准分子激光原位角膜磨镶术治疗儿童高度远视屈光参差性弱视的效果

目的评价准分子激光原位角膜磨镶术（LASIK）矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性,并探讨其对术后弱视治疗效果的影响。方法采用前瞻性自身对照法观察42例高度远视屈光参差性弱视儿童病例,年龄范围6～14岁。使用SVS Apex plus准分子激光系统（其中联合L型mask盘矫正单纯远视9例,联合P型mask盘矫正远视合并散光12例）及鹰视世纪波准分子激光系统（21例）,在局部麻醉或全身麻醉下对患儿高度远视眼行LASIK,术后进行弱视治疗。术后对视力、屈光度和双眼视功能进行分析。随访时间6～24个月。结果矫治屈光度数为＋3．00-＋7．50D,术后2年66．6％术眼残余屈光度数在预计矫正屈光度数±1．00D的范围内。术后随访发现睫状肌麻痹下等值球镜屈光度数波动范围为＋0．99～＋0．67D。最佳戴镜矫正远、近视力均不丢失。术后2年平均最佳戴镜矫正远视力为0．40±0．28,平均最佳戴镜矫正近视力为0．78±0．39。经规范弱视治疗,双眼不等像、同时视、融合、立体视及隐斜均得以改善。结论对患有高度远视性屈光参差且不能耐受戴镜矫治的儿童,采用LASIK矫治屈光参差是安全、有效的,具有良好的可预测性和稳定性,且这一手术有助于提高高度远视屈光参差性弱视的治愈率。     

Correctable and non-correctable visual impairment in a population-based sample of 12-year-old Australian children

PURPOSE: To document the prevalence of correctable and non-correctable visual impairment in a representative sample of Australian children, predominantly age 12 years. DESIGN: Population-based cross-sectional study. METHODS: Logarithm of the minimum angle of resolution (logMAR) visual acuity was measured in both eyes unaided, with spectacles if worn, and after subjective refraction if required, in 2353 children, examined during 2004 to 2005. Cycloplegic autorefraction (using cyclopentolate) and dilated fundus examination were performed. Using a cut-off of 0.3 logMAR units (<20/40), presenting visual impairment was defined using unaided visual acuity if spectacles were not worn or with usual correction if spectacles were worn. Impairment not eliminated by refraction was considered non-correctable; any difference between this and presenting impairment was defined as correctable impairment. Myopia was defined as spherical equivalent refraction (SER) < or =-0.50 diopters (D), hyperopia as SER > or =+2.0 diopters, anisometropia as SER difference > or =1.00 diopters, and astigmatism as cylinder > or =1.0 diopters. Amblyopia was defined as corrected visual acuity <0.3 logMAR not attributable to an underlying structural eye or visual pathway abnormality. RESULTS: Visual impairment was found in the worse eye of 117 children (5.0%) and comprised correctable (82%) and non-correctable impairment (18%). Correctable impairment was due to myopia in 67 (69.8%), hyperopia in 11 (11.5%) and astigmatism in 32 subjects (33.3%). Causes of non-correctable impairment were: amblyopia 66.7%, congenital glaucoma 9.5%, optic nerve hypoplasia 9.5%, congenital nystagmus 4.8%, and cortical blindness 4.8%. CONCLUSIONS: Visual impairment had a relatively low prevalence in this older childhood population, a large proportion of which was correctable by refraction alone.     

