调节性内斜视眼镜处方方法研究

目的 探讨调节性内斜视最佳配镜处方方法及疗效。方法 55例调节性内斜视患儿,随机分为两组。A组：全矫组,28例,麻痹睫状肌后行远视全矫配镜。B组：同视机组,27例,麻痹睫状肌待瞳孔恢复后,在同视机上观察不同矫正镜片对斜视度、视功能的影响,选择达到双眼最佳融像、眼正位的度数配镜。采用卡方检验比较两组的配镜疗效。结果 经3.5年跟踪观察,B组51.9%患儿配镜度数比总远视度低0.50 D以上,平均（1.38±0.43）D;B组较A组配适好,脱镜现象少;B组远视度平均年降幅比A组大0.64 D;两组立体视恢复率差异无统计学意义。结论 调节性内斜视患儿在同视机及其客观检测指标的指导下进行配镜的方法,可能优于粗略的全矫配镜方法。     

Clinical features predictive of successfully weaning from spectacles those children with accommodative esotropia.

PURPOSE: It has been reported that most children with accommodative esotropia are not able to discontinue spectacle wear as they become older. We conducted a prospective study to determine which factors are predictive of successfully weaning children from spectacles. METHODS: Beginning in 1995, children with fully accommodative esotropia with a baseline refractive error of + 1.50 to + 5.00 diopters (D) were gradually weaned from their hyperopic correction. Patients with amblyopia or who had previously undergone strabismus surgery were excluded. Children were weaned in 0.50 D increments until spectacles were discontinued or they developed esotropia, asthenopia, or decreased vision. A multivariate analysis was performed to assess the association between successful weaning and various clinical characteristics. RESULTS: Twelve of 20 children (60%) were successfully weaned from spectacles. Spectacles were prescribed at a mean age of 4.2 +/- 1.5 years, and weaning was initiated at a mean age of 8.0 +/- 1.1 years. The spherical equivalent of the least hyperopic eye when spectacles were prescribed was 2.99 +/- 1.06 D. The clinical characteristic most clearly associated with successful weaning was the refractive error at the time glasses were prescribed. Whereas 10 of 11 (91%) patients with < 3 D of hyperopia were weaned from spectacles, only 2 of 9 (22%) patients with 3 to 5 D of hyperopia were successfully weaned from their spectacles (P =.005). CONCLUSIONS: Many children with fully accommodative esotropia can be weaned out of spectacles during the grade school years. The degree of baseline hyperopia appears to be one of the best predictors of success.     

儿童屈光性调节性内斜视的临床观察

目的观察儿童屈光性调节性内斜视戴镜后的眼位、屈光度、视力及双眼单视功能情况。方法随机搜集45例屈光性调节性内斜视儿童,随访观察5年,并进行回顾性分析。结果44例眼位正位,1例眼位回退。远视屈光度平均减少 2.16D。84只眼弱视,治愈70只眼(83.33%),进步14只眼(16.67%)。获得Ⅲ级双眼单视功能者37例(82.22%),Ⅱ级5例(11.11%),无双眼单视功能3例(6.67%)。结论屈光性调节性内斜视患儿要早治疗、坚持长期戴矫正眼镜,定期检查。     

Oculometric features of hyperopia in children with accommodative refractive esotropia

PURPOSE: To determine the nature of hyperopia in children with accommodative refractive esotropia (ARE) by evaluating the relationships between corneal radius (CR), axial length (AL), age and equivalent spherical refraction (SEQ). METHODS: A total of 112 children with ARE were included in the study. The children underwent an overall ophthalmic examination including cycloplegic refraction, keratometry and ultrasonic AL measurement. RESULTS: Statistical analysis revealed a strong relationship between AL and SEQ (p < 0.001). A significant correlation was also found between AL and CR (p < 0.001). The relationship between AL and age was weak but statistically significant (p = 0.02). Multiple regression analysis, using SEQ as the dependent variable and CR, AL and age as independent variables, revealed that AL accounts for 43.5% of the variance, and the combination of CR and AL accounts for 60.9% of the variance. CONCLUSION: Hyperopia is predominantly axial in nature in children with ARE. However, other refractive components are also involved in producing hyperopic refractive errors.     

