飞秒制瓣LASIK术后调节痉挛致视力下降1例

本文报告1例28岁男性青年患者,行飞秒制瓣准分子激光原位角膜磨镶术(laser-assisted situ keratomileusis,LASIK)术后1个月视力进行性下降,小瞳下行电脑验光矫正视力,右眼为0.3(?0.25×86°),左眼为0.2(?0.50×91°).眼前节及眼底检查未见器质性病变,视觉电生理检查...     

集合不足型外隐斜合并调节不足三种治疗方法的比较

目的 比较集合调节训练、三棱镜配戴矫正和近视屈光过矫在集合不足型外隐斜合并调节不足患者中的疗效.方法 横断面研究,将10～35岁的60名确诊为集合不足型外隐斜合并调节不足患者随机分为3组,每组20例,A组行三棱镜配戴矫正,B组行近视屈光过矫-0.50 D戴镜矫正,C组行集合调节视功能训练,于3个月后复查隐斜度和视功能采用配对t检验和单因采方差分析 结果 复查各项视功能参数3组患者之间差异有统计学总义 A组患者隐斜度增加(t=1 2.65,P＜0.01),近距正相对融合范围减小(t=12.65,P＜0.01),症状先短暂缓解后加重;B组患者隐斜度增加(t=4.63,P＜0.01),近距正E相对融合范围减小(t＝6.71,P＜0.01),调节幅度减小(t=14.3,P＜0.01),症状明显加重;C组患者隐斜度显著减小(t=-11.61,P＜0.01),近距正相对融合范围显著增大(t=-22.40,P＜0.01),调节幅度显著增大(t=-31.06,P＜0.01),症状明显改善 结论 集合不足型外隐斜合并调节不足患者采用集合调节视功能训练能明显改善症状,减少近距隐斜度,增加近距正相对融合范围和调节幅度,是一种有效可行的治疗方法.     

斜视弱视、双眼视觉异常诊疗新进展培训班通知

为加强眼科医师的斜视弱视专业知识和基本技能,提高斜弱视专科医生的临床诊疗能力和双眼视检查、问题处理能力,温州医学院眼视光学院将于2010年4月在苏州市举办“斜视弱视、双眼视觉异常诊疗新进展”培训班。该项目为国家级继续医学教育基地项目,课程内容包括双眼视功能训练仪器的介绍、斜视的双眼视功能检查、斜视的双眼视异常改变、     

视觉训练对成年人视功能异常所致视疲劳的改善作用

目的:分析视觉训练对成年人视功能异常所致视疲劳症状的改善作用。方法:采用系列病例观察研究方法,收集2018年10月至2019年10月在天津市眼科医院视光中心视觉训练室进行视觉训练的成年人视功能异常所致的视疲劳患者93例186眼,其中男48例,女45例;平均年龄(30.43±6.39)岁。所有患者双眼视功能初次检查包括综...     

非斜视性双眼视觉异常临床分析

目的 对5例不同的非斜视性双眼视觉异常的视功能检测结果进行综合分析.方法 对2012年4月至2013年4月在南昌大学附属眼科医院在验光基础上,应用综合验光仪测量集合幅度、调节幅度以及正负相对调节,用Von Graefe法测量在远近距离的隐斜方向和隐斜度、调节集合/调节值(AC/A)比率(调节性集合与调节量之比),用Risley可变棱镜测量远近水平正负融像聚散,用Worth4点灯和R.D.S立体视觉图测量立体视觉.参照Morgan分析法加以分析并采取相应视觉训练.结果 (1)1例集合不足的特征是远距隐斜在正常范围而近距高度外隐斜,且近距正相对聚散(PRC)低、AC/A低.(2)1例集合过度是近距内隐斜、远距隐斜在正常范围、负相对聚散(NRC)低、AC/A高.(3)1例散开过度是远距高度外隐斜、近距隐斜在正常范围、高AC/A.(4)1例融像性聚散减低是远、近距隐斜均在正常范围,AC/A正常、但正负融像性聚散均下降.(5)1例单纯内隐斜是远、近距内隐斜均超过正常范围,负相对聚散下降、AC/A正常.结论 5例都属于非斜视性双眼视觉异常,临床症状虽相似,检查结果却不同,诊断和治疗也不尽相同.     

