肉毒杆菌毒素A治疗先天性眼球震颤疗效分析

为研究用肉毒杆菌毒素Ａ（ＢｏｔｕｌｉｎｕｍｔｏｘｉｎＡ简称ＢＴＸＡ）治疗先天性眼球震颤的疗效,并进一步探讨其与手术等其他方法治疗该病的优缺点。采用兰州生物制品所生产的ＢＴＸＡ一定剂量注射入相应的眼外肌,比较注射前与注射后一周和一月的视功能、眼震和三级视功能,用统计学方法处理,确认该治疗是否有效。结果：注药后一月的近视力比注药前提高,有明显统计学差异。远视力的变化无明显统计学差异。注药后一月与注药前相比,３ｍ及３３ｃｍ原眼位的眼震振幅或震频降低有明显统计学差异。三级视功能在注药前后无明显统计学差异。最小震强出现的位置虽在注药前后无显著差异,但该处眼震振幅降低有显著差异。代偿头位的矫正率在注药后一月为８０％。结论：该方法治疗先天性眼球震颤有效。     

肉毒杆菌毒素A治疗先天性眼球震颤疗效的眼震电图分析

目的 观察肉毒杆菌毒素Ａ（ＢＴＡ）治疗先天性眼球震颤（ＣＮ）的效果,并进一步探讨其应用规律。方法 对２２例先天眼震患者,用兰州生物制品所生产的ＢＴＡ,以眼震图（ＥＮＧ）检查注射前与注射后１周,１,３,６月的近、远距离眼震情况,各组进行统计学处理,并比较统计学差异。结果 注药后１击与注药前相比近距离原眼位眼震振幅降低有明显统计学差异（Ｐ〈０．０５）;注药后１月与注药前相比,除近距离原眼位震频降低无明     

A型肉毒杆菌毒素治疗先天性眼球震颤临床研究

目的用Ａ型肉毒杆菌毒素（ＢＴＸＡ）治疗先天性眼球震颤,探求有效治疗方法。方法６２例病人治疗前后行肌电图,眼震图．头位扭转角及视力等对比检查。在肌电图监护下,将Ａ型肉毒杆菌毒素注入被选定的眼外肌内,２３例手术病人为对照组。结果ＢＴＸＡ治疗前后疗效对比、肌电图,眼震图,头位扭转角及视力差别极显著（Ｐ＜０．００１）。与手术对照组对比无显著性差异（Ｐ＞０．０５）。基本治愈率８３．８７％,总有效率９１．９３％。结论Ａ型肉毒杆菌毒素可作为治疗先天性眼球震颤的一种简便、经济、安全、有效的非手术疗法。     

先天性眼球震颤手术效果的眼震电图评定

报告了21例先天性眼球震颤手术治疗前后眼震图对比情况，提示手术总有效率为76.2%，列举了典型病例的手术前后眼震图检查结果，并探讨了采用脑电图机作眼震检查的方法和特点。     

先天性眼球震颤检查及手术治疗进展

先天性眼球震颤(congenital nystagmus.CN)是指出生或生后2～4月内出现的一种不自主性眼球运动.随着现代科技的迅速发展,各种检查手段引入CN的研究领域,如视觉电生理,眼震电图频谱分析,电子计算机,实现了对CN患者精确、完整地定量评估.手术治疗在传统的术式基础上也有了大的改进.本文扼要综述近年来对CN患者的检查方法和手术治疗的一些进展.     

先天性眼球震颤的眼震图检查及应用

先天性眼球震颤是眼球有节律的不自主运动。由于多数病例的眼震频率较高，振幅小等原因，仅靠肉眼目测以精确测定其震频和振幅的数值，彩和ＥＯＧ方法描记眼震图是一较精确的客观定量检查，为临床观察眼震波形变化规律，分析震颤波形、测量震频、振幅及震强等提供了客观指标。通过眼震图描记，可以确定零带位置，为临床治疗眼震提供依据，对眼震图的具体描记方法及临床应用进行了叙述。     

先天性眼球震颤的视诱发电位与视网膜电图的研究

目的探索先天性眼球震颤(congenitalnystagmus,CN)的视诱发电位(VEP)和视网膜电图(ERG)的电生理特征。方法对68例CN患者与36例正常人应用发光二极管刺激记录视诱发电位,其中60例CN患者,33例正常人描记闪光视网膜电图。结果(1)CN患者的F-VEPLED的N1、P1、N2波幅降低,N1、N2波潜时延迟。(2)跳动型与钟摆型CN患者的VEP与ERG各观察指标无差异。(3)CN患者与正常人F-ERG无差异。结论CN患者的视神经传导功能与视网膜黄斑部感受机能较正常人降低。把CN分为运动缺陷型与知觉缺陷型是不合适的。     