674例3~6岁视力低常儿童屈光状态分析

目的分析3~6岁视力低常儿童的屈光状态分布并探讨不同屈光类型与弱视发生的关系。方法描述性研究。对674例（1 348眼）3~6岁裸眼视力低于正常（3岁≤20/40,4岁≤20/32,5岁及以上≤20/25）儿童进行阿托品散瞳后验光检查屈光状态及矫正视力。分析不同年龄段、弱视眼和非弱视眼的屈光状态分布,不同年龄段屈光参差分布以及屈光参差与弱视发生的关系。不同年龄段屈光分布的构成比及弱视发生率比较采用卡方检验。结果视力低常儿童中屈光分布以远视为主,近视发生率较低;随着年龄增加,远视所占比例逐渐降低,近视所占比例逐渐增加,差异有统计学意义（χ²=99.7,P＜0.001）。弱视眼和非弱视眼屈光分布差异有统计学意义（χ²=20.1,P=0.01）;弱视眼中前3位屈光类型分别为复性远视散光（59.4%）、单纯远视散光（17.8%）和混合性散光（15.8%）,而单纯近视眼中无弱视发生。双眼等效球镜度差值≥1 D时容易引起屈光参差性弱视,并且弱视发生率随屈光参差程度增大而升高（χ²=62.9,P＜0.001）。结论学龄前视力低常儿童的屈光状态分布以远视为主,远视性屈光不正、散光、屈光参差等屈光异常更容易引起弱视的发生。     

LASIK in children with hyperopic anisometropic amblyopia

PURPOSE: To evaluate the results of LASIK for hyperopia in pediatric eyes with amblyopia resulting from anisometropia. METHODS: Thirty-two children with anisometropic amblyopia in whom conventional therapy was unsuccessful underwent unilateral LASIK between 1999 and 2005. Mean patient age was 10.3 +/- 3.1 years (range: 4 to 15 years), and mean follow-up was 20.1 +/- 15.1 months (range: 12 to 60 months). At the last follow-up examination, spherical equivalent refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications were recorded. RESULTS: Mean preoperative and postoperative manifest spherical equivalent refraction of the treated eyes was 5.17 +/- 1.65 and 1.39 +/- 1.21 diopters (D), respectively (P < .01). Mean UCVA was 0.06 +/- 0.09 (range: 0.01 to 0.5) preoperatively and 0.27 +/- 0.23 (range: 0.05 to 0.8) postoperatively (P < .01). Mean BSCVA was 0.20 +/- 0.17 (range: 0.01 to 0.8) preoperatively and 0.35 +/- 0.25 (range: 0.1 to 1.0) postoperatively (P < .01). Six eyes gained > or = 4 lines of BSCVA, 4 eyes gained 2 to 3 lines, 12 eyes gained 1 line, and 9 eyes were unchanged; only 1 eye lost 1 line of BSCVA due to haze in the flap-stroma interface. None of the patients reported halos or glare. There were no intraoperative or postoperative flap complications. CONCLUSIONS: LASIK seems to be an effective and safe procedure for the management of hyperopic anisometropic amblyopia in select cases. Visual acuity improved in the amblyopic eyes and was associated with decreased anisometropia. The refractive response to hyperopic LASIK in children appears to be similar to that of adults with comparable refractive errors.     

Correction of high astigmatism and astigmatic anisometropia by intrastromal photokerato-ablation in children and adolescents

A total of 151 photorefraction operations for correction of medium and high astigmatism in 38 children (9-15 years) and 47 adolescents (16-17 years) carried out by LASIK method are analyzed. The operations were performed under local anesthesia with EC-5000 eximer laser (Nidek) and Hansatome microkeratome (B & L). Complicated and common myopic astigmatism (2.07 +/- 0.89 to 2.91 +/- 0.63 diopters) was decreased by 61.2% in children and by 62.2% in adolescents. Visual acuity without correction increased by 0.58 +/- 01.2. Correction of astigmatic anisometropia resulted in its decrease to 0.75-1.5 diopters in 77.9% children and 62.8% adolescents. Hypermetropic astigmatism decreased by 64.9% of its initial value in children and by 56.9% in adolescents. Mixed astigmatism decreased by 62.7% of its initial value. The resultant visual acuity without correction was 0.39 +/- 0.13 in children and 0.47 +/- 0.17 in adolescents. According to questionnaires distributed among parents, 13.5% patients studied better at school after the operation and 19.2% went in for sports in athletic sections. The main causes for the intervention were limitations in choice of profession (for 49.6%) and desire to practice modern athletics (in 13.8%). Photorefraction correction of astigmatism in children and adolescents brings about an effective stable result decreasing refraction amblyopia and improving the quality of life.     