部分调节性内斜儿童术后疗效观察

目的:探讨部分调节性内斜手术时机及术后疗效。方法:观察65例部分调节性内斜患儿术前术后双眼三级视功能的变化以及不同手术年龄组视功能的恢复情况。检测术前术后视觉诱发电位(VEP)的变化。结果:部分调节性内斜患者术前术后三级视功能的变化差异有统计学意义(Z=7.253,P=0.000);手术年龄对术后三级视功能的恢复差异有统计学意义(H=6.739;P=0.034);术后P100波潜伏期较术前变短,振幅加大(P潜伏期=0.029;P波振幅=0.037)。结论:部分调节性内斜患者术后视功能得到明显改善。手术年龄越早,术后出现高级视功能的可能性越大。     

Risk factors for accommodative esotropia among hypermetropic children

PURPOSE: Identification of risk factors for accommodative esotropia may help to determine which children with hyperopia may benefit from early spectacle correction or preventive therapy. METHODS: Participants in the family history study were 95 consecutive patients, aged 18 to 60 months, with accommodative esotropia. Participants in the binocular sensory function study were a subgroup of 41 children enrolled in the family history study within 1 month of onset, while the esodeviation was still intermittent. Participants in the hypermetropia study were 345 consecutive patients, ages 12 months to 8 years, with refractive error of +2.00 D or greater and no esodeviation before age 12 months. RESULTS: In the family history study, 23% of children with accommodative esotropia had an affected first-degree relative, and 91% had at least one affected relative. In the binocular sensory function study, random-dot stereoacuity was abnormal in 41% of children, whereas an abnormal motion VEP, Worth 4-dot, or positive 4-PD base-out prism responses were present in 4% or less of the children. In the hypermetropia study, patients with a mean spherical equivalent of < +3.00 D and significant anisometropia had a 7.8-fold increased risk for accommodative esotropia over nonanisometropic patients. CONCLUSIONS: A positive family history, subnormal random-dot stereopsis, and hypermetropic anisometropia each pose a significant risk for the development of accommodative esotropia. Assessment of these risk factors in conjunction with refractive screening should help to identify those children who are most likely to benefit from early spectacle correction or preventive treatment.     

Nonaccommodative esotropia after cataract extraction in a patient with previous accommodative esotropia

We report a case of nonaccommodative esotropia developing after bilateral cataract surgery that corrected the preexisting hyperopia in a patient with accommodative esotropia since childhood. The esotropia required surgical correction despite the good visual acuity after the cataract surgery. In patients with preexisting strabismus, there is a possibility of decompensation of adaptive binocular mechanisms after cataract surgery and refractive procedures.     

调节性内斜视的治疗

目的探讨与调节有关的内斜视矫正规律.方法随机选择56例有调节性因素的内斜视进行散瞳检影、戴镜和综合弱视治疗,首次、治疗后6个月、12个月和24个月检影验光1次,检查内斜矫正度.结果治疗6月后内斜度数基本稳定.结论与调节性有关的内斜视戴镜治疗6个月后,即可考虑手术矫正非调节部分内斜视.     

屈光性调节性内斜视远期疗效分析

目的 :观察屈光性调节性内斜视 (refractiveaccom modativeesotropia ,RAET)戴镜后眼位、视力、屈光度及双眼单视功能情况。方法 :回顾性分析RAET 10 4例 ,平均随访 7.5年 ,以末次检查结果为准。结果 :82例眼位良好 ,16例眼位回退 ,6例合并间歇性外斜视。治疗前注视眼平均屈光度(5 .84± 1.93)D ,非注视眼 (6 .6 7± 1.6 5 )D ,治疗后注视眼平均屈光度 (4 .2 2± 2 .2 0 )D ,非注视眼 (5 .2 8± 2 .0 8)D。 183眼合并弱视 ,14 5眼弱视治愈。 80例有融合范围 ,6 8例有立体视。结论 :RAET在长期临床观察中发现 ,多数持续到青春期或成年早期。随着年龄的增长 ,注视眼与非注视眼同时正视化。眼位回退、合并垂直斜视、两眼较大屈光参差、重度弱视影响双眼单视功能的恢复。     