原发性对比视觉功能异常

目的探讨原发性对比视觉功能异常的特点与意义。方法采用YC－4020型激光视网膜MTF测定仪，测定了28例主诉视力模糊，而视力表测定的视力正常、眼部无明显病变者的激光干涉条纹视力（IVA）及对比敏感性功能（CSF）。结果正常人记录对照发现，MTF曲线明显异常。结论完整的中心视力包括对比视觉，MTF可作为一个实用的视功能评定指标。     

屈光不正患者的异常双眼视功能情况分析处理

目的 :探讨屈光不正患者视觉不适的异常双眼视功能情况。方法 :用综合验光仪规范主觉验光 ,用VonGvafe法测远近水平隐斜 ,检测 1999年 2月— 2 0 0 1年 12月门诊 43例屈光不正患者的双眼视功能临床表现及治疗方法进行分析。结果 :视功能异常如辐辏不足 2 1例、散开不足 3例 ,予视觉训练治疗 ;辐辏过度 18例、散开过度 2例 ,采用近距正镜附加 ,予渐进多焦点镜矫正。结论 :对屈光不正患者视觉不适 ,行视功能检查 ,综合评价。提出完善的医学验光应该是规范主觉验光基础上结合双眼视功能情况来决定屈光不正处方。     

视功能训练对调节功能影响的初步报告

调节是眼重要的视功能之一,是指正常眼或经屈光矫正后的人眼能通过改变眼的屈光状态,使眼前不同距离的物体能清晰地聚焦在视网膜上的能力。反映调节功能的参数有调节幅度(amplitude of accommodation,AMP)、调     

白内障术后晶状体后囊膜混浊及远期视力下降影响因素分析

目的探讨白内障术后晶状体后囊膜混浊(posterior capsular opacification,PCO)发生及术后远期视力下降的影响因素。方法收集行白内障超声乳化摘出联合人工晶状体植入术的年龄相关性白内障患者37例(47眼),记录患者术前、术后的眼部检查情况及是否行后囊膜抛光处理等术中情况,于术后2a对PCO进行分级评价。结果 47眼中,有25眼在术后2a发生了PCO,其中18眼混浊已累及中心3mm区,4眼已行YAG激光后囊膜切开术,后囊膜切开率8.5%。统计分析显示,PCO和混浊累及中心3mm区的发生率在是否行后囊膜抛光眼之间的差异均有统计学意义(均为P<0.05)。在各因素中,行后囊膜抛光是发生PCO以及混浊累及中心3mm区仅有的保护性因素。累及中心3mm区的PCO、眼底疾病和黄斑病变与术后2a视力变化之间的关联均有统计学意义(均为P<0.05)。结论白内障术后发生累及中心3mm区的PCO可导致术后远期视力下降;术中行后囊膜抛光处理可显著降低PCO的发生率和严重程度。     

Evaluation of Accommodative Insufficiency with the Visual Analogue Scale (VAS)

Purpose: The purpose of this study was to evaluate whether asthenopic symptoms in schoolchildren diagnosed with accommodative insufficiency (AI) and graded with the Visual Analogue Scale (VAS) could be correlated with the degree of accommodative deficiency in these children, and to investigate if VAS grading of the asthenopic symptoms could be used as an instrument to indicate the level of improvement of AI. Methods: Forty-nine children (mean age 10.2 years ± 2.7) diagnosed with AI graded their degree of asthenopia on the VAS before and after a 12-week treatment period wearing individually dispensed reading glasses. Results: The improvement in accommodation after treatment was statistically significant (p < 0.001) and 83.7% of the children obtained normal accommodative amplitude in relation to age. The reduction in asthenopic symptoms as graded with the VAS was also statistically significant (p < 0.001) after treatment and 89.9% of the children obtained a normal VAS score. However, no correlation between the degree of accommodative deficiency and the VAS grading could be found, neither before nor after treatment. Discussion: Based on these results we conclude that the visual analogue scale (VAS) cannot be used as an instrument to indicate the degree of accommodative deficiency nor can it be used to indicate the level of improvement during the course of treatment. However, the VAS can be used as an instrument to verify and document whether or not asthenopic symptoms are present, and therefore also to indicate when symptoms have been relieved.     

