共同性斜视手术前后双眼单视功能的临床观察

目的　观察非调节性内斜视、恒定性外斜视和间歇性外斜视患者手术前后双眼单视功能的变化。方法　将 5 2例共同性斜视患者分为 3组 :非调节性内斜视、恒定性外斜视和间歇性外斜视组。用同视机测定远双眼单视功能 ,用《颜少明立体视觉检查图》测定看近立体视锐度。观察术前、术后5天、 1月、 3～ 6月的斜视角度、远双眼单视功能、近立体视锐度变化。结果　三组斜视的视远双眼单视功能无统计学差异 (P >0 0 5 )。非调节性内斜视与恒定性外斜视组近立体视觉无统计学差异 (P<0 0 5 )。间歇性外斜视组近立体视觉损害较远立体视觉轻 (P <0 0 5 )。结论　非调节性内斜视、恒定性外斜视对双眼单视功能的影响一致。间歇性外斜视组对远双眼单视功能的影响与非调节性内斜视、恒定性外斜视组一致 ,而近立体视觉破坏较轻。     

成人斜视术后双眼单视功能的临床观察

目的观察成人斜视术后双眼单视功能情况。方法对35例18岁以上的共同性斜视患者手术矫正眼位后的双眼单视功能进行检测。用同视机测定视远双眼单视功能,用Titmus立体视图谱测定近立体视锐度。结果30例共同性外斜视患者,28例有不同程度的近立体视,范围50″～400″；仅1例通过同视机Ⅲ级功能检查,2例术后仍无双眼单视。5例共同性内斜视患者,2例获得同视机Ⅰ～Ⅲ级功能及400″近立体视。结论一部分成人斜视患者手术矫正眼位后可以获得一定程度的双眼视觉。共同性外斜视术后获得视近双眼单视的可能较性大。     

儿童间歇性外斜视术后远期定量立体视觉测定与分析

目的 了解儿童间歇性外斜视手术后的远期疗效并探讨手术后远期获得中心凹立体视的影响因素.方法 对216例4～15岁的间歇性外斜视儿童进行斜视矫正手术,并于手术前、手术后1个月及手术后≥1年时行眼位、双眼视功能、近及远距离立体视锐度检查.术后远期平均随访3.68年.结果 术后≥1年,216例中有90.74％的儿童获得≤60"的近立体视锐度,74.07％的儿童获得≤60″的远立体视锐度,近、远距离中心凹立体视检出率差异无统计学意义.按手术年龄将患者分为≤6岁组、6～9岁组和≥9岁组,三组间术后远期近、远距离中心凹立体视锐度的检出率差异无统计学意义.术后远期有150例(69.44％)眼位正位,66例(30.56％)眼位欠矫,远期正位组与远期欠矫组≤60″的近立体视锐度检出率差异无统计学意义;远期正位组≤60"的远立体视锐度检出率为80.00％,远期欠矫组≤60″的远立体视锐度检出率为60.61％,两组间比较差异有统计学意义(x2=12.17,P＜0.01).Logistic多因素回归分析结果显示,术后远期远距离中心凹立体视的检出率与术前患者是否存在远立体视锐度的密切相关.术后远期保持正位与检出中心凹立体视相关.结论 儿童间歇性外斜视术后远期近、远距离立体视锐度均较术前有明显改善,且不受手术年龄影响.影响远距离中心凹立体视锐度形成的不良因素为远期眼位回退.术前存在远立体视有利于术后形成远距离中心凹立体视,故儿童间歇性外斜视的最佳手术时机应选择在远立体视丧失以前.     

斜视手术前后双眼视觉的临床研究

目的探讨斜视对双眼视觉的影响及不同双眼视检查方法的评价。方法89例共同性斜视分为间歇性外斜、恒定性外斜及恒定性内斜3组。定量测量斜视度；检查双眼视觉状态及视网膜对应情况；测定远近立体视锐度。并观察斜视手术前及手术后1周、1月的斜视度、双眼视觉状态及远、近立体视锐度变化。结果3组术后双眼视功能较术前均有明显改善（P〈0．05），术后1周与1月双眼视功能的差异无统计学意义（P〉0．05）；恒定性斜视术后立体视恢复好于间歇性外斜视，且近立体视恢复好于表视；立体视检查非随机点画片（Titmus与Optec3500）与随机点画片（TNO）检查结果的差异有统计学意义（P〈0．05）；线状镜较Worth四点检测阳性率高；大于9岁患者术后双眼视觉较术前增加32％。结论斜视手术是恢复、重建双眼视觉的有效方法，不同检测方法结果不一致，需综合考虑。     