儿童部分调节性内斜视的手术探讨

目的探讨儿童部分调节性内斜视的手术时机，手术量。方法对35例部分词节性内斜视的患儿戴全矫眼镜半年以后，手术矫治与调节因素无关的非调节因素所致的内斜视。手术量按裸眼和戴镜后斜视度的平均值设计。结果35例中．眼位矫正满意32例占91．43％，良好3例占8．57％；功能治愈有立体视19例占54．29％。结论儿童部分调节性内斜视，其由解剖因素所致的斜视需手术矫正。当患儿戴全矫眼镜半年眼位仍不能恢复正位时，可尽早手术矫治其残存的内斜度，手术量按裸眼与戴镜平均斜视度设计，术后由于调节因素所致内斜仍需配镜矫正。     

Refractive accommodative esotropia: a surgical problem?

Among the reasons given for surgery in refractive accommodative esotropia (RAET) are (1) frequent functional deterioration and (2) high prevalence of cyclovertical strabismus and oblique muscle dysfunctions. Of 30 patients with RAET, corrected with glasses and followed for an average of seven years only one deteriorated. We tested a second group of 53 patients with RAET for A- and V-patterns and dysfunction of the oblique muscles. Pseudo-A- and V-patterns occurred without glasses but were absent when glasses were worn during the measurement. Dysfunctions of the oblique muscles were observed without glasses but were clinically insignificant. Our data do not support the reasons cited above for performing surgery in RAET.     

调节性内斜视儿童双眼屈光差值的变化趋势及其对立体视的影响

目的研究调节性内斜视患者屈光差值的变化趋势和立体视的发展变化。方法回顾性研究。对有完整病历资料的屈光调节性内斜视儿童进行回顾性研究和总结。根据初始双眼屈光差值分为低度屈光差异组（双眼SE差≤1.0 D）、中度屈光差异组（1.0 D<双眼SE差<2.5 D）和高度屈光差异组（双眼SE差≥2.5 D）;根据初始视力情况分为双眼视力相等组和弱视组。对初始视力与初始屈光差值的关系进行独立样本t检验,对初始屈光差值随戴镜治疗时间的变化采用重复测量混合线性模型进行分析,对初始屈光差值与末次立体视进行卡方检验。结果在平均（6.8±2.8）年后,末次随访时87例（82.1%）屈光差值为低度,14例（13.2%）为中度,5例（4.7%）为高度。①不同视力组别间屈光差值差异有统计学意义（t=9.787,P<0.05）;②不同的屈光差异组间的末次立体视差异有统计学意义（χ2=18.785,P<0.01）;③戴镜后,随着年龄的增加3组屈光差值均有下降的趋势（F=142.913,P<0.01）。结论初始就诊时,调节性内斜视伴远视性屈光差异者,初始屈光差值越大,初始弱视眼视力越差,末次随访时获得的立体视越差。随戴镜时间增加,双眼屈光差值逐渐趋减。     

调节性内斜视儿童远视矫正后的散光变化

目的 观察调节性内斜视儿童远视矫正后的散光改变.方法 收集看远和看近内斜视10 PD以上、远视1.0 D以上、配戴足矫远视眼镜看远斜视度在10 PD以内的初诊病人;按初诊年龄分为≥2岁＜4岁组和≥4岁＜8岁组;根据睫状肌麻痹检影验光结果予以配戴足矫眼镜.每年再次验光,应用向量分解法,用90°～180°轴向的散光J180,及45°～135°轴向的散光J45作为散光统计指标.连续观察3年以上.结果 符合条件的调节性内斜视儿童共44名,平均初诊年龄(4.7±1.7)岁,观察(4.3±1.4)年.≥2岁＜4岁组儿童右眼的散光J180平均为(0.35 ±0.34)D,在配戴眼镜的第2年和第3年出现了分别为0.28 D、0.20 D的散光增加(P＜0.05),≥4岁＜8岁组右眼的散光J180,平均为(0.34±0.44)D,在戴镜后的第1年和第2年也分别增加了0.22 D和0.18 D(P ＜0.05),两组儿童在随后的2～3年下降到初诊水平并保持稳定;两组儿童的散光J45平均为(0.14±0.16)D、(-0.002±0.16)D,数值小且无明显变化.结论 调节性内斜视配戴远视足矫眼镜以后散光会出现少量的增加,之后有所降低,该变化与最初配戴眼镜的年龄无关.戴镜在一定时期内能影响儿童屈光的发育趋势.     