Facilitation of amblyopia management by laser in situ keratomileusis in high anisometropic hyperopic and myopic children

PURPOSE: To assess the efficacy of laser in situ keratomileusis (LASIK) in facilitating amblyopia management of children from 6 to 14 years old, with high hyperopic and myopic anisometropia. PATIENTS AND METHODS: Between 2000 and 2005, 42 children with high hyperopic anisometropic amblyopia and 32 children with high myopic anisometropic amblyopia underwent LASIK to reduce their anisometropia. LASIK was performed under topical or general anesthesia. Pre- and postoperative best-corrected visual acuity, cycloplegic refraction, and binocular vision were recorded. Follow-up ranged from 6 months to 3 years, the averages of which were 17.45 months in the hyperopic group and 18.31 months in myopic group. RESULTS: Hyperopic anisometropia correction ranged from +3.50 D to +7.75 D, and the mean postoperative anisometropia was +0.56 +/- 0.75 D at 3 years. Myopic anisometropia correction ranged from -15.75 to -5.00 D and the mean postoperative anisometropia at 3 years was -2.20 +/- 1.05 D. The best-corrected visual acuity for distance and reading in the myopic group improved from 0.4 +/- 0.25 and 0.58 +/- 0.27, respectively, before surgery to 0.59 +/- 0.28 and 0.96 +/- 0.35, respectively, 3 years after surgery. In the hyperopic group, best-corrected visual acuity for distance and reading improved from 0.23 +/- 0.21 and 0.34 +/- 0.32, respectively, before surgery to 0.53 +/- 0.31 and 0.80 +/- 0.33, respectively, 3 years after surgery. The proportion of patients who had stereopsis increased from 19.1% preoperatively to 46.7% postoperatively in the hyperopic group and from 19% to 89% in the myopic group. CONCLUSIONS: LASIK reduced high hyperopic and myopic anisometropia in children, thus facilitating amblyopia management and improving their visual acuity and stereopsis.     

Photorefractive keratectomy for pediatric anisometropia: safety and impact on refractive error, visual acuity, and stereopsis

PURPOSE: To establish the safety and possible efficacy of excimer laser photorefractive keratectomy (PRK) for treatment of pediatric anisometropia. DESIGN: Interventional case series METHODS: This is a prospective, noncomparative interventional case series at an individual university practice of photorefractive keratectomy in 11 children aged 2 and 11 years with anisometropic amblyopia who were unable or unwilling to use contact lens, glasses, and occlusion therapy to treat the amblyopia. The eye with the higher refractive error was treated with PRK using a standard adult nomogram. The refractive treatment goal was to decrease the anisometropia to 3 diopters or less. Main outcome measures were cycloplegic refraction, refractive correction, degree of corneal haze, uncorrected and best spectacle-corrected visual acuity, and stereopsis over 12 months. RESULTS: All patients tolerated the procedure well. The mean refractive target reduction was -10.10 +/- 1.39 diopters for myopia and +4.75 +/- 0.50 diopters for hyperopia. The mean achieved refractive error reduction at 12 months for myopia was -10.56 +/- 3.00 diopters and for hyperopia was +4.08 +/- 0.8 diopters. Corneal haze at 12 months was minimal. Uncorrected visual acuity improved by 2 or more lines in 6 (75%) of the eight children able to perform psychophysical acuity tests. Best spectacle-corrected visual acuity improved by 2 lines in 3 (38%) of patients. Stereopsis improved in 3 (33%) of nine patients. CONCLUSIONS: Pediatric PRK can be safely performed for anisometropia. The refractive error response in children appears to be similar to that of adults with comparable refractive errors. Visual acuity and stereopsis improved despite several children being outside the standard age of visual plasticity. Photorefractive keratectomy may play a role in the management of anisometropia in selected pediatric patients.     

