青少年儿童近视性屈光参差双眼眼动参数的临床研究

目的：观察儿童和青少年近视性屈光参差患者双眼眼动参数,初步探讨儿童和青少年近视性屈光参差对眼动参数的影响。

方法：病例对照研究。选取2014-09/2016-05于重庆医科大学附属大学城医院就诊的7～14岁儿童及青少年82例,其中正视者(对照组)47例,近视性屈光参差者(试验组)35例,检测所有入选者的屈光度、5m和40cm隐斜、梯度性和计算性AC/A比值及调节功能〖40cm的调节反应(FCC)、正负相对调节(NRA/PRA)、调节力(AMP)和调节灵敏度(AF)〗。

结果：两组受检者5m和40cm隐斜度数、40cm FCC、PRA及AC/A比值差异均有统计学意义(P<0.05); AF、NRA、AMP与正常值最小值的差值差异均无统计学意义(P>0.05)。

结论：近视性屈光参差对儿童和青少年5m和40cm隐斜、40cm FCC、PRA及AC/A比值有显著影响。     

儿童屈光参差的临床表现

目的　观察研究儿童屈光参差的临床表现 ,探讨儿童屈光参差的发育规律及其对视功能的影响。方法　对 8所幼儿园的 2 10 0名 4～ 6岁儿童进行远视力普查筛选 ,视力低常者行眼科常规检查及阿托品散瞳验光。对屈光参差 (球镜差≥ 1.5 0 D,柱镜差≥ 1.0 0 D)儿童 ,进行同视机检查 ,按常规配镜及遮盖治疗弱视、随访。结果　屈光参差患病率 0 .86 % ,其中单纯柱镜屈光参差 10人、单纯球镜屈光参差 7人、球镜及柱镜屈光参差同时存在 1人。柱镜屈光参差双眼相差 :1.0 0 DC6只眼、1.2 5 DC2只眼、1.5 0 DC3只眼。球镜屈光参差双眼相差 :3.2 5 DS2只眼 ,1.75 DS、2 .5 0 DS、3.5 0 DS、4 .5 0 DS、4 .75 DS及 6 .2 5 DS各 1只眼。所有患儿均戴用框架眼镜完全矫正屈光参差 ,接受良好。一年的随访发现 ,基础屈光向正视方向发育 ,远视度数有所降低 ,但屈光参差度没有明显变化。屈光参差大小不影响弱视的治疗效果 ,最佳矫正视力优势眼平均从 0 .93提高到 1.0 7,劣势眼平均从 0 .5 1提高到 0 .81,全组患者均存在立体视功能 ,一年随访同视机检查结果无明显变化 (P >0 .0 5 )。结论　双眼屈光不等是普遍现象 ,绝大多数在中低度 ,发育生长时变化较小 ,大都可通过戴用框架眼镜完全矫正 ,不导致双眼融合障碍 ,不影响双眼单视     

屈光参差眼的屈光结构分析

目的 探讨屈光参差眼屈光要素的差异程度对屈光参差的形成作用.方法 收集双眼等效球镜度数差＞2.00 D的屈光参差患者91例,按屈光参差类型分为远视性屈光参差和近视性屈光参差2组.用日本Topcon KR.8800自动验光仪测量双眼屈光度数和角膜曲率（CC）.用法国Quantel 0459 A型超声生物测量仪测量双眼前房深度（ACD）、晶状体厚度（LT）、玻璃体腔长度（VCL）及眼轴长度（AL）,将患者的双眼进行自身对照观察,所测数据采用配对t检验进行统计学分析.屈光参差眼各屈光要素与年龄及分组的关系采用多元线性回归进行分析,屈光参差眼的屈光要素与眼轴的关系采用偏相关的方法进行分析.结果 屈光参差者双眼之间只有玻璃体腔长度和眼轴长度存在差异（tVCL=9.506、3.654,P均＜0.01 tAL=12.334、3.447,P均＜0.01）.多元线性回归分析发现：屈光参差者双眼的角膜曲率、前房深度都与年龄无关 近视性屈光参差眼的角膜曲率、前房深度都大于远视性屈光参差眼（tK=4.600,P＜0.01 tACD=2.894,P＜0.01）,而晶状体厚度没有差异 2组屈光参差者双眼的角膜曲率、前房深度都与眼轴长度无关,而晶状体厚度与眼轴相关（r=0.358、0.296,P＜0.01）.玻璃体腔的长度与眼屈光状态和眼轴都相关（r=0.975、0.979,P＜0.01）.结论 玻璃体腔长度的变化是屈光参差发生的内在根本原因.     