调节性内斜视的治疗

目的 探讨调节性内斜视的综合治疗方法.方法 总结分析87例调节性内斜视的治疗情况,所有病例经1%阿托品扩瞳验光后戴镜矫正,弱视眼进行综合训练.戴镜半年后对眼位戴镜不能矫正且双眼视力基本平衡的患儿通过手术干预矫正眼位.结果 经戴镜眼位恢复正位69例(79.31%).戴镜并同时进行弱视训练半年后18例斜视角无法全部矫正的患儿采用手术方法矫正眼位.术后进行双眼单视训练.所有病例恢复正常眼位及双眼单视功能.结论 调节性内斜视的治疗是一个综合性的治疗过程,双眼视力基本平衡时可手术干预残余斜视角.强调双眼单视功能的检查和训练.(中国眼耳鼻喉科杂志,2009,9:33-34)     

间歇性外斜视合并调节性内斜视：附8例报告

本文对我院3年2158例初诊斜视者中遇到的8例间歇性外斜视合并调节性内斜视进行分析讨论.归纳本型斜视病人的临床特征为:(1)发病年龄较早.(2)先发现内斜视.(3)患者常有中或高度远视(6/8).(4)AC/A 比率正常或偏低.(5)其斜视度变化大,外科30～15°(?)正位(?)内科15～30°.(6)内斜视可戴镜矫正.3例患者做了视觉电生理的眼球运动检查,但没获规律性的结果.最后讨论了本病的发病情况(0.4%,8/2158)和治疗问题.     

Longitudinal changes in the cylinder power of children with accommodative esotropia.

PURPOSE: To assess the longitudinal changes in the cylindrical refractive errors of children with accommodative esotropia according to the age when glasses were prescribed. METHODS: Refractive errors were followed longitudinally for 120 children with accommodative esotropia for a mean of 4.4 +/- 2.5 years. Cycloplegic refractions were performed using an autorefractor. The refractive data were analyzed for three groups of children based on their age at the time spectacles were prescribed. RESULTS: In all three age groups, the mean cylinder power was initially about 1.0 D. Over time, the mean cylinder power in the two younger age groups gradually increased by about 0.5 D. In the oldest age group, the mean cylinder power remained relatively unchanged with some suggestion of a decrease in the later years. A regression model demonstrated the statistical significance of both the age when spectacles were prescribed (p < 0.0001) and the interaction of age and time after spectacles were prescribed (p = 0.0034). CONCLUSIONS: Longitudinal changes in cylinder power for children with accommodative esotropia vary according to their age when spectacle wear is initiated. The greatest increase in cylinder developed in the children who were youngest when initially treated.     

儿童部分调节性内斜视的手术矫正与立体视觉

为探讨儿童部分调节性内斜视的手术时机，观察了７８例儿童部分调节性内斜视矫正术后的立体视恢复情况；分析各种因素对其立体视恢复的影响。结果：７８例中，５５例术后获得立体视，功能治愈率为７０．５％，且术后立体视的恢复率与术前相比，差异非常显著（ｐ＜０．０１）；早期手术组及具有融合功能组的立体视的恢复率显著高于较晚手术组及无融合功能组（ｐ＜０．０１）；发病越早，术后建立立体视的预后越差。结论：儿童部分调节性内斜视与部分调节因素有关，其由于解剖因素所引起的斜视需手术矫治。从立体视恢复上考虑，当患儿全矫配镜半年眼位仍不能正位时，应尽早手术矫正其残存的内斜度。术中应根据戴全矫眼镜后的眼位决定手术量。术后由于调节因素所致的内斜视仍需配镜矫正。