儿童白瞳症的临床诊断

目的探讨儿童白瞳症的诊断。方法对１３６例儿童白瞳症病例进行回顾性分析。结果患儿平均年龄４．３岁,病因以先天性白内障最多,共８８例,占６４．７％,其次为视网膜母细胞瘤．占２３．５％,第三位为转移性眼内炎,占５．９％。误诊５例,误诊率为３．７％。结论超声波检查、ＣＴ扫描对儿童白瞳症诊断和鉴别诊断有重要价值。     

儿童白瞳症的CT诊断价值

目的:探讨不同眼内疾病所致的儿童白瞳症的CT表现,为临床诊断及鉴别诊断提供客观的影像学依据。方法:对30例33眼儿童白瞳症患者进行双眼CT扫描检查。结果:不同疾病所致的白瞳症,CT扫描征象有所不同。结论:CT扫描可清晰显示儿童白瞳症的病变,可为儿童白瞳症的临床诊断及鉴别诊断提供客观、可靠的影像学依据,具有极其重要的价值。     

68例儿童白瞳症的CT诊断及分析

目的 探讨不同眼内疾病所致的儿童白瞳症的CT表现，为临床诊断及鉴别诊断提供客观的影像学依据。方法 对68例儿童白瞳症患者进行双眼CT扫描检查。结果 不同疾病所致的白瞳症，CT扫描征象有所不同，部分先天性白内障及永存性原始玻璃体增生症患者伴有眼部其他先天异常的征象。结论 CT扫描可清晰显示儿童白瞳症的病变，可为儿童白瞳症的临床诊断及鉴别诊断提供客观、可靠的影像学依据，具有极其重要的价值。     

以非"白瞳症"为主要表现的视网膜母细胞瘤111例诊断分析

目的 探讨以非"白瞳症"为主要表现的视网膜母细胞瘤(Rb)病例的诊断与鉴别诊断要点.方法 顾性分析1990～2006年间在北京同仁医院就诊的111例以非"白瞳症"表现Rb患儿的临床及组织病理学资料.结果 此类患儿占同期Rb患儿总数的19.2%.患儿平均年龄为40.8个月,主要症状平均持续4.8个月.超过50%的患儿大于等于3岁,5岁及5岁以上的患儿占有相对较大的比例(23.4%).就诊时的主要表现依次为视力下降(40.5%)、斜视(27.9%)、眼红肿痛(21.6%)、眼球变大(6.3%)、畏光流泪(4.5%)、眼球萎缩(3.6%),其他(11.7%).组织病理学示73.9%的肿瘤位于眼球内,26.1%的肿瘤侵至眼球外,其中6只眼(5.4%)视神经断端受累.5只眼肿瘤发生自发退行,其中4例表现为眼球萎缩.结论 临床中对不明原因(或伴反复发作)的视力下降、斜视、眼红肿痛、眼球变大或萎缩、眼内出血、畏光流泪的患儿应排除Rb的可能性.     

彩色多普勒超声在儿童眼眶肿瘤诊断中的价值

目的探讨彩色多普勒超声（CDI）技术在儿童眼眶肿瘤诊断中的临床价值。方法应用CDI技术对39例儿童眼眶肿瘤患者肿瘤内部回声及彩色血流显像进行检测。结果在39例儿童眼眶肿瘤中,毛细血管瘤8例,横纹肌肉瘤2例,瘤体内CDI均可检测出丰富的动脉血流信号;皮样囊肿12例,淋巴管瘤8例,瘤体内CDI检测均无血流信号;静脉性血管瘤6例中,CDI检测出静脉血流信号3例;3例静脉曲张在颈静脉加压和压力解除过程中示动态血流变。结论CDI技术在儿童眼眶肿瘤的鉴别诊断中有重要的临床价值,联合判断肿瘤特征性内部回声及声像图有助于对肿瘤进行定性诊断。     

渗出型老年性黄斑变性的超声诊断

目的 探讨渗出型老年性黄斑变性的B型超声图像特征。方法 应用Alcon公司生产的Ultrascan眼科A/B超声诊断仪,检查15例15眼渗出型老年性黄斑变性患者,并全部经荧光素眼底血管造影术证实。结果 该病具有一定的B型超声图像特征,球后壁黄斑区呈盘状隆起,隆起回声为中等强度,其下呈液性暗区或中低回声。结论 B型超声诊断渗出型老年性黄斑变性具有简便、安全、可重复性好的优点,对屈光间质混浊的患者更具有价值。     