Bilateral Concurrent Eye Examination with a Head-Mounted Perimeter for Diagnosing Functional Visual Loss

The authors here report a case series where bilateral concurrent eye examination, using a head-mounted perimeter (imo®), was employed to facilitate diagnosis of functional visual loss, as regular ophthalmological tests were ineffective. Subjects (11-year-old female, 15-year-old male, and 24-year-old male) were diagnosed with unilateral functional visual loss by using the imo®, at the Kitasato University hospital. The results of the imo® and those of Goldmann perimetry or Humphrey Field Analyzer II differed for all subjects, which is indicative of potential functional visual loss. Bilateral concurrent examination with the imo® may become a standard for future diagnosis of unilateral functional visual loss.     

Visual Loss Due to Wernicke Syndrome Following Gastric Bypass

Purpose: To report a case of Wernicke encephalopathy after gastric bypass surgery resulting in vision loss, ophthalmoplegia, and ataxia, all of which reversed with a single dose of IV thiamine. Methods: Observational case report. Results: A 34-year-old woman presented with decreased vision and intermittent diplopia after gastric bypass surgery. She was found to have bilateral limitation of horizontal gaze, decreased vision with bilateral central scotoma and mild disc edema OU. Her cranial magnetic resonance imaging (MRI) was normal. A presumptive diagnosis of Wernicke encephalopathy was made. The patient was admitted, and a single dose of IV thiamine reversed the ophthalmoplegia and vision loss within 24 hours. Conclusion: Wernicke encephalopathy should be considered in patients with vision loss after gastric bypass surgery. The classic triad of confusion, ataxia, and ophthalmoplegia may not be present and, although uncommon, the findings of optic disc edema and vision loss should not deter the clinician from making the diagnosis. Replacement thiamine if given promptly may rapidly reverse the findings.     

Visual Loss Secondary to Bioccipital Calcifications Associated with Coeliac Disease

ABSTRACT

The purpose of this paper was to present a case report of permanent visual loss secondary to occipital lobe calcifications in coeliac disease. A 58-year-old grave digger was referred by his work place occupational health and safety department for vision assessment. His past medical history included coeliac disease (CD) diagnosed 20 years previously, as well as an over 40-year history of poor vision that had not been investigated. Examination showed bilaterally decreased visual acuity of <6/60 and a right homonymous inferior quadrantanopia confirmed on automated perimetry. The optic discs appeared normal with no pallor or neuroretinal rim loss. Computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed bilateral occipital calcifications. Diffusion tensor imaging showed reduced anisotropy and difficulty tracing the optic radiations to the occipital lobes. This is the first described case of visual loss secondary to occipital lobe calcifications in coeliac disease.     

Tuberculous Orbital Apex Syndrome with Severe Irreversible Visual Loss

A 16-year-old girl presented with a unilateral red eye, progressive visual loss and diplopia. A detailed clinical assessment with appropriate investigations led to a diagnosis of Orbital Apex Syndrome (OAS) secondary to Tuberculosis (TB). We report this unusual case of TB OAS, which resulted in a poor visual outcome despite appropriate management.     

Study of the Immediate Effects of Autostereoscopic 3D Visual Training on the Accommodative Functions of Myopes

PurposeStereoscopic viewing has an impact on ocular dynamics, but its effects on accommodative functions are not fully understood, especially for autostereoscopic viewing. This study aimed to investigate the changes in dynamic accommodative response, accommodative amplitude, and accommodative facility of myopes after autostereoscopic visual training.MethodsWe enrolled 46 adults (men = 22 and women = 24; age = 21.5 ± 2.5 [range = 18–25] years, spherical equivalent: −4.52 ± 1.89 [−8.88 to −1.75] diopters [D]) who visited the Eye & ENT Hospital of Fudan University. The study population was randomly divided into three-dimensional (3D) and two-dimensional (2D) viewing groups to watch an 11-minute training video displayed in 3D or 2D mode. Dynamic accommodative response, accommodative facility, and accommodative amplitude were measured before, during, and immediately after the training. Accommodative lag and the variability of accommodation were also analyzed. Visual fatigue was evaluated subjectively using a questionnaire.ResultsAccommodative lag decreased from 0.54 ± 0.29 D to 0.42 ± 0.32 D (P = 0.004), whereas accommodative facility increased from 10.83 ± 4.55 cycles per minute (cpm) to 13.15 ± 5.25 cpm (P < 0.001) in the 3D group. In the 2D group, there was no significant change in the accommodative lag (P = 0.163) or facility (P = 0.975), but a decrease in accommodative amplitude was observed (from 13.88 ± 3.17 D to 12.71 ± 2.23 D, P = 0.013). In the 3D group, the accommodative response changed with the simulated target distance. Visual fatigue was relatively mild in both groups.ConclusionsThe immediate impact of autostereoscopic training included a decrease in the accommodative lag and an increase in the accommodative facility. However, the long-term effects of autostereoscopic training require further exploration.     