Laser in situ keratomileusis for spherical hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser

PURPOSE: To assess the efficacy, predictability, and safety of LASIK for the surgical correction of low to moderate hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser. METHODS: In a multicenter United States Food and Drug Administration (FDA) regulated study of LASIK, 7 centers enrolled 293 eyes with manifest refraction sphere that ranged from +0.50 to +6.00 diopters (D) with or without astigmatism up to 3.00 D. The intended outcome was plano in all eyes. Patients were treated bilaterally. One year postoperative outcomes are reported. RESULTS: The mean spherical equivalent refraction (MRSE) for all eyes changed from +2.61 +/- 1.19 D (range: +0.50 to +6.63 D) preoperatively to +0.35 +/- 0.54 D (range: -1.63 to +2.00 D) 1 year postoperatively. Overall, 61% (170/279) of eyes achieved distance uncorrected visual acuity (UCVA) of 20/20 or better, 82% (228/279) of eyes saw 20/25 or better, and 99% (277/279) of eyes saw 20/40 or better. Refractive accuracy was demonstrated as 63.1% (176/279) of eyes achieved a MRSE within +/- 0.50 D and 90.3% (252/279) of eyes within +/- 1.00 D. Less than 2% (4/279) of eyes lost 2 lines of distance best spectacle-corrected visual acuity. Stability of refraction was demonstrated by 6 months, with a mean hyperopic shift of < 0.03 D from 3 to 6 months. CONCLUSIONS: The NIDEK EC-5000 corrected hyperopia and hyperopic astigmatism with UCVA, refractive accuracy, 1-year stability, and safety that surpassed all FDA criteria.     

Laser in situ keratomileusis for hyeropia and hyperopic astigmatism.

PURPOSE: To evaluate the efficacy, stability, and safety of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism using a prospective clinical trial. METHODS: LASIK was performed using the Automatic Corneal Shaper and the Keracor 117C excimer laser on 192 hyperopic eyes with astigmatism of less than 1.00 D (spherical group) and 164 hyperopic eyes with corneal astigmatism of 1.00 to 7.50 D (toric group). RESULTS: At 12 months after LASIK, 110 eyes were available for follow-up examination. In low spherical hyperopia (+1.00 to +3.00 D), 13 eyes (55%) were within +/-0.50 D of emmetropia and none lost 2 or more lines of spectacle-corrected visual acuity. In low toric hyperopia (+1.00 to +3.00 D), 14 eyes (61%) were within +/-0.50 D and none lost 2 or more lines of spectacle-corrected visual acuity. In moderate spherical hyperopia (+3.10 to +5.00 D) 9 eyes (44%) were within +/-0.50 D and none lost 2 or more lines of spectacle-corrected visual acuity and in moderate toric hyperopia (+3.10 to +5.00 D) 5 eyes (36%) were within +/-0.50 D and 2 eyes (14%) lost 2 or more lines of spectacle-corrected visual acuity. In high spherical hyperopia (+5.10 to +9.00 D), 6 eyes (38%) were within +/-0.50 D and 2 eyes (13%) lost 2 or more lines of spectacle-corrected visual acuity, and in high toric hyperopia (+5.10 to +9.50 D) 4 eyes (31%) were within +/-0.50 D and 2 eyes (15%) lost 2 or more lines of spectacle-corrected visual acuity. CONCLUSIONS: LASIK seems to be reasonably effective and safe in spherical hyperopia of +1.00 to +5.00 D but less effective for hyperopic astigmatism. For hyperopia greater than +5.00 D, loss of spectacle-corrected visual acuity occurred in a significant number of eyes and accuracy was sufficiently poor to advise against LASIK in these eyes.     