学龄前儿童屈光参差性弱视眼的屈光结构分析

对８２例学龄前儿童单纯性屈光参差性弱视眼进行了屈光结构测定和分析。结果表明，正视、近视、远视三种不同屈光状态的角膜曲率半径差异无显著性。两眼轴长度差和晶体厚度差随屈光参差程度而增大（远视：ｒ值分别为０．９３６、０．８９５。近视：ｒ值分别为０．９９３、０．８７２，Ｐ＜０．０１）。提示眼轴长度和晶体厚度共同参与了屈光参差的形成，其中眼轴长度起主导作用，晶体屈光度在匹配和协调中为重要成分。眼轴和晶体的发育不等以及比例失调是形成儿童屈光参差性弱视的解剖基础。     

屈光参差与视功能

对验光门诊５８９例屈光参差进行了统计分析，结果表明：在各种屈光参差类型中，屈光不正较高侧眼的矫正视力以近视性屈光参差最好，混合性屈光参差次之，远视性屈光参差最差，在不同程度屈光参差中，两眼屈光度相差≤３Ｄ组的矫正视力明显优于相差≥４Ｄ组的矫正视力，屈光参数有斜视组与无斜视组其矫正视力无显著差异，对屈光参差与视功能的关系进行了讨论。     

屈光参差的研究进展

屈光参差是指两眼的屈光度不同,屈光参差的发病率呈现随年龄逐渐上升的趋势。近年发现造成双眼屈光度不等的主要原因是双眼眼轴长度发育不平衡,与角膜屈光力无关;主导眼的近视程度较严重,眼轴较长;屈光参差会引起对比敏感度和视觉诱发电位以及视乳头旁视网膜神经纤维层厚度、视盘面积的改变。屈光参差的正确矫正应予重视,框架眼镜、角膜接触镜仍是屈光参差的常规矫正方法,对成人屈光参差及儿童、青少年难治性和眼镜不能耐受的屈光参差性弱视可试行准分子激光手术治疗,但儿童、青少年的手术时机和治疗程度还有待进一步探讨。     

综合治疗儿童屈光参差性弱视的临床分析

目的:评价综合治疗儿童屈光参差性弱视的临床疗效。方法:选择2005-01/2010-01确诊为屈光参差性弱视的儿童患者48例,随机分为两组,其中试验组24例,采用综合治疗的方法进行治疗,对照组24例,仅采用矫正屈光不正及传统的遮盖疗法进行治疗,观察记录并比较两组患儿的视力恢复情况、立体视觉情况等。结果:试验组疗效与对照组比较P=0.007,其差异具有统计学意义;试验组显效时间与对照组比较P=0.005,其差异具有统计学意义;试验组立体视觉恢复情况与对照组比较P=0.022,其差异具有统计学意义。结论:综合治疗儿童屈光参差性弱视疗效肯定、显效时间短且对立体视觉的恢复具有积极的意义。     

屈光参差的研究现状

两眼的屈光不等称为屈光参差,其发病率随着地区、年龄的不同而有所差别.病因学研究发现屈光参差有遗传倾向,发育及环境因素进一步影响其发病,而外伤、其他疾病及手术也可导致其发生.屈光参差是影响视功能、形成弱视的常见原因.目前相关的实验性研究报道不多.临床发现屈光参差眼具有一定的生物学检测特征.     

