reduced. Possible reasons for this and its implications are discussed.     

Variability of stereoacuity in intermittent exotropia

PURPOSE: Distance stereoacuity is used to monitor deterioration of intermittent exotropia (IXT), but variability of stereoacuity has not been studied rigorously. The purpose of this study was to assess the variability of stereoacuity over one day in children with IXT. DESIGN: Prospective cohort study. METHODS: Twelve children with IXT were recruited. Stereoacuity was assessed using the Frisby Davis Distance test and the Distance Randot test at distance, and the Frisby and Preschool Randot tests at near. Tests were repeated three or four times over the day, with at least two hours between assessments. The main outcome measure was variable stereoacuity defined as a change by two or more log levels between any two time points over the day. RESULTS: Variable stereoacuity at distance was found in five (42%) of 12 patients. Four (33%) of 12 patients demonstrated variable results using the Distance Randot test, three of whom also showed variable results using the Frisby Davis Distance test. One patient had variable results using the Frisby Davis Distance test only. Nine (75%) of 12 patients completed near stereoacuity testing; two (22%) of nine showed variable near stereoacuity. Two (22%) of nine showed variable results using the Preschool Randot test, one (11%) of whom also had variable results using the Frisby test. In some cases, stereoacuity changed from measurable stereoacuity on one assessment to nil on another. CONCLUSIONS: Nearly half of children with IXT show marked changes in stereoacuity over the course of a single day. When based on isolated measures, an apparent change in distance stereoacuity between visits should be interpreted with caution.     

Evaluation of distance and near stereoacuity and fusional vergence in intermittent exotropia

Aim: To evaluate the role of distance and near stereoacuity and fusional vergence in patients with intermittent exotropia [X(T)] and their change after surgery. Materials and Methods: This prospective interventional institution-based clinical study included 31 cases of X(T) requiring surgery and 33 age, sex-matched controls. All subjects underwent complete orthoptic assessment including near stereopsis (Randot stereogram) and distance stereopsis by polaroid stereo-projector apparatus using special paired slides and fusional vergence assessment at distance and near prism bar at baseline and one week, one month, three months and six months after surgery in X(T). Results: The successful surgical alignment rate was 74.2%. Preoperatively, cases demonstrated significantly poor distance and near stereoacuity, compared to controls ( P P Conclusion: Early detection of abnormal stereoacuity (near and if possible distance) and near fusional vergence amplitudes may help to decide proper timing of surgery in X(T).     

间歇性外斜视患者的屈光状态对立体视功能影响的研究

目的 分析合并不同屈光状态的间歇性外斜视患者立体视功能的差异。设计 回顾性病例系列。研究对象 北京同仁医院2014年7月至2015年8月间歇性外斜视需要进行手术治疗的238例患者。方法 将患者按照屈光状态分为远视组（双眼等效球镜均≥+1.00 D）、正视组（-1.00 D＜双眼等效球镜＜+1.00 D）、近视组（双眼等效球镜均≤-1.00 D）和屈光参差组（双眼等效球镜相差≥1.00 D）,用同视机检查患者的远立体视,颜少明《立体视觉检查图》检查近立体视,比较分析四组患者的远近立体视功能状况。主要指标 远立体视功能和近立体视功能。结果 （1）238例间歇性外斜视患者平均看近斜视度（45.71±18.81）△,平均看远斜视度（43.98±19.55）△,远视组、正视组、近视组和屈光参差组保留远立体功能的比率分别为23.3%、15.5%、19.7%、 18.8%,各组之间远立体视功能比较差异无统计学意义;保留近立体视功能的比率分别为66.7%、79.8%、81.6%、64.6%,屈光参差组的近立体视功能丢失最多,近视组的近立体视功能丢失最少,屈光参差组与近视组的近立体视功能有统计学差异（P=0.033）。（2）间歇性外斜视合并屈光参差的检出率为20.1%,其中近视性屈光参差所占比例（12.6%）最高,远视性屈光参差所占比例（1.3%）最低。（3）间歇性外斜视合并屈光参差的患者中,有、无远立体视的患者双眼等效球镜差值分别为（2.35±0.75）D和（2.34±1.75）D,两组间差值比较无统计学意义（P=0.21）;无近立体视患者双眼等效球镜的差值（3.11 D±2.29 D）明显大于有近立体视患者的双眼等效球镜差值（1.93 D±0.83 D）,两组的差值间比较有统计学意义（P=0.002）。结论 对于斜视角度较大的间歇性外斜视患者,不同的屈光状态对远立体视功能影响不大,屈光参差加重对近立体视功能的损伤,屈光参差度越大,近立体视功能损伤越重。（眼科, 2016, 25： 396-399）     

The use of binocular visual acuity in the assessment of intermittent exotropia.