眼科B型超声检查在诊断玻璃体后脱离中的应用

目的:探讨眼科B型超声检查在诊断玻璃体后脱离(posterior vitreous detachment,PVD)中的应用价值。方法:选取2011-09/2012-09来我院进行治疗的PVD患者305例506眼,应用B型超声进行检查和分析。结果:选取506眼中共计179眼(35.4%)为不完全PVD,327眼(64.6%)为完全PVD。其中有61眼(12.1%)出现少量玻璃体出血,经检查26眼(5.1%)为视网膜裂孔,裂孔周边激光光凝治疗后痊愈。结论:眼科B型超声检查可以准确诊断PVD,同时具有无创和快捷等特点,值得在临床上推广。     

B型超声在眼挫伤诊断中的应用

目的探讨B型超声检查在眼后段挫伤诊断中的临床价值。方法对58例（65眼）眼后段挫伤进行眼部B型超声检查,并对其眼底表现与B超检查结果进行比较分析。结果眼底表现：黄斑水肿26眼（40．0％）、视网膜出血及视网膜下出血17眼（26．2％）、黄斑区色素紊乱9眼（13．8％）、玻璃体积血8眼（12．3％）、视盘水肿7眼（10．8％）、视网膜脱离3眼（4．6％）等。B型超声的阳性发现率：玻璃体积血、视网膜脱离均为100．0％,视盘水肿85．7％,视网膜出血及视网膜下出血84．2％,黄斑水肿69．2％,对黄斑色素紊乱不能显示。结论B型超声对眼后段挫伤是一种安全、有效的检查方法,对玻璃体积血、视网膜脱离、视盘水肿、视网膜大量出血、黄斑水肿等诊断具有重要价值。     

眼内异物的超声诊断

目的 探讨眼内异物B型超声影像分析的方法及意义。方法 以眼科专用超声诊断仪对1999-2002年经手术证实的眼内异物52例54眼，回顾性分析其检测和声像图结果。结果 眼内异物的B超影像、伴随征像及异物定位的影像表现均可提供具体的数据与结果。结论 B型超声检查对眼内异物的诊断治疗有重要意义。     

山东省盲校盲童致盲原因调查

目的：确定山东省盲校16岁以下盲生致盲的解剖及发病原因,为防治儿童盲提供依据。方法：WHO儿童视力障碍检查法对山东省11所盲校盲生进行检查,诊断,结果：275名16岁以下盲生中,258人为严重视障或盲,占93．8％;主要病变部位为全眼球、视网膜、晶状体、视神经;主要致盲原因为先天异常及遗传性眼病;26．8％为潜在性可防治盲,以先天性白内障,青光眼为主,结论：本调查一定程度上反映了山东省儿童盲的现状,营养性及感染性盲病少见,无天异常及遗传性眼病是主要原因。     