屈光参差眼角膜地形图分析

目的　观察屈光参差近视眼双眼角膜地形图的异同。方法　用AlconEH 2 70角膜地形图仪测量 5 9例屈光参差组双眼角膜地形图 ,分析双眼角膜地形图参数及图形分布情况 ,并与对照组比较。结果　屈光参差组中双眼角膜地形图一致者占 77 97% ,与对照组相比无明显差异 (P >0 0 5 )。屈光参差组中两眼Ks ,Kf值无明显差异 (P >0 0 5 )。结论　屈光参差近视眼双侧角膜地形图形状高度一致 ,屈光参差眼的发生与角膜屈光力无关。     

屈光参差的研究现状

两眼的屈光不等称为屈光参差,其发病率随着地区、年龄的不同而有所差别。病因学研究发现屈光参差有遗传倾向,发育及环境因素进一步影响其发病,而外伤、其他疾病及手术也可导致其发生。屈光参差是影响视功能、形成弱视的常见原因。目前相关的实验性研究报道不多。临床发现屈光参差眼具有一定的生物学检测特征。     

屈光参差与立体视觉

屈光参差是指两眼屈光度的程度和（或）性质有一定的差别,其主要相关原因是由于双眼眼轴长度发育不平衡。立体视觉是人类和高等动物所特有的一项高级视功能,同时也是人类从事多种工作及日常生活中必备的一种重要功能。屈光参差引起的视网膜像模糊和不等像视是影响立体视觉的主要原因。屈光参差矫正方法不同,对立体视觉的影响也是不同的。     

近视眼患者诱导屈光参差对视功能的影响

目的通过观察实验性屈光参差对40岁以上近视眼患者双眼视功能的影响,探讨老视患者的屈光手术治疗。方法对40岁以上近视患者48例用综合验光仪完全矫正其屈光不正后,在单眼前加不同度数正球镜,诱导单纯近视性( 0.5D、 1.0D、 1.5D、 2.0D、 2.5D和 3.0D)屈光参差。测定诱导屈光参差后的远视力、双眼同时视、融像功能、立体视情况。结果诱导的屈光参差超过 1.5D时,欠矫眼的远视力、立体视、融像功能和同时视随着屈光参差度数的增加逐渐下降。结论近视性屈光参差可引起中年近视患者双眼视功能异常,当屈光参差超过 1.5D时可引起双眼视功能急剧下降。大于40岁近视患者行屈光手术可留有小于 1.5D的近视性屈光参差,利于视近,且对高级视功能的影响不明显。     

综合治疗大龄儿童及青少年屈光参差性重度弱视疗效分析

目的:观察大龄儿童及青少年屈光参差性重度弱视综合性治疗的疗效。方法:将56例56眼9~19岁的屈光参差性重度弱视患者分成两组,两组患者均充分散瞳验光,观察组(A组)配戴高透氧性硬性角膜接触镜(rigid gas permeable contact lens,RGPCL),对照组(B组)给予足矫框架眼镜,两组均进行遮盖、增视治疗、脱抑制治疗,在弱视眼矫正视力>4.7时,除继续遮盖、增视治疗、脱抑制治疗外,增加双眼视觉及立体视觉训练,随访观察24mo。结果:弱视治疗18mo后,两组的总有效率均为100%。比较两组的弱视治疗24mo时临床治愈率、脱抑制率、立体视≤100患者所占百分比。A组临床治愈率为33%,B组为8%,A组的临床治愈率高于B组,两组疗效差异有显著性(χ2=4.02,P<0.05)。A组的脱抑制率为37%,而B组的脱抑制率为4%,两组疗效差异有显著性(χ2=14.43,P<0.05)。A组立体视≤100患者占30%,B组占4%,两组疗效差异有显著性(χ2=4.83,P<0.05)。A组全部患者均能满意接受配戴RGPCL,所有患者均未出现角膜上皮损伤、感染、结膜明显充血、分泌物增多及眼部磨痛、痒、异物感等不适。在配戴过程中未出现镜片护理方面问题。结论:对大龄儿童及青少年屈光参差性重度弱视应采取积极弱视治疗,两组的有效率达到了100%。配戴RGPCL组24mo脱抑制率、临床治愈率、立体视优于戴框架眼镜组。对于屈光参差性弱视,应建议患者戴RGPCL以提高临床治愈率,最大可能地恢复立体视。     