BACKGROUND: It has been suggested that a decrease in distance stereoacuity in patients with intermittent exotropia is a good indicator of diminishing control. However, there has been no adequate explanation for this reported reduction in distance stereoacuity in these patients. We postulate that the decrease in stereoacuity is related to blurred visual acuity created by an increasing demand on accommodation, which these patients use in an attempt to control the exodeviation. This can best be assessed by measuring binocular visual acuity (BVA). Analysis of BVA could provide a useful clinical tool to evaluate control measures used by patients with intermittent exotropia. METHODS: A prospective study of patients with intermittent exotropia, ranging in age from 6 to 60 years, was performed. Only those patients with the presence of either basic or divergence excess (simulated or true) type exodeviation were included in the study. The data analysis included the age of these patients, age at onset of the deviation, monocular and binocular visual acuity, oculomotor and fusional status, and near and distance stereoacuity. RESULTS: Data from 36 patients show that the measurements of BVA correlated well with a corresponding loss of distance stereoacuity but not with the size of the deviation. CONCLUSION: The decrease of stereoacuity reported in patients with exotropia can be explained by increased accommodation and decreased distance BVA. This measurement can be a simple method of quantifying the fusional control of patients with intermittent exotropia.     

Overcorrecting minus lens therapy for treatment of intermittent exotropia

The purpose of this paper is to determine the value of overcorrecting minus lenses in treating children with intermittent exotropia. The aim with this therapy is to secure an increase in the quality of fusion and to induce a quantitative decrease in the angle of strabismus. Thirty-five children were treated with 2.00 to 4.00 diopters of overcorrecting minus lenses for a median of 18 months duration. Of these, 46% had an improved quality of fusion during therapy; 26% had an improved quality of fusion and also had a quantitative decrease in their angle of deviation; and 28% had an inadequate improvement in their quality of fusion and decrease in the angle of their deviation with this therapy. Two children went from intermittent exotropia to esotropia while wearing their minus lenses--both had high accommodative-convergence/accommodation ratios (11.5 delta/1D and 10.7 delta/1D). Seventy percent of good responders who were followed for at least 1 year after discontinuing the therapy maintained a qualitative or quantitative improvement in their intermittent exotropia.     

间歇性外斜视患者的屈光状态对术后短期立体视功能重建的影响

目的 比较不同屈光状态的间歇性外斜视患者术后立体视功能重建的差异。设计 回顾性病例系列。研究对象 北京同仁医院2014年7月至2015年8月被诊断为间歇性外斜视已经接受手术治疗的患者227例。方法 将患者按照屈光状态分为远视组、正视组、近视组和屈光参差组,比较分析四组患者术前术后的远近立体视功能状况。主要指标 远立体视功能和近立体视功能。结果 （1）不同屈光状态组患者术后1个月以眼位评价的手术成功率无统计学差异（P=0.775）。（2）远视、正视、近视和屈光参差组的患者术前远立体视保存率分别为24.1%、16.3%、20.5%和20.0%（P=0.802）,术后1个月远立体视保存率分别为17.2%、26.3%、41.1%和24.4%。正视、近视和屈光参差组患者术后的远立体视的保存率均较术前有所提高,但只有近视组患者的术后远立体视保存率的提高有统计学意义（P=0.001）。（3）远视、正视、近视和屈光参差组的患者术前近立体视保存率分别为65.5%、81.3%、82.2%和64.4%,术后1个月近立体视保存率分别为65.5%、87.5%、90.4%和62.2%,正视组和近视组的患者术前术后的近立体视保存率均高于远视组和屈光参差组（P均＜0.05）。结论 合并近视的间歇性外斜视患者术后短期内的远立体视功能重建优于合并远视、正视及屈光参差的患者。     

Intermittent exotropia, overcorrecting minus lenses, and the Newcastle scoring system.