远立体视测定对间歇性外斜视手术时机选择的临床观察

目的探讨间歇性外斜视最佳手术时机,以求达到矫正斜视并获得完善的双眼单视功能目的。方法采用颜氏远用和近用随机点立体图,对69例间歇性外斜视进行手术前后立体视锐度测定;用三棱镜法测量远近斜视角;用同视机法测定双眼单视功能。结果69例间歇性外斜视中术前4例通过远立体视,47例通过近立体视,二者有高度显著性差异(P<0．001);术后37例通过远立体视,与术前比较有高度显著性差异(P<0．001),而近立体视手术前后无明显差异;病程愈长,术后获得立体视者愈少,病程短则相反。结论通过测定远近立体视,合理掌握间歇性外斜视手术时机,对其预后估计及疗效评价有重要意义。     

成人共同性斜视术后双眼视觉功能重建的临床研究

目的:探讨成人共同性斜视术后双眼视觉功能的重建。方法:观察21例成人共同性斜视患者,用同视机测定三级视功能,用《颜少明立体视检查图》检查近立体视锐度、交叉视锐度及非交叉视锐度,分析比较患者术前,术后3d;6wk;6mo双眼视觉功能的变化。结果:术前16例患者存在单眼抑制,术后6wk有6例患者消除单眼抑制,双眼视觉功能得到重建,差别具有统计学意义(P<0.05);术前具有同视机双眼视觉功能者5例,术后6wk增加至11例,其中7例得到改善,改善率36.8%,差别具有统计学意义(P<0.05);术前存在近立体视者3例,术后6wk增加至7例,其中4例得到改善,改善率22.2%,差别具有显著统计学意义(P<0.01);术前存在正常交叉视锐度者3例,术后6wk增加至7例,其中4例得到改善,改善率22.2%,差别具有显著统计学意义(P<0.01);术前存在正常非交叉视锐度者4例,术后6wk增加至7例,其中3例得到改善,改善率17.6%,差别具有显著统计学意义(P<0.01)。结论:成人共同性斜视术后双眼视觉功能得到不同程度的改善,主要体现在同时视和融合功能,但立体视难以重建,尤其是远立体视;对错过双眼视觉发育敏感期的成人共同性斜视手术,也不应忽视重建患者的双眼视觉功能。     

成人共同性水平斜视术后双眼视功能重建的研究

目的探讨成人水平性共同性斜视矫正术后双眼视功能的重建。方法分析45例年龄为18～50岁共同性水平斜视矫正手术后的双眼视功能。结果本组患者术前最佳矫正视力≥0．3，双眼最佳矫正视力相差≤2行，术前均无双眼视功能。斜视矫正术后6周，40例（88．89％）有不同程度的近立体视，其余5例（11．11%）术后无双眼单视，但仅2例经同视机检查有Ⅲ级功能。结论成人共同性斜视术后不仅达到美容目的，而且还可获得一定程度的双眼视功能。     

间歇性外斜视手术时机探讨

目的 通过观察不同年龄、双眼视功能状态手术前后变化,探讨间歇性外斜视的手术时机.方法 将56例间歇性外斜视患者根据手术时年龄≤5岁、5～9岁和≥9岁分为A、B、C三组,再根据术前有无融合功能及远或近立体视分组,统计分析不同年龄组手术前后眼位、双眼视功能变化,以及手术前后融合功能变化、远或近立体视功能变化.结果 术后眼位正位率A组77.8%、B组91.7%、C组85.7%,差异无统计学意义.双眼视觉功能的恢复率A组88.9%、B组87.5%、C组50.0%,差异显著有统计学意义.结论 B组术后正位率优于A组,但双眼视觉功能的恢复却A组优于B组.术前具有融合点及融合范围者,术后双眼视功能恢复率高.近立体视丧失、远立体视保存者术后远立体视锐度恢复好,术后立体视的恢复由远立体视开始.间歇性外斜视的手术时机应根据病人眼位、年龄、融合状态及立体视功能多方面综合考虑.     

间歇性外斜视手术前后双眼单视功能的观察

目的观察间歇性外斜视矫正术后双眼单视功能的临床恢复规律。方法对50例间歇性外斜视患者术前术后的双眼单视功能进行测定并分析比较。结果(1)50例患者斜视度25Δ～100Δ,术后近期正位48例。(2)术前具有不同程度的近立体视患者22例(占44％),术后增至47例(占94％)。术前具有远立体视的患者4例,术后增至18例。术后具有远、近立体视功能患者人数显著上升(P<0．05)。(3)术前同视机法具有Ⅰ级功能者22例,术后44例,术后Ⅰ级功能恢复的患者人数显著增多(P<0．05)。(4)术前同视机法测到Ⅱ级功能的患者10例,术后上升到44例。术后Ⅱ级功能的患者比例显著上升(P<0．05)。结论对间歇性外斜视患者提倡早期手术治疗以期改善和恢复立体视功能。     

不同类型斜视手术前后远近立体视的变化

目的：探讨斜视类型对术后远、近立体视恢复的影响。

方法：选取72例不同类型斜视患者,按斜视类型分为四组：组1为非调节性内斜视,组2为间歇性外斜视,组3为恒定性外斜视,组4为外斜V征伴下斜肌亢进。手术前后分别应用同视机检查远立体视。采用颜少明编绘的《立体视觉检查图》检查近立体视锐度。记录并分析术前、术后第7d,1、3、6mo的各项检查数据。