先天性眼球震颤及其手术治疗（二）

(六)治疗先天眼震治疗目的有三:减轻或停止眼震,纠正代偿头位和改善视功能.关于先天眼震的治疗,至今尚无十分令人满意的方法.不过,近些年来采用以下治疗方法,取得了一定的效果,有些临床效果相当显著.现择疗效较好者简述如下:     

先天性眼球震颤及其手术治疗（三）

合并斜视的先天眼震的手术方法先天眼震合并斜视者约占五分之一,绝大多数为水平斜.对于这类病人的手术治疗,具体方法如下:在无休止眼位或无明显代偿头位的跳动型水平先天眼震,如所合并的斜视,为分开过强     

先天性眼球震颤的视功能临床研究

对７８例不合并斜视和屈光不正的先天性眼球震颤（ｃｏｎｇｅｎｉｔａｌｎｙｓｔａｇｍｕｓ，ＣＮ）患者进行了视力、立体视和眼震图检查，结果表明：（１）ＣＮ患者近视力优于远视力，双眼同时注视视力优于单眼视力。（２）ＣＮ患者的双眼视觉显然已经得到发育，不但具有双眼单视功能，而且具有一定程度的立体视觉。（３）ＣＮ患者的立体视锐度较差与视力不良有关，与震颤参数无关。（４）立体视觉的检查受到多种因素的影响，各种检查方法间无本质差别。（５）眼震对视力的影响是多因素的。     

应用改进的眼震图检查先天性眼球震颤

目的评价改进后的眼震图对先天性眼球震颤波形的分析,为其手术治疗提供较为精确的量化标准.方法改进电生理仪的视网膜电图(EOG)程序,分别记录68例患者33cm原在位、右5°、10°、15°、20°,左5°、10°、15°、20°,3m原在位及闭眼的波形,并对其中28例手术患者术前和术后的眼震图进行比较.结果68例患者中,跳动型48例,其中水平跳动46例,垂直跳动2例;水平钟摆型20例.跳动型中,有代偿头位的40例,钟摆型无明显代偿头位.28例手术患者中,水平跳动型26例,水平钟摆型2例.26例跳动型患者均有中间位和代偿头位.术后20例代偿头位消失,6例代偿头位在左5°～10°.按震频、振幅、震强的分组中,处于中等震频、振幅、震强范围内的多见.结论改进的眼震图可以对眼震的振幅、震频、震强、中间位进行量化的检测,从而指导其治疗.     

Effects of acupuncture on foveation characteristics in congenital nystagmus

AIMS/BACKGROUND—To examine the effects of acupuncture at the sternocleidomastoid muscles on foveation characteristics in congenital nystagmus.
METHODS—Six patients with congenital nystagmus (CN) received a series of treatments consisting of two needles inserted into each sternocleidomastoid, stimulated by tapping gently every 5 minutes, for 20 minutes per session. Their eye movements were recorded using scleral search coils and changes in their CN waveforms analysed at each point in the treatment. Changes in the stability and duration of foveation periods were examined.
RESULTS—Four of the six patients showed improved foveation at the commencement of treatment; three maintained this response throughout the treatment period and after the needles were removed. In two, the CN waveform itself was modified.
CONCLUSION—This study and others involving afferent stimulation to the neck and face suggest that projections from these areas to the reticular formation and vestibular nucleus may alter the behaviour of the pathophysiological mechanism underlying congenital nystagmus.

Keywords: congenital nystagmus; foveation; acupuncture     

先天性眼球震颤治疗方法研究进展

先天特发眼球震颤是以眼部表现为主的疾病,虽然不属于常见或多发病,但在临床上并非罕见,多见于婴幼儿,发病时间一般都在半岁以内。该病的特点为:发病早或发病时间不能确定,眼球不自主的持续跳动或摆动,极少患者有晃视感,大多数患者都有不同程度的视力损害,有的视力减低比较严重,而且不能矫正,较多患者有侧视现象和代偿头位表现,有的头部摇晃,还有的表现为频繁眨眼等代偿现象。该病的主要治疗手段是手术治疗,但影响手术效果的因素很多:发病年龄,眼震强度,代偿头位,休止眼位,视力,手术方式和手术量等。随着近年的发展,对该病有了更深入的认识,我们就一些问题做一简要回顾。     

先天性眼球震颤手术疗效的临床观察

目的探讨先天性眼球震颤的治疗方法。方法总结26例先天性眼球震颤采用parks(部分调整)法手术,合并水平斜视者同时进行斜视矫正手术。结果26中代偿头位消失21例,明显改善5例,建立双眼单视功能19例。结论采用parks(部分调整)法治疗先天性眼球震颤不仅可以矫正代偿头位和斜视,还有利于双眼单视功能的建立。     

