《斜视弱视与小儿眼科》征订通知

由孟祥成、孟令勇主编 ,张方华主审的《斜视弱视与小儿眼科》已于 2 0 0 1年 3月由黑龙江人民出版社出版 ,现已开始征订。本书是主编者在原版《斜视弱视学》、《儿童视力不良与斜视》、《小儿临床眼病》的基础上 ,吸收国内外新观点、新技术 ,总结这些年来临床经验 ,最新编著的一本系统性很强的专著。本书内容系统、简明、实用 ,包括斜视弱视的诊断、检查、治疗和手术及小儿眼科综合征和遗传疾病等。全书上卷共 16章(解剖、视觉生理、检查法、眼的屈光、斜视与弱视的诊断及治疗 ) ;下卷共 15章 (小儿眼内眼外疾病、小儿眼肿瘤、遗传病及小儿…     

《斜视弱视与小儿眼科》征订通知

由孟祥成、孟令勇主编 ,张方华主审的《斜视弱视与小儿眼科》已于 2 0 0 1年 3月由黑龙江人民出版社出版 ,现已开始征订。本书是在原版《斜视弱视学》、《儿童视力不良与斜视》、《小儿临床眼病》的基础上 ,吸收国内外新观点、新技术 ,总结这些年来临床经验 ,最新编著的一本系统性很强的专著。本书内容系统、简明、实用 ,包括斜视弱视的诊断、检查、治疗和手术及小儿眼科综合征和遗传疾病等。全书上卷共16章 (解剖、视觉生理、检查法、眼的屈光、斜视与弱视的诊断及治疗 ) ;下卷共 15章 (小儿眼内眼外疾病、小儿眼肿瘤、遗传病及小儿综合征…     

有关弱视诊断的思考--弱视定义的再商榷

我国人口众多,如果弱视患者按检出率2.8%来计算,保守估计达4千万。早期发现和早期治疗是成功治疗弱视的关键,准确掌握弱视的定义及发病机理是进行正确诊断的的基础。虽然全国斜视与小儿眼科学组,先后制定了斜视弱视的定义和分类(1985)以及弱视的防治规范(1993),与我国早期眼科学专著[1～3]中的有关论述来比,有定义更加周严,且可操作性较以往强的特点,在我国的防治弱视工作中发挥了重要的作用。但在临床工作中,也遇到一些实际问题。有些患者临床一般检查未见眼部器质性病变,矫正视力低于0.8,但经角膜接触镜矫正或经手术矫正后视力达到或超过1…     

小儿眼科与斜视学习班通知

由首都医科大学附属北京同仁医院眼科中心承办的国家级继续教育项目（编号：2010-07-02-119）——“小儿眼科与斜视学习班”将于2010年9月11-15日在北京举办。届时将邀请该领域的国内外知名专家作精彩讲演。小儿眼科与斜视学习班采用理论讲授、手术示教和专题讨论等形式进行学习交流，重点介绍小儿眼科与斜视领域规范化诊疗及新进展。内容包括：（1）儿童眼病诊疗进展（儿童眼底病、儿童眼表疾病、先天性青光眼、儿童眼整形的诊疗进展；屈光手术与儿童斜、弱视相关性的临床研究）；（2）婴幼儿视力筛查，弱视的规范化诊断和治疗；（3）斜视领域新进展（眼球运动与双眼视觉相关术语；     

儿童全麻下斜视手术疗效分析

斜视儿童在经过系统的屈光矫正,弱视治疗后,如斜视未能得到纠正,尽早为其施行手术矫正斜视,对于双眼视功能的重建和恢复有着极重要的临床意义。学龄前后的一些儿童斜视患者有时难于承受局麻下手术,这样的患者在全麻下手术是必要的。自86年以来,我院眼科为部份学龄前后的斜视儿童     

中国儿童弱视防治专家共识（2021年）

弱视是视觉发育期由于形觉剥夺和（或）双眼异常的相互作用所致,根据病因分为斜视性、屈光不正性、屈光参差性和形觉剥夺性弱视。弱视需要正确诊断、尽早干预。中华医学会眼科学分会斜视与小儿眼科学组继2011年制定弱视诊断相关共识,再次组织我国相关领域专家,以国内外循证医学研究成果为基础,汇总与弱视治疗相关的专家意见,经过充分讨论...     