学龄前儿童弱视的屈光不正临界值的研究

目的:测定我国学龄前儿童中引起屈光不正性弱视的临界值。方法:诊断性试验,符合纳入标准的5～7岁单纯散光147例294眼(附带球镜<1.00DS),单纯远视633眼(附带散光<0.50DC),远视伴轻度散光(0.50DC≤散光值<1.00DC)312眼,用受试者工作特征(receiver operating characteristic,ROC)曲线找出临界值。结果:通过诊断效能和ROC曲线观察,5～7岁儿童单纯散光≥1.00DC诊断弱视的敏感度和特异度分别是89.7%和88.7%,≥1.50DC诊断弱视的敏感度和特异度分别是83.3%和95.2%;单纯远视≥2.25DS诊断弱视的敏感度和特异度分别是63.0%和82.0%,单纯远视≥2.75DS诊断弱视的敏感度和特异度分别是45.2%和91.3%;远视伴轻度散光≥2.25DS诊断弱视的敏感度和特异度分别是60.0%和54.3%,远视伴轻度散光≥2.75DS诊断弱视的敏感度和特异度分别是24.9%和88.2%。结论:临界值提供小儿眼科医师诊断学龄前儿童屈光不正性弱视病因证据;提供了学龄前儿童屈光不正验光配镜的起点依据。适合5～7岁儿童普查筛选要求是散光≥1.00DC;适合诊断危险值的是散光≥1.50DC,单纯远视引起弱视的筛查临界值是≥2.25DS,适合诊断危险值的是≥2.75DS,远视伴轻度散光的临界值同单纯远视。     

屈光参差性弱视儿童双眼视觉状态

目的：分析屈光参差性弱视儿童的屈光状态、矫正视力情况及其与双眼视觉功能的关系。方法：横断面研究。收集2015年11月至2016年9月就诊于北京9家医院（分布于8个区县）的屈光参差性弱视儿童患者106例（106眼），年龄（6.2±5.4）岁。根据屈光参差危险因素将所有患者分为远视性屈光参差组（67例）、近视性屈光参差组（5例）、散光性屈光参差组（12例）、远视合并散光性屈光参差组（20例）及近视合并散光性屈光参差组（2例）。对所有患者行裸眼视力（UCVA）、矫正视力（BCVA）、屈光状态、远近立体视等检查。采用Pearson相关性分析双眼屈光参差的差值程度与高度屈光不正眼UCVA、BCVA及双眼视觉间的相关性，并分析双眼矫正视力差值程度与双眼视觉的相关性。采用单因素方差分析比较5组高度屈光不正眼BCVA及远近立体视情况。结果：屈光参差的差值程度与高度屈光不正眼UCVA和BCVA、远立体视、近立体视（即随机点立体视，包括立体视锐度、交叉立体视、非交叉立体视）均呈负相关（均P<0.05）；双眼矫正视力差值与远立体视、近立体视均呈负相关（均P<0.05）。5组间在高度屈光不正眼BCVA、远立体视、近立体视方面总体差异均有统计学意义（F=6.221、5.271、3.622、3.647、3.464，P<0.05），进一步两两比较显示高度屈光不正眼BCVA在近视性屈光参差组最好，然后依次为远视性屈光参差组、散光性屈光参差组、近视合并散光性屈光参差组以及远视合并散光性屈光参差组，组间差异均有统计学意义（均P<0.05）；远立体视在远视性屈光参差组最好，然后依次为近视性屈光参差组、散光性屈光参差组，组间差异均有统计学意义（均P<0.05），但远视合并散光性屈光参差组与近视合并散光性屈光参差组的远立体视差异无统计学意义；近立体视在近视性屈光参差组最好，然后依次为远视性屈光参差组、散光性屈光参差组、远视合并散光性屈光参差组以及近视合并散光性屈光参差组，组间差异均有统计学意义（均P<0.05）。结论：屈光参差性弱视儿童的屈光参差程度与视力、立体视功能相关，且立体视功能和双眼矫正视力差值也有相关性。不同类型屈光参差儿童立体视损害有所差异。     

Laser in situ keratomileusis for correction of hyperopia and hyperopic astigmatism with the Technolas 117C