PURPOSE: We sought to determine whether the Newcastle Control Score (NCS) could be used to indicate a successful outcome in patients with intermittent exotropia that were treated with minus lenses. METHODS: We studied patients with an intermittent exotropia who were prescribed minus lens therapy in an effort to manage their strabismus conservatively. The NCS, which quantitatively estimates the control of an intermittent exotropia, was applied before treatment and 4 months after treatment. The results of minus lens therapy with a pretreatment NCS of > or =5 (group 1) were compared with those with a NCS of < or =4 (group 2). RESULTS: There were 24 patients (13 girls, 11 boys) treated with minus lenses. The mean age of the patients was 6.8 +/- 3.8 years (range, 2-17 years; median, 5). The mean pretreatment distance angle was 28.5 +/- 10 prism diopters (range, 6-45; median, 30) and the mean post-treatment distance angle was 18.3 +/- 8.9 prism diopters (range, 0-35; median, 18) P = 0.001. Using the NCS minus lenses significantly (P = 0.041) improved control of exotropia. In group 2 (n = 16) 75% had improved scores post-treatment compared with 62.5% in group 1 (n = 8), P = 0.68. CONCLUSIONS: These data suggest that the NCS is a useful method to indicate the success in the control of intermittent exotropia with conservative treatment with minus lens therapy.     

The use of the Newcastle Control Score in the management of intermittent exotropia

AIM: To evaluate the use of the Newcastle Control Score (NCS) in the management of intermittent exotropia (X(T)). Participants and methods: Children aged <11 years with X(T) had an assessment of NCS as part of routine management. Other data collected included visual acuity, near and distance alignment with alternating prism cover test and near (Frisby test) and distance stereoacuity (Frisby Davis Distance Stereotest (FD2TM)). Analysis involved correlation between baseline NCS, angle and stereoacuity, examination of change over time and logistic regression to determine predictors of surgery. RESULTS: Baseline data were obtained on 272 children and follow-up data on 157. Mean (SD) age was 4 (1.9) years. Complete NCSs were obtained for all except one child at baseline, and all children at follow-up. At baseline, total NCS and the home control component were correlated with near stereo (r = -0.22, p<0.01 and r = -0.19, p<0.02, respectively), near alignment (r = 0.34, p<0.001 and r = 0.19, p<0.02) and distance alignment (r = 0.30, p<0.001 and r = 0.26, p<0.001). The clinic near control component was correlated with near alignment (r = 0.39, p<0.001), but not near stereoacuity, and the clinic distance control with near alignment (r = 0.16, p<0.02), distance alignment (r = 0.27, p<0.001) and distance stereoacuity (r = -0.25, p<0.03). A high (poor) NCS (> or =4) at the latest follow-up predicted surgery (p<0.001, OR 29.3, 95% CI 6.2 to 138.7). CONCLUSION: The NCS is a useful measure of the clinical severity of X(T), can be used to serially assess improvement or deterioration and is a useful tool for the management of these patients.     

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.     

间歇性外斜视手术矫正前后融合和立体视功能对照研究

目的 对间歇性外斜视患者手术矫正前、后的双眼融合功能和立体视锐度进行对照比较.方法 回顾性系列病例研究.对2008年9月至2011年8月在山东大学附属省立医院眼科中心确诊为间歇性外斜视并一次性手术正位(+5～-10 PD)的连续性病例114例,采用Titmus立体视图测定患者看近立体视锐度;采用手电筒式Worth四点灯评估患者的中心融合和周边融合功能;采用三棱镜加交替遮盖法测量患者戴镜注视6 m及33 cm调节性视标的第一眼位斜视度.按照患者术后不同斜视度分为A组(+1～+5 PD)、B组(0 PD)、C组(-1～-5 PD)、D组(-6～-10 PD)四组,采用r检验及配对设计的符号秩和检验分别对手术前、后的双眼融合功能和立体视锐度进行比较,以P ＜0.05为差异有统计学意义.结果 术前与术后双眼融合功能的差异有统计学意义(P =0.000).A、B、C、D四组之间术后双眼融合功能的差异有统计学意义(P =0.004).术前与术后立体视锐度的差异有统计学意义(P =0.000).A组手术前、后立体视锐度的差异无统计学意义(P =0.336),其余各组手术前、后立体视锐度的差异均有统计学意义(P =0.001).结论 间歇性外斜视患者手术矫正后的双眼融合功能和立体视锐度比手术前明显提高.     

间歇性外斜视患者远距离立体视的临床特点

目的探讨间歇性外斜视患者远距离立体视的临床特点及其相关影响因素，为手术时机的选择提供参考依据。方法利用Optec 3500视觉检查仪检查61例间歇性外斜视患者的远距离立体视。采用Titmus立体图检查近距离立体视。结果①术前远距离立体视丧失的比例和视锐度损伤的程度均明显高于近距离立体视。②术后远距离立体视重建的比例提高和立体视锐度改善显著。③术后患者的远距离立体祝与病程呈正相关。结论①患者术前远距离立体视大部分丧失，近距离立体视保持较好。②手术矫正可明显提高患者的远距离立体视，主要影响因素为病程。③远距离立体视锐度可作为选择手术时机的一个重要参考依据。