早期发现和早期干预努力提高弱视的防治水平

全国斜视与小儿眼科学组 (原斜视弱视防治学组 ,以下简称学组 )成立 18年来 ,在老一辈眼科专家的带领下 ,团结全国眼科同道 ,积极开展斜视弱视专业培训 ,促进国内外学术交流 ,先后制定了斜视弱视的分类 (1985 )和弱视的防治规范 (1993)。目前 ,国内已由眼科专业技术人员和儿童保健工作者组成了约 5 0 0人的斜视弱视专业防治队伍 ,这支队伍分布广泛 ,活动积极 ,进行了大量流行病学调查和斜视弱视早期筛查工作 ,有条件的医疗机构还开展了弱视分子病理机制和电生理机制 ,以及双眼视、立体视和药物治疗等研究。近年部分单位采用瞳孔眼底照相屈光…     

当前弱视诊疗中值得关注的几个问题

弱视是儿童常见眼病,近年来弱视的诊疗水平不断提高。但是,在弱视诊疗中还存在一些值得关注的问题,应当引起重视,如弱视诊断未充分考虑年龄因素,遮盖治疗时遮盖时间、随访时间存在随意性,片面夸大弱视治疗仪的作用,对弱视的复发重视不够等。因此,本文就相关问题进行阐述,并借此与眼科同道探讨。     

弱视治愈行斜视矫正术后视力追踪观察

目的了解斜视性弱视及斜视性屈光参差性弱视患者在弱视治愈,行斜视矫正术后,弱视眼视力的变化.方法对1992～1997年在我院弱视治愈后行斜视手术矫正患者103例进行视力追踪观察.结果弱视治愈后行斜视手术后原弱视眼有50.49%存在不同程度视力减退,并且与开始治疗时弱视程度有关,即弱视开始治疗时的视力越低越易出现视力减退.结论弱视治愈行斜视术后的弱视眼,应密切监护,直到视力、眼位均巩固在正常范围为止.     

皮质类固醇治疗婴幼儿眼睑血管瘤

皮质类固醇治疗婴幼儿眼睑血管瘤广州市第二人民医院眼科李东豪中山医科大学眼科医院庞友鉴婴幼儿眼睑血管瘤常常引起屈光不正，弱视、斜视及上脸下垂等多种并发症，应当积极治疗［１－３］。过去曾用冷冻、放射、手术、注射硬化剂治疗眼睑血管瘤，但都存在一些缺点，有的...     

Perspective on strabismus, 2006

During the last half of the 20th century, the field of strabismus did not undergo as many major advances as other areas of ophthalmology. In recent years, an increase in basic science research has fostered important advances in our understanding and treatment of disorders of binocular vision. This article identifies 4 important questions that need to be addressed by the pediatric ophthalmology and adult strabismus community: (1) What terms should be used to describe muscle dysfunction? (2) By what mechanism does strabismus surgery work? (3) What is the role of orbital imaging in the management of strabismus? (4) What is the role of refractive surgery in the treatment of patients with amblyopia and strabismus?     

Rapid, high-accuracy detection of strabismus and amblyopia using the pediatric vision scanner

Purpose. The Pediatric Vision Scanner (PVS) detects strabismus by identifying ocular fixation in both eyes simultaneously. This study was undertaken to assess the ability of the PVS to identify patients with amblyopia or strabismus, particularly anisometropic amblyopia with no measurable strabismus. Methods. The PVS test, administered from 40 cm and requiring 2.5 seconds of attention, generated a binocularity score (BIN, 0%-100%). We tested 154 patients and 48 controls between the ages of 2 and 18 years. BIN scores of amblyopic children and controls were measured, and 21 children received sequential PVS measurements to detect any changes in BIN resulting from amblyopia treatment. Results. With the pass/refer threshold set at BIN 60%, sensitivity and specificity were 96% for the detection of amblyopia or strabismus. Assuming a 5% prevalence of amblyopia or strabismus, the inferred positive and negative predictive values of the PVS were 56% and 100%, respectively. Fixation accuracy was significantly reduced in amblyopic eyes. In anisometropic amblyopia patients treated successfully, the BIN improved to 100%. Conclusions. The PVS identified children with amblyopia or strabismus with high sensitivity and specificity, while successful treatment restored normal BIN scores in amblyopic patients without strabismus. The results support the hypothesis that the PVS detects strabismus and amblyopia directly. Future strategies for screening by nonspecialists may thus be based on diagnostic detection of amblyopia and strabismus rather than the estimation of risk factors, allowing for rapid, accurate identification of children with amblyopia early in life when it is most amenable to treatment.     