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correction of hyperopia and hyperopic astigmatism. METHODS: Fifty-four hyperopic eyes of 35 patients with a spherical equivalent refraction between +1.00 and +6.00 D were followed for at least 12 months following LASIK. All surgery was performed with the scanning Chiron Technolas Keracor 117C excimer laser. Data on uncorrected and spectacle-corrected visual acuity, predictability, stability of refraction, and complications were analyzed. RESULTS: At 12 months, the average residual refraction was +0.29 +/- 0.78 D; 83.3% of eyes (45 eyes) were in the range of +/- 1.00 D and 61.1% of eyes (33 eyes) were within +/- 0.50 D of emmetropia. Fifty eyes (92.6%) had uncorrected visual acuity of 20/40 or better and 34 (63.0%) eyes had 20/20 or better. One eye (1.9%) lost two lines of best spectacle-corrected visual acuity and two eyes (3.7%) gained two or more lines. Two patients (two eyes, 3.7%) had complaints of halos and one patient (one eye, 1.9%) had glare at 12 months after LASIK for hyperopia. CONCLUSIONS: LASIK was used to treat hyperopia from +1.00 to +6.00 D with good predictability and safety. Primary and second hyperopia require different nomograms, according to our experience.     

视网膜神经纤维层厚度及黄斑中心凹在儿童远视屈光参差性弱视中的临床意义

目的:分析眼轴长度与屈光度数及视网膜神经纤维层厚度在儿童远视屈光参差弱视患儿中的临床意义.方法:选取2015-01/2017-01在本院接受治疗被诊断为远视性屈光参差性弱视患儿103例,均为单眼发病,发病眼设为试验组(103眼),另一正常眼为对照组(103眼);检测患儿眼轴长度、屈光度数、黄斑中心凹厚度、矫正视力、屈光度和视盘周围神经纤维层的平均厚度.结果:两组对象在眼轴、屈光度和矫正视力方面的差异均有统计学意义(P<0.05);两组对象在视盘周围神经纤维层厚度对比差异无统计学意义(P>0.05),黄斑中心凹厚度对比差异有统计学意义(P<0.05);患儿矫正视力、眼轴与黄斑中心凹、视盘周围神经纤维层厚度无明显相关性(P>0.05),屈光度与黄斑中心凹、视盘周围的神经纤维层的厚度无明显相关性(P>0.05).结论:远视屈光参差弱视患儿的视网膜黄斑中心凹的厚度比正常眼要厚,弱视眼视盘周围的神经纤维层厚度和对侧眼无显著差异,屈光度和眼轴与视盘的周围神经纤维层和黄斑的中心凹厚度没有显著的关联.     

Laser in situ keratomileusis for hyperopia and hyperopic astigmatism with the Nidek EC-5000 Excimer laser.

PURPOSE: We evaluated the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism. METHODS: A retrospective study was performed for 92 eyes of 62 consecutive patients to evaluate uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA) and manifest refraction before and 3 and 6 months after LASIK (Moria LSK-ONE microkeratome, Nidek EC-5000 excimer laser). Eyes were divided into groups: Group 1 (low hyperopia) for spherical correction of +1.00 to +3.00 D (22 eyes), Group 2 (low hyperopic astigmatism) for toric correction with spherical equivalent refraction of +1.00 to +3.00 D (18 eyes), Group 3 (moderate hyperopia) for spherical correction of +3.25 to +6.00 D (10 eyes), and Group 4 (moderate hyperopic astigmatism) for toric correction with spherical equivalent refraction between +3.25 and +6.00 D (18 eyes). RESULTS: At 3 and 6 months after LASIK, 68 eyes (73.9%) were available for follow-up examination. Percentage of eyes with a spherical equivalent refraction within +/-0.50 D of emmetropia for Group 1 was 54.5% (12 eyes); Group 2, 50% (9 eyes); Group 3, 40% (4 eyes), and Group 4, 38.8% (7 eyes). UCVA > or =20/20 in Group 1 was 14% and in Groups 2, 3, and 4, 0%. One eye (5.5%) lost two lines of BSCVA. CONCLUSION: LASIK with the Moria LSK-ONE microkeratome and the Nidek EC-5000 excimer laser reduced low and moderate hyperopia and was within +/-0.50 D of target outcome in approximately 50% of eyes. Undercorrection was evident in all groups. The procedure was safe.     