Grey Filter Contact Lens as Therapeutic Option for Acquired Reduced Binocular Visual Performance

Disturbing binocular problems can be too complex to be treated in such a way that comfortable binocular single vision is restored. The grey filter contact lens could offer a safe and clinically useful way to help these patients.Background:In unilateral acquired reduced visual performance or intractable diplopia the binocular performance often is less than the performance of the better eye, possibly leading to complaints of binocular visual functioning. The hypothesis is to use a grey filter contact lens on the affected eye to obtain more binocular visual comfort. The grey filter changes the binocular central visual image in the brain through delaying the image of the affected eye and has minimal effect on the peripheral vision. The purpose of this study was to evaluate the effect of the grey filter contact lens on the reduction of patients’ binocular complaints in daily life.Methods:In 19 consecutive patients with unilateral acquired reduced visual performance or intractable diplopia a grey filter contact lens was fitted. The contact lens was chosen from six available filters with different transmissions, based on patient preference. The chosen filter contact lens was fitted according to the normal practice of contact lens fitting.Results:The results of 18 patients are reported, one patient was lost to follow-up. Twelve patients (67%) reported good results when wearing the grey filter contact lens. Five patients (28%) discontinued wear of the grey filter contact lens because their binocular visual complaints disappeared during filter contact lens wear and remained absent after contact lens wear was terminated.Conclusion:The grey filter contact lens is a clinically useful, safe, and easily reversible treatment option for patients with binocular visual complaints due to an acquired monocular reduction in visual quality.     

The Parameters of Pattern Visual Evoked Potential in the Severe Visual Loss Patients in Korean

PurposeTo compare the characteristics of the pattern visual evoked potential (PVEP) in patients with severe visual loss and normal controls, and to demonstrate the range of PVEP parameters in normal Koreans.MethodsThe patients were divided into three groups according to visual acuity: group 1, ranging from no light perception to less than 0.02; group 2, ranging from 0.02 to 0.1; and group 3, ranging from 0.125 to 0.25. Group 4 was established as a healthy control group. The 95% confidence intervals (CIs) of the PVEP parameters were calculated for group 4. The PVEP parameters were compared among these four groups, and the amplitudes were evaluated with respect to the 95% CIs. We used the area under the curve to integrate the sensitivity and the specificity of the PVEP parameter quantitative values (7.01 to 9.57 µV and 6.75 to 10.11 µV).ResultsA total of 101 eyes were investigated. The 95% CIs of the P100 and N135 amplitudes of group 4 were 7.01 to 9.57 µV and 6.75 to 10.11 µV, respectively. The amplitudes of P100 and N135 were significantly higher in group 4 (p < 0.001). The P100 and N135 amplitude were below the 95% CI in all group 1 patients. The area under the curve of the P100 amplitude was the highest (0.789).ConclusionsNo legally blind patient in the present study exhibited a value within the 95% CI of the controls. The P100 amplitude may be the best parameter for defining blindness in patients.     

高度近视SMILE和FS-LASIK术后早期局部调节和中枢视感知觉功能变化

目的：:探讨高度近视患者行飞秒激光小切口角膜基质透镜取出术（SMILE）和飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）术后早期双眼调节功能和视感知觉功能的变化及差异。方法：:前瞻性临床研究。选取2019年11月至2020年7月在中南大学湘雅医院眼科中心行SMILE和FS-LASIK手术的患者60例（120眼...