Spectral-domain optical coherence tomography in patients with congenital nystagmus

AIM: To study macular features in patients with congenital nystagmus and to assess the utility of spectral-domain optical coherence tomography (SD-OCT) in nystagmus. METHODS: The macular areas of 51 outpatients with congenital nystagmus were examined using SD-OCT. Morphological changes in the retinal layers of the macular area were analysed. RESULTS: Macular images were successfully obtained with SD-OCT from 50 (98%) patients. Patients with ocular albinism mainly have macular hypoplasia, abnormal foveal depression, and increased foveal thickness with persistence of an inner nuclear layer, an inner plexiform layer, a ganglion cell layer and a nerve fiber layer. Macular morphology similar to albinism was observed in three patients with idiopathic macular hypoplasia. The OCT findings of cone dystrophy included unclear, disrupted or invisible photoreceptor outer segment/inner segment in the fovea; fusion, thickening and uneven reflection of the outer segment/inner segment with external limiting membrane. Some patients with congenital idiopathic nystagmus showed normal macular morphology and structure, and others showed indistinct macular external limiting membrane reflection. CONCLUSION: SD-OCT is an effective and reliable method to detect the macular morphology of congenital nystagmus patients. This technique has diagnostic value in particular for patients with macular hypoplasia and cone cell dystrophy with no distinct abnormality on fundoscopy.     

调整Parks法治疗有代偿头位的先天性眼球震颤

目的 观察采用调整Parks法手术量治疗有代偿头位(compensatory head posture,CHP)的先天性眼球震颤(congenital nystagmus,CN)的临床效果.方法 对28例伴有CHP的CN患者,采用调整Parks方法的手术量行中间带移位术,当代偿头位为15°～25°、25°～30°、30°～40、＞40时,从慢相侧到快相侧4条水平直肌手术量分别为7050 mm、6446mm、7557 mm、7658 mm.对比观察术前、术后视力及CHP情况.结果 与术前相比,术后单眼或双眼同时注视时的最佳矫正视力和第一眼位视力均有显著提高.CHP基本消除者(CHP＜10°)21例,明显改善者(CHP＞10°)6例,无变化者1例,与术前相比疗效显著.3例伴水平斜视者全部矫正为正位.结论 调整Parks法手术量适用于治疗各种大小CHP的CN患者.     

手术治疗伴有斜视的先天性冲动型眼球震颤

目的探讨先天性冲动型眼球震颤合并斜视的手术治疗方法及效果。方法回顾性分析行手术治疗的先天性冲动型眼球震颤伴有斜视11例,所有患者均根据中间带位置、代偿头位、斜视角度和注视眼的关系进行中间带的移位以及斜视的矫正。结果9例术后代偿头位完全改善,1例术后残留15°面转角,1例残留10°上斜视,所有患者原在位视力均提高两行以上。结论通过中间带移位及斜视度叠加矫正斜视,可以明显改善先天性冲动型眼球震颤的代偿头位及外观,并能提高第一眼位的双眼视力。     

Characteristics of braking saccades in congenital nystagmus

Several of the characteristic waveforms of congenital nystagmus (CN) contain braking saccades. We test the hypothesis that braking (including foveating) saccades, while not always satisfying the standard relationships for saccades, are normal; any differences are due to the presence of high-velocity, slow-phase eye movements. Better measurements of saccadic properties, including position- and velocity-based measures and skewness, can eliminate some of this apparent distortion. We also evoked an analogous effect in normal subjects by use of a ramp-step-ramp stimulus. Finally, we used a model to further demonstrate this distortion in the saccades of normals, deviating from their intended magnitude as a function of the magnitude of the opposing velocity. The saccadic analysis methods developed herein are applicable to all saccades made during ongoing eye movements, whether normal or pathological. The above findings support the hypothesis that the braking saccades integral to many CN waveforms have normal characteristics and are the result of a normal saccadic system's responses to a slow-eye-movement oscillation.     

先天性特发性眼球震颤合并水平斜视的手术治疗

目的:探讨先天性特发性眼球震颤合并水平斜视的手术治疗方法。方法:对27例合并水平斜视的先天性特发性眼球震颤患者,采用主导眼中间带移位术联合斜视眼斜视矫正术。结果:在27例患者中,所有患者主导眼第1眼位视力均提高2行以上,22例代偿头位消失,明显改善5例,术后25例患者眼位映光基本正位(±5°以内),2例患者眼位映光在±5°～±10°,部分患者双眼视功能较术前有所好转。结论:对合并水平斜视的先天性特发性眼球震颤行主导眼中间带移位术联合斜视眼斜视矫正术,不仅能改善原在位视力,矫正代偿头位和斜视,还有利于双眼视的建立。