结果：斜视患者72例术后远、近立体视的恢复较术前有明显改善,其差异有统计学意义(P<0.05)。间歇性外斜视组术后远、近立体视的恢复优于非调节性内斜视组、恒定性外斜视组及外斜V征伴下斜肌亢进组,其差异有统计学意义(P<0.05)。非调节性内斜视组、恒定性外斜视组和外斜V征伴下斜肌亢进组术后不同时期远、近立体视的恢复差异无统计学意义(P>0.05)。远立体视(0例)比近立体视(19例,26%)的损害更严重,术后近立体视(51例,71%)的恢复明显优于远立体视(17例,24%),术后1mo远、近立体视恢复效果明显。

结论：不同斜视类型对术后远、近立体视恢复的影响存在差异,间歇性外斜视术后远、近立体视的恢复效果最佳。非调节性内斜视、恒定性外斜视和外斜V征伴下斜肌亢进对术后远、近立体视的恢复影响一致。斜视患者远立体视损害较重,术后近立体视恢复明显优于远立体视。     

Concomitant strabismus: of strabismus in strabismus syndromes]

PURPOSE: To show how to progress from the deviation of the visual axis (provided the diagnosis of concomitant strabismus is certain) to the classification of the squint in one out of the different squint syndromes and consequently to adopt the appropriate therapeutic strategy. METHOD: Every sign correlated with the deviation contributes to progress step by step to the diagnosis of a given squint syndrome. The age on onset of strabismus, either convergent or divergent, and its characteristic, intermittent or constant, allow in a first step to evaluate the potential binocularity, as well in early as late (acquired) strabismus. The first group of early strabismus includes manifest infantile strabismus and microstrabismus. Both have abnormal binocularity. The possibility of functional amblyopia, angle variability and additional incomitances have to be investigated. Early intermittent strabismus keeping a potential normal binocularity are seldom. In the second group of late onset strabismus, retinal correspondence has to be investigated by correspondence tests and prism or bifocus compensation to distinguish between the two possible types (including the accommodative forms of strabismus), i.e. decompensated microstrabismus with abnormal binocularity or normosensorial strabismus with potential normal binocularity. In some cases potential binocularity may be initially uncertain and/or remain later on subnormal. RESULTS: As the result of this systematic approach, every cases of squint can be classified in one out of the different squint syndromes. Based on the precise diagnosis, the appropriate treatment can be carried out. The goals of treatment which can be reached in every syndrome are indicated. DISCUSSION: For an overall view of the squint syndromes a classification with two entrances are necessary, on the one hand early or late onset, on the other hand normal or abnormal binocular conditions. CONCLUSION: This approach of concomitant strabismus should serve as guide lines for clinical practice.     

Cyclic strabismus

An unusual age of presentation of cyclic strabismus, which became constant in a relatively short period of time without a previous history of surgery, trauma, or strabismus, is reported. The mechanism of cyclic strabismus is still unknown; however, most cases are treated successfully with strabismus surgery. Cyclic strabismus is distinct from other rhythmic diseases in that peripheral manipulation of the target organ results in resolution of the deviation.     

Comitant strabismus

This article briefly overviews the recent literature regarding comitant strabismus. The evaluation and management of esodeviations and exodeviations, which are still topical questions today, are discussed. Several relevant basic studies focus on the prevalence and the role of sensory mechanisms in the clinical findings of essential infantile esotropia. Data reported on by the authors reinforce the validity of early surgery in congenital strabismus. Other articles deal with the accommodative esotropia. The beneficial effect of adequate corrective eyeglasses in accommodative esotropia is emphasized, in both children and adult patients. A major informative review of intermittent exotropia and a worldwide survey of current management of intermittent exotropia are also presented.     

Comitant strabismus

This review reports on articles written on comitant strabismus during the past year. Congenital esotropia was a recurring theme in these publications. Included in this review are articles that provide an insight into the basis for motor epiphenomena such as optokinetic nystagmus asymmetry and latent nystagmus. The optimum window of opportunity to achieve quality binocular vision by surgical alignment in congenital esotropia is discussed. We also report on articles that address various aspects of the management of comitant strabismus including the amount of medial rectus recession for esotropia, the target angle for best results in accommodative esotropia with high accommodation convergence/accommodation ratio, and issues related to comitant exotropia.     

Paralytic strabismus

This review of the year's literature on paralytic strabismus contains some especially interesting contributions on epidemiology of ischemic ocular motor palsies, new imaging diagnostic techniques in sixth and fourth nerve palsy and in Graves' ophthalmopathy, and bilateral histological findings in one case of clinically monolateral Duane's retraction syndrome. Some reports concern the reliability of diagnostic tests routinely used for measuring cyclotorsion in superior oblique palsies.