Long-term results of surgery in childhood glaucoma

Purpose The aim of this study is to assess the functional results and morphological parameters in children surgically treated for glaucoma. Methods Data from 43 patients and 68 eyes who were operated in our department between 1990 and 2002 were collected. This retrospective trial included primary congenital glaucoma (n=36), and secondary glaucoma (n=7) in Rieger-Axenfeld syndrome and Sturge Weber syndrome. Intraocular pressure (IOP), axial length of the eyeball, visual acuity, refractive errors and orthoptic status were analysed. Results The age of patients at the first surgery was 6.0±5.3 months (range 0.7 to 28.0 months). The mean period of follow-up was 57.3±36.8 months (6.0–161.0).The mean number of surgical procedures performed on one eye was 2.5±2.4 procedures (1–11). The mean IOP before the first surgery was 31.0±7.9 mmHg (17.5–52.0), and was 15.0±3.9 mmHg (7.0–28.0) at the last visit. 49 eyes (72.1%) did not need any further medical treatment after the last surgical procedure. The IOP was 18 mmHg or lower without medication in 29 eyes (42.6%) after just one surgical procedure (21 trabeculotomy, 8 combined trabeculotomy/trabeculectomy with or without mitomycin-C). At the first examination, the mean axial length of the eyeball was 22.6±1.8 mm (the mean normal value at this age is 20.3±0.7 mm), and was 24.4±2.0 mm at the last visit (the mean normal value at this age is 22.2±0.6 mm). The best corrected visual acuity at the last visit was 0.25±4.6 lines; the normal range of visual acuity at this age is from 0.4±4.0 lines to 0.8±3.0 lines. Visual acuity was 0.32 or more in 53.0% of the eyes. Visual acuity was lower than 0.1 in only 15.2% of the eyes. Myopia was present in 57.4% of the eyes with a mean spherical equivalent of −6.1±3.9 dioptres. 15 patients (34.9%) developed strabismus. 22 patients (51.2%) were treated with part-time occlusion. Binocular function as assessed with the Lang-1 test was positive in 17 of 30 patients (56.7%). Conclusions Although a good long-term IOP-control can often be achieved in childhood glaucoma, the visual acuity remains below the normal range in most cases despite close orthoptic follow-up. Excerpts presented at the meeting of the German Society of Ophthalmology (DOG), Berlin, 2004.     

内窥镜下睫状体光凝治疗儿童青光眼的长期临床观察

目的评价内窥镜下睫状体光凝(ECP)治疗儿童青光眼的长期疗效和安全性。方法回顾性系列病例研究。收集2013年8月至2020年5月在首都医科大学附属北京同仁医院眼科中心接受内窥镜下睫状体光凝的儿童青光眼患者。观察指标包括第一次ECP手术时的年龄、青光眼类型、术前与术后最后一次随访时的视力及眼压等。采用配对t检验比较术前及术后末次随访眼压和视力。采用独立样本t检验和卡方检验比较成功组及失败组的各项临床特征。结果 22例(27眼)儿童青光眼患者纳入本研究。其中先天性白内障术后12眼,玻璃体切除视网膜复位联合硅油填充术后10眼,外伤性白内障术后2眼,先天性青光眼3眼。随访时间为6个月至6年(中位数:5年)。术前眼压为37.8±8.1 mmHg,ECP平均次数为1.2±0.6次,术后末次随访眼压为22.6±9.8 mmHg,术后眼压下降幅度约40%。末次随访时,19眼眼压控制,7眼眼压失控,1眼眼球萎缩。行1次及以上ECP手术的1年,3年,5年及6年的累积成功率分别为84.4%,71.7%,71.7%,53.8%。手术成功组首次ECP范围(均值:287^O)比失败组大(均值:223^O)。结论 ECP对治疗儿童青光眼,尤其是难治性继发性青光眼是有效的。术后眼压在药物辅助下可以长期稳定。对儿童青光眼长期乃至终身眼压随访是至关重要的。     

Causes of childhood blindness in the northeastern states of India

Background:

The northeastern region (NER) of India is geographically isolated and ethno-culturally different from the rest of the country. There is lacuna regarding the data on causes of blindness and severe visual impairment in children from this region.

Aim:

To determine the causes of severe visual impairment and blindness amongst children from schools for the blind in the four states of NER of India.

Design and Setting:

Survey of children attending special education schools for the blind in the NER.

Materials and Methods:

Blind and severely visually impaired children (best corrected visual acuity <20/200 in the better eye, aged up to 16 years) underwent visual acuity estimation, external ocular examination, retinoscopy and fundoscopy. Refraction and low vision workup was done where indicated. World Health Organization′s reporting form was used to code anatomical and etiological causes of visual loss.

Statistical Analysis:

Microsoft Excel Windows software with SPSS.

Results:

A total of 376 students were examined of whom 258 fulfilled the eligibility criteria. The major anatomical causes of visual loss amongst the 258 were congenital anomalies (anophthalmos, microphthalmos) 93 (36.1%); corneal conditions (scarring, vitamin A deficiency) 94 (36.7%); cataract or aphakia 28 (10.9%), retinal disorders 15 (5.8%) and optic atrophy 14 (5.3%). Nearly half of the children were blind from conditions which were either preventable or treatable (48.5%).