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。     

Association between Ocular Dominance and Spherical/Astigmatic Anisometropia, Age, and Sex: Analysis of 1274 Hyperopic Individuals

Purpose. To determine the association between ocular dominance and spherical/astigmatic anisometropia, age, and sex in hyperopic subjects. Methods. The medical records of 1274 hyperopic refractive surgery candidates were filtered. Ocular dominance was assessed with the hole-in-the-card test. Refractive error (manifest and cycloplegic) was measured in each subject and correlated to ocular dominance. Only subjects with corrected distance visual acuity of >20/22 in each eye were enrolled, to exclude amblyopia. Associations between ocular dominance and refractive state were analyzed by means of t-test, χ(2) test, Spearman correlation, and multivariate logistic regression analysis. Results. Right and left eye ocular dominance was noted in 57.4 and 40.5% of the individuals. Nondominant eyes were more hyperopic (2.6 ± 1.27 diopters [D] vs. 2.35 ± 1.16 D; P < 0.001) and more astigmatic (-1.3 ± 1.3 D vs. -1.2 ± 1.2 D; P = 0.003) compared to dominant eyes. For spherical equivalent (SE) anisometropia of >2.5 D (n = 21), the nondominant eye was more hyperopic in 95.2% (SE 4.7 ± 1.4 D) compared to 4.8% (1.8 ± 0.94 D; P < 0.001) for the dominant eye being more hyperopic. For astigmatic anisometropia of >2.5 D (n = 27), the nondominant eye was more astigmatic in 89% (mean astigmatism -3.8 ± 1.1 D) compared to 11.1% (-1.4 ± 1.4 D; P < 0.001) for the dominant eye being more astigmatic. Conclusions. The present study is the first to show that the nondominant eye has a greater degree of hyperopia and astigmatism than the dominant eye in hyperopic subjects. The prevalence of the nondominant eye being more hyperopic and more astigmatic increases with increasing anisometropia.     

学龄前儿童视力低常眼的静态屈光分析

目的了解学龄前儿童视力低常眼的静态屈光,分析视力与屈光关系。方法对象为幼儿园普查及视光门诊就诊视力低常的〉3~6岁学龄前儿童1000名（1934只眼）,进行眼科常规检查,重点包括远近视力,并进行1%阿托品眼膏散瞳验光。结果学龄前儿童视力低常眼的静态屈光中屈光不正类型以复性远视散光为主,程度以轻度多见;在屈光不正性弱视中,远视性弱视占主要部分。结论学龄前儿童视力低常眼的静态屈光主要为远视类屈光不正,确定学龄前儿童的视力低常是生理性还是病理性不能仅据视力。静态屈光测定是定性视力、确定屈光是否异常的必不可少的选择。     

Wavefront-guided laser in situ keratomileusis retreatment for consecutive hyperopia and compound hyperopic astigmatism

PURPOSE: To evaluate the efficacy, predictability, and safety of wavefront-guided laser in situ keratomileusis (LASIK) using the Visx CustomVue excimer laser (Advanced Medical Optics) in eyes with consecutive hyperopia and compound hyperopic astigmatism after LASIK. SETTING: Stanford University School of Medicine, Department of Ophthalmology, Stanford, California, USA. METHODS: This retrospective analysis included 19 eyes of 16 patients who had wavefront-guided LASIK for consecutive hyperopia and compound hyperopic astigmatism after initial LASIK surgery. Primary outcome variables, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), higher-order aberration (HOA) analysis, and spherical equivalence, were evaluated at 1 and 3 months. Nine eyes of 7 patients were available for all visits. RESULTS: The mean patient age was 51.7 years +/- 3.77 (SD) (range 44 to 55 years). The mean preoperative manifest refractive spherical equivalent (MRSE) was 0.99 +/- 0.32 diopters (D) (range 0.50 to 1.50 D) and the mean 3-month postoperative MRSE, -0.04 +/- 0.66 D (range -1.50 to 0.75 D). At 1 month, 57.9% of eyes had a UCVA of 20/20 or better and 78.9% of 20/25 or better; 84.2% were within +/-1.00 D of emmetropia. At 3 months, 66.7% of eyes had a UCVA of 20/20 or better and 88.9% of 20/25 or better; 88.9% were within +/-1.00 D of emmetropia. No eye lost 2 or more lines of BSCVA at 1 or 3 months. CONCLUSION: Wavefront-guided LASIK was an effective, predictable, and safe procedure for consecutive hyperopia and compound hyperopic astigmatism after LASIK.     