Strabismus management

In this article, three topics of current interest in strabismus are covered. These include strabismus after glaucoma implant surgery, management of accommodative esotropia, and the timing of treatment for strabismic amblyopia. Glaucoma implants have improved our results with difficult glaucoma syndromes, however, a high incidence of postoperative strabismus has been associated with this procedure. The mechanism of the strabismus has not been clearly defined in previous literature, but in this article we describe three mechanisms that cause strabismus after glaucoma implant surgery and describe methods for managing this problem. The standard management of accommodative esotropia has historically resulted in a large number of undercorrections. Patients with accommodative esotropia have good fusion potential as the strabismus is acquired and binocular visual development occurred during the critical period. Recent studies indicate that we should increase our surgical numbers when managing patients with accommodative esotropia. Various treatment strategies are covered in the section on accommodative esotropia. Finally, a discussion on the management of strabismic amblyopia is presented. The importance of treating amblyopia first, then secondarily correcting the strabismus is emphasized.     

Value of orthoptics in pre-and post-surgical management of strabismus

Orthoptics as an aid to the diagnosis and assessment of a case of strabismus is of great value, and so it is in the evaluation of the result of treatment. But orthoptic treatment in the form of exercises, although important in certain cases, has its limitations, for instance it is useless unless the patient is old enough to be fully co-operative. Indeed if a child suffers from a non-paralytic convergent strabismus which started in earliest infancy and if the correct treatment is given at an early stage it will be too soon for any form of orthoptic exercise. In such circumstances the prevention and correction of amblyopia by means of occlusion and the full correction of refractive errors are the most important initially, to be followed by surgical treatment if indicated.The necessity for keeping a patient under observation for many years after treatment appears to be completed is emphasized, especially when amblyopia had to be overcome initially or when the function of binocular vision has been unstable. Examples of typical cases are shown.     

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...     

儿童弱视愈后防治的对策

儿童弱视愈后转归,不只是弱视复发,还会发生调节性近视和形成真性近视,应引起小儿眼科界的注意.儿童弱视愈后复发应区分为:基本治愈后弱视复发、痊愈后弱视复发、脱镜后弱视复发."愈前反弹"不属于弱视复发,这样的分类法对儿童弱视的防治是有其实用价值的.在对儿童弱视的治疗和追踪观察中,结合儿童视力、屈光和眼轴发育的特点,提出了儿童弱视愈后脱镜指标为:(1)双眼裸眼远近视力≥1.0,6mo以上者;(2)眼位正常或斜视性弱视治愈后残余斜视度﹤5°者;(3)远视屈光度≤+1.00DS;(4)远视散光度≤+0.50DC.治愈后的弱视儿童必须达到上述4项指标方可摘掉眼镜.我们对儿童弱视的研究进展进行综述,并提出了防治的对策.     

The psychosocial effects of amblyopia study.

PURPOSE: The purpose of this study was to assess the psychosocial effects of growing up with and living with amblyopia and to determine whether patients with amblyopia but without strabismus encounter psychosocial problems similar to those encountered by individuals with strabismus. METHODS: A 20-question survey focusing on medical background, education, self-image, history of amblyopia, treatment of amblyopia, and effects of amblyopia on work, school, friendships, and self-esteem was provided to patients with amblyopia but not strabismus at Saint Louis University Eye Institute and at the University of Iowa Department of Ophthalmology. In addition, patients were evaluated in terms of somatization, obsession-compulsion, interpersonal sensitivity, depression, and anxiety. Results for patients with amblyopia were compared with those of strabismic, normative, and psychopathologic groups using the Hopkins Symptom Checklist (HSC). RESULTS: Twenty-five patients with amblyopia but without strabismus or previous surgery responded. A significant number of patients felt that amblyopia interfered with school (52%) and work (48%) to some degree and were generally affected in their lifestyle (50%). Fewer were affected in their play of sports (40%) or were influenced as to their job choice (36%). Patients with amblyopia as a whole had a greater degree of somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, and anxiety than patients with strabismus and HSC control subjects. Differences between patients with amblyopia and those with strabismus were not statistically significant (P > .05), but differences between patients with amblyopia and HSC control subjects were significant (P < .05) in each category. Patients with amblyopia, however, were less symptomatic in these areas than HSC Anxious and HSC Depressed groups. CONCLUSION: Psychosocial difficulties related to amblyopia affect individuals' self-image, work, school, and friendships. Amblyopia has a significant effect on psychosocial functioning and warrants aggressive screening, prevention and treatment during the amblyogenic years.     