Clinical characteristics of unilateral myopic anisometropia in a juvenile optometric practice population

PURPOSE: A retrospective study of longitudinal case histories, undertaken to establish the clinical and statistical characteristics of unilateral myopic anisometropia (UMA) amongst the juvenile and adolescent population at an optometric practice, is reported. UMA was defined as that specific refractive state where an unequivocally myopic eye is paired with a 'plano' [spherical equivalent refraction, (SER) = +/-0.25 Dioptres (D)] companion eye. METHODS: The clinical records of all patients aged <19 years on file at an established independent optometric practice were categorised as 'myopic' (SER < or =-0.50 D), 'hypermetropic' (> or =+0.75 D) or 'emmetropic' (> or =-0.37< or =+0.62 D). Subsequently all juvenile patients matching the UMA criterion, together with a case-matched group of bilaterally myopic individuals, were selected as the comparative study populations. RESULTS: A total of 14.4% (n = 21 of 146) of the juvenile myopic case histories were identified as cases of UMA. More than half of these UMA cases emerged between the ages of 11.5 and 13.5 years. There was a marked female gender bias. The linear gradient of the age-related mean refractive trend in the myopic eye of the UMA population was not statistically significantly different (p > 0.1) to that fitted to the ametropic progression recorded in either eye of the case-matched population of young bilateral myopes; uniquely the slope associated with the companion eye of UMA cases was statistically significantly (p < 0.025) less steep. Compared with bilateral myopes fewer cases of UMA required a refractive correction to relieve visual or asthenopic symptoms, and this initial correction was dispensed on average 1 year later (at age 12.7 years) in UMA patients. CONCLUSIONS: Individuals identified as demonstrating clinically-defined UMA can be considered as distinct but functionally normal cases on the continuum of human refractive error. However, any unilaterally-acting determining factor(s) underlying the genesis of the condition remain obscure.     

The Prevalence of Anisometropia,Amblyopia and Strabismus in Schoolchildren of Shiraz,Iran

Purpose: To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran.

Materials and Methods: A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus.

Results: Mean age of 2638 schoolchildren was 12.5 years (response rate?=?86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p?=?0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively.

Conclusions: Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.     

不同程度近视性屈光参差患者双眼间调节参数的差异性分析

目的：探讨近视性屈光参差患者双眼间调节力差异与屈光参差程度间的关系。方法：横断面研究。收集2019年11月至2021年6月在山东第一医科大学附属青岛眼科医院就诊的近视患者123例（246眼）,年龄8~21岁。根据双眼间等效球镜度（SE）差值分为屈光不正组（SE差值≤0.25D）29例、低度屈光参差组（1.00D≤SE差值<2.50D）62例及高度屈光参差组（SE差值≥2.50D）32例3组。所有患者符合双眼最佳矫正视力（BCVA）≥0.8且各项原始数据较为完善。使用综合验光仪测量3组患者的单眼调节幅度（AMP）、单、双眼负相对调节（NRA）、正相对调节（PRA）、调节反应（AR）及调节灵活度（AF）在睫状肌麻痹下验光后确定双眼间屈光度数,分析3组间双眼调节相关参数及单眼调节参数差差值（双眼间调节参数差值＝近视屈光度较高眼调节数值-近视屈光度较低眼调节数值）之间的差异。对3组间调节参数比较采用单因素方差分析;对屈光参差程度与双眼调节参数值及双眼间调节参数差值间的关系分析选择Spearman相关分析。结果：3组间双眼NRA、PRA、AR、AF值及单眼间NRA、AF差值比较差异均无统计学意义。3组AR差值分别为-0.03±0.25、0.20±0.30、0.26±0.36,差异有统计学意义（F=7.36,P<0.001）;3组PRA差值分别为0.04±0.27、0.34±0.72、0.66±0.63,差异有统计学意义（W=7.47,P<0.001）;3组AMP差值分别为0.41±0.86、-1.07±1.53、-1.02±2.18,差异有统计学意义（W=9.25,P<0.001）。事后多重比较显示,屈光不正组与低度屈光参差组和高度屈光参差的AR差值、PRA差值、AMP差值比较差异均有统计学意义（均P<0.05）。相关性分析显示,SE差值与AR差值、AMP差值存在低强度的正相关性（r=0.22,P=0.014;r=0.36,P<0.001）。结论：不同程度近视性屈光参差患者双眼间调节参数差值不同,且双眼间AR差值、AMP差值与双眼间屈光度差异程度存在一定相关性。     