Conclusion:

Nearly half the childhood blindness in the NER states of India is avoidable and Vitamin A deficiency forms an important component unlike other Indian states. More research and multisectorial effort is needed to tackle congenital anomalies.     

二维超声及彩色多普勒血流显像对外伤性视网膜脱离的诊断价值

本文应用二维超声（２－Ｄｕｌｔｒａｓｏｕｎｄ）及彩色多普勒血流显像（ｃｏｌｏｒＤｏｐｐｌｅｒｆｌｏｗｉｍａｇｉｎｇ）对３８例外伤性视网膜脱离（因玻璃体出血机化眼底镜检查无法进行）患者进行患眼二维结构和脱离视网膜上分支动脉的血流信号进行系统检测。结果表明：外伤性视网膜脱离（部分性脱离７１．１％,完全性脱离２８．９％）合并玻璃体混浊１００％,合并白内障２３．７％,合并脉络膜脱离７．９％,合并视网膜下积血５．３％,合并脉络膜下积血２．６％。脱离视网膜上有红色血流信号显示７３．７％,记录到搏动性血流频谱６８．４％。     

Diagnostic ultrasound in cases of acute iritis

Summary The A-scan ultrasound technique was used to examine the vitreous bodies of both the sick and the healthy eye in 47 patients with acute iritis. The acoustic findings were then compared to observations made with the slit lamp. Of the 47 iritis eyes, only 19 were amenable to at least some degree of optical examination. The most common factors preventing optical examination were opacity of the aqueous humor and posterior synechias. Comparison of optical and acoustic findings was difficult, since optical examination was possible in only 19 eyes. It would seem, however, that there is a fairly close correlation between acoustic and optical findings. Ultrasound often offers the only possibilty of ascertaining the presence and degree of exudation in cases of acute iritis, and such information may be important in planning treatment and following the course of the disease.

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Zusammenfassung Mit dem A-Bild-Ultraschallverfahren wurde der Glaskörper des gesunden Auges sowie der Glaskörper des kranken Auges bei Patienten, die an einseitiger akuter Iritis litten, untersucht und Ultraschall- und Spaltlampenbefunde wurden miteinander verglichen. Von 47 Iritis-Augen war nur bei 19 wenigstens eine teilweise optische Untersuchung möglich. In der Regel wurde die optische Untersuchung durch Trübung des Kammerwassers und durch hinteren Synechien verhindert. Es fiel schwer, die optischen und echographischen Befunde miteinander zu vergleichen, weil die optische Untersuchung nur bei 19 Augen gelang. Die Arbeit vermittelte jedoch den Eindruck, daß die optischen und akustischen Befunde der Glaskörper einander weitgehend entsprachen. Die Ultraschalluntersuchung ist oft die einzige Methode bei akuter Iritis das Vorkommen und den Grad der Glaskörperexudation zu klären. Vorstellungen hierüber nützen der Planung der Therapie und der Verfolgung des Verlaufs der Krankheit.

     

Changing pattern of childhood blindness in eight North-Eastern states and review of the epidemiological data of childhood blindness of India

Purpose:To assess the causes of visual impairment and blindness in children in all the schools for the blind in eight northeastern states and to determine its temporal trend, and to analyze the result with reference to various regional epidemiological data on childhood blindness in India.Methods:Children aged ≤16 years, with a visual acuity of ≤6/18 in the better eye, attending 17 schools for the blind were examined between November 2018 and March 2020. WHO protocol and reporting format was used for the evaluation, diagnosis, and classification of the causes.Results:Out of 465 eligible study participants, 93.76% were blind and only 12.26% of causes were avoidable. Anatomical causes of childhood blindness were whole globe (43.2%), cornea (17.20%), optic nerve (12.04%), retina (9.68%), and lens (9.46%). Etiological causes were unknown (52.69%), hereditary (26.02%), intrauterine (15.05%), and 26.08% had blinding congenital ocular abnormality (s). Regional temporal trend revealed a decrease in corneal and childhood causes and an increase in retina, optic nerve, hereditary, and intrauterine causes.Conclusion:A constellation of causes were differentiable but matched with the overall emerging trend of childhood blindness in India. Higher corneal, unavoidable, and unknown causes suggest a region-specific action plan for controlling childhood blindness as well as rehabilitation.