Corneal suture for the correction of hyperopia following radial keratotomy

PURPOSE: To report the visual and refractive changes observed after double concentric corneal suture to correct hyperopic shift after radial keratotomy (RK). METHODS: This retrospective consecutive case series comprised 17 eyes (15 patients) that underwent two concentric corneal sutures (modified Grene Lasso suture) to correct hyperopic shift after RK. All surgeries were performed by the same surgeon between 2000 and 2003. RESULTS: The mean time after RK was 11.6 +/- 3.2 years. The mean follow-up was 20.3 +/- 11.3 months. The spherical equivalent refraction was reduced from a preoperative mean of +4.38 +/- 2.87 diopters (D) to -0.54 +/- 2.59 D at last postoperative follow-up (P < .001). No statistically significant difference was observed in mean refractive astigmatism before and after the corneal suture (P = .15). Before surgery, no eye presented with best spectacle-corrected visual acuity (BSCVA) > or = 20/20. At final follow-up, 3 (17.6%) eyes attained this level. Seven (41.2%) eyes improved their BSCVA by > or = 2 Snellen lines. One (5.9%) eye lost 2 Snellen lines of BSCVA. CONCLUSIONS: Corneal suture can be used to correct RK-induced hyperopia, improving the corneal asphericity in an attempt to stabilize these corneas. It appeared to be effective even for high degrees of hyperopia and in cases with associated irregular astigmatism or open incisions.     

Laser-assisted subepithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children

PURPOSE: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK) for high myopic anisometropia with amblyopia and contact lens (CL) intolerance in children. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: This prospective comparative study comprised 27 children with high myopic anisometropia and amblyopia. The mean age of the children was 5.4 years (range 4 to 7 years). Multizonal PRK (13 eyes) or LASEK (14 eyes) was performed in the more myopic eye under general anesthesia using the Nidek EC-5000 excimer laser. After surgery, the dominant eye was patched. The postoperative visual and refractive outcomes were analyzed; all children had a 2-year follow-up. The 27 children (Group A) were compared with a control group of 30 children (mean age 5.1 years) (Group B) in whom myopic anisometropia and amblyopia were treated conventionally by CLs and patching the dominant eye. The visual acuity and binocular vision outcomes in both groups were analyzed and compared. RESULTS: In Group A, the mean spherical equivalent refraction was -8.25 diopters (D) +/- 2.37 (SD) (range -6.00 to -11.25 D) preoperatively and -1.61 +/- 0.73 D (range +0.50 to -2.25 D) postoperatively. The mean best corrected visual acuity (BCVA) was 0.23 +/- 0.21 preoperatively and 0.78 +/- 0.19 at 2 years. In Group B, the mean BCVA was 0.16 +/- 0.19 at the start of CL correction and amblyopia therapy and improved to 0.42 +/- 0.15 after 2 years. The mean BCVA at the final examination was significantly better in Group A (P<.05). Binocular vision improvement expressed by the proportion of patients who gained fusion and stereopsis was better overall in Group A (78%) than in Group B (33%) (P<.05). There were no complications postoperatively. CONCLUSIONS: Photorefractive keratectomy and LASEK were effective and safe methods for correcting high myopic anisometropia and improving amblyopia in children aged 4 to 7 years who were CL intolerant. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of anisometropia than in those who were treated conventionally by CLs.