Visual Outcome in 879 Children Treated for Strabismus: Insufficient Accommodation and Vision Deprivation,Deficient Emmetropisation and Anisometropia

Purpose: To identify the effect of infant hypermetropia on residual amblyopia in children remaining after treatment.

Materials and Methods: 879 strabismic children had cycloplegic retinoscopy at the age of 6 months and later when strabismus was diagnosed. A total of 26 hypermetropes consistently wore glasses from the age of 6 months, and 305 other hypermetropes had their accommodation periodically assessed by dynamic retinoscopy before strabismus was diagnosed. The relation between the last known visual acuity after treatment and all other clinical findings was analysed using t-tests and regression analysis.

Results: Vision less than 6/12 in nonfixing eyes was associated with infantile hypermetropia > +5.0D, and in rare instances in excess of -3.0D of myopia. In hypermetropes only, anisometropia was associated with worse amblyopia. Astigmatism was associated with myopia and low levels of hypermetropia but not with worse vision. The vision of fixing eyes that were hypermetropic was significantly worse than that of emmetropic or myopic eyes. Wearing spectacles from the age of 6 months was associated with better vision in the nonfixing eye. Vision in the nonfixing eye of 19 hypermetropic heterotropes who started wearing glasses between 6 and 18 months of age also was better than that of those who started wearing glasses after 18 months of age. Insufficiency of accommodation was related to the degree of infantile hypermetropia, to worse vision and to failure to emmetropise. Difference in amplitude of accommodation between the eyes was largest in hypermetropes with anisometropia > +1.50 D and was marginally associated with worse vision in microtropes who became anisometropic after infancy. Hypermetropia decreased more in fixing eyes than in nonfixing eyes, thereby causing anisohypermetropia to increase after infancy. This change was most pronounced in hypermetropic microtropes. Conversely, failure of fixing eyes to emmetropise was associated with an increase in their inability to accommodate and heterotropia.

Conclusions: On the basis of these findings, severe residual amblyopia in children remaining after treatment could be explained by additional vision deprivation. It can be reduced by starting spectacle correction of hypermetropia before the age of 18 months. Anisometropia seemed the result of deficient emmetropisation.     

儿童视网膜脱离发病特点分析

目的 探讨视网膜脱离在儿童中的发病特点。方法 对１１２例（１２０眼）１４岁以下儿童视网膜脱离眼的病因、病程及发病情况等进行回顾性分析。结果 儿童视网膜脱离具有男孩发病比例高,外伤性视网膜脱离多,伴有先天性眼部发育异常患者多等特点。患者多发病至就诊时间间隔长,增生性玻璃体视网膜病变重。结论 儿童视网膜脱离具有与成人不同的发病特点,眼科医生应根据其特点随访高危人群,做到早发现,早治疗。     

Recent advances in uveitis of juvenile idiopathic arthritis

Chronic scarring-type uveitis is a frequent extra-articular manifestation of juvenile idiopathic arthritis. It occurs in about 20% of children with this disease, commencing typically within a few years from its onset. The risk of uveitis is greatest in antinuclear antibody-positive girls with early onset oligoarthritis. The classic clinical picture is chronic bilateral anterior uveitis, usually asymptomatic until substantial damage to intraocular structures occurs. In view of the asymptomatic nature of the condition, routine screening of juvenile idiopathic arthritis patients 2-4 times a year is crucial to prevent complications. The treatment consists of topical corticosteroids and mydriatics, in severe cases with immunosuppressive agents, and surgical management of complications. Although the prognosis of uveitis is improving, there are cases refractory to standard regimens. Patients in whom uveitis commences prior to the onset of arthritis present a special problem.