斜弱视及其治疗与儿童心理健康关系的研究进展

斜弱视是儿童期常见的视觉发育相关性眼病,斜弱视及其治疗与患儿的社会心理健康密切相关。目前研究发现,斜视患儿容易受到疏远和歧视,社会心理问题发生率较正常儿童高,严重者可出现精神障碍,及时的斜视治疗能给患儿带来积极的社会心理影响。弱视对儿童心理影响的已有研究结论尚不一致,但是大多数研究表明弱视治疗可能给患儿社会心理健康带来负面影响,有效的心理干预措施可以提高弱视治疗的依从性,使治疗过程对心理健康的影响最小化。随着研究的深入,斜弱视患儿在社会生活、学习及治疗中面临的社会心理健康问题将逐步得以阐明,可为心理干预治疗提供更多理论依据。     

共同性斜视矫正术后双眼总和图形视觉诱发电位的对比分析

目的：通过分析共同性斜视矫正手术前后双眼总和图形视觉诱发电位的变化,探讨共同性斜视手术时机及其在斜视性弱视治疗中的作用。 方法：回顾性分析18岁以内在院接受共同性斜视矫正术治疗,且术后斜视矫正正位（斜视度≤±10△）的病历资料67例。按手术前斜视类型、接受手术时年龄、弱视程度分组,对各组术前、术后1,3 mo分别进行双眼总和P-VEP检测。结果以双眼反应/单眼反应（ B/M）比值作为评价指标。 结果：所有病例术后1 mo B/M值均升高,差异有显著统计学意义（P〈0.01）。其中（1）内斜视组术后3mo的B/M值升高较外斜视组明显（P〈0.05）;（2）≤6岁组,术后3mo B/M值升高较〉12岁组明显（P〈0.05）。（3）重度弱视组术后1mo的B/M值升高较轻度弱视组明显（P〈0.05）;术后3mo,重度弱视组B/M值升高较轻度、中度弱视组明显（P〈0.01）。 结论：经过弱视治疗后视力仍难以提高的共同性斜视患者建议6岁前行斜视矫正手术,特别是重度弱视及内斜视患儿（调节性内斜视除外）。早期手术有利于弱视的进一步治疗及双眼视功能的恢复。     

The Effect of Amblyopia Therapy on Ocular Alignment

PURPOSE: We sought to describe the change in ocular alignment at 2 years after treatment of amblyopia in children younger than 7 years of age at enrollment. METHODS: A randomized clinical trial of patching versus atropine for 6 months followed by standard clinical care for 18 months was conducted in 357 children with anisometropic, strabismic, or combined amblyopia (20/40-20/100) whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment was evaluated at enrollment and after 2 years of follow-up. RESULTS: At enrollment when tested at distance fixation, 161 (45%) children were orthotropic, 91 (25%) had a microtropia (1-8 Delta), and 105 (29%) had a heterotropia >8 Delta. Of the 161 patients with no strabismus, similar proportions of patients initially assigned to the patching and atropine groups developed new strabismus by 2 years (18% vs. 16%, P = 0.84). Of these cases of new strabismus, only 2 patients in the patching group and 3 patients in the atropine group developed a deviation that was greater than 8 Delta. Microtropia at enrollment progressed to a deviation greater than 8 Delta with similar frequency in both treatment groups (13% vs. 15%, P = 1.00). Of the 105 patients with strabismus greater than 8 Delta at enrollment, 13% of those in the patching group and 16% of those in the atropine group improved to orthotropia without strabismus surgery. Strabismus surgery was performed in 32 patients during the 2-year study period. CONCLUSIONS: Patients who had amblyopia treatment with patching or atropine for 6 months followed by standard clinical care were found to have similar rates of deterioration and improvement of ocular alignment. When parents begin amblyopia treatment for children without strabismus, they should be warned of the possibility of development of strabismus, although it is most often a small angle deviation. Strabismus resolved after amblyopia therapy in some cases.