80例儿童弱视复发原因分析

目的探讨儿童弱视复发的相关因素。方法对80例（143只眼）临床基本治愈的弱视患儿进行3年以上的随访观察,经散瞳验光矫正视力下降至〈0.9者为弱视复发。结果弱视复发率为26.6%,屈光参差性和斜视性弱视复发率明显高于屈光不正性弱视,并显示弱视程度越重,复发率越高,旁中心注视弱视复发率高于中心注视性弱视。结论儿童弱视复发与弱视的类型、程度及注视性质有关。     

大龄儿童弱视69例疗效观察

目的探讨大龄儿童弱视治疗的方法及疗效。方法10～17岁弱视儿童69例（81眼）,经综合疗法治疗弱视,观察其治疗效果,并对年龄和弱视类型、弱视程度、注视性质等相关影响因素进行统计分析。结果69例81眼,基本治愈53眼（65.43%）,进步20眼（24.69%）,无效8眼（9.88%）,总有效率90.12%;按年龄分组,10～12岁组50眼,基本治愈34眼（68.00%）,13～17岁31眼,基本治愈19眼（61.29%）,两组间差异无统计学意义（P〉0.05）。不同程度弱视之间的疗效差异有非常显著意义（P〈0.01）;屈光不正性弱视疗效优于屈光参差性弱视和斜视性弱视（P〈0.01）;中心凹注视和中心凹旁注视患者的疗效明显优于黄斑旁注视和周边注视患者（P〈0.01）。结论大龄弱视儿童,只要坚持治疗,大部分治疗有效。其疗效与弱视类型、程度、注视性质密切相关。     

儿童屈光参差性弱视复发原因探讨

目的探讨屈光参差性弱视远期疗效的相关影响因素．．方法随访观察了123例217眼屈光参差性弱视，基本治愈后3a以上的病例，经再次扩瞳验光后证实矫正视力低于0.8以下。结果本组屈光参差性弱视的复发因其类型和程度不同存在着明显的差异，总复发率为25．2％，其中近视性屈光参差性弱视的复发率最高，依次为单眼性屈光参差性弱视，远视性屈光参差性弱视，和双眼性屈光参差性弱视。结论屈光参差性弱视治愈后的巩固是预防复发的根本。对弱视中易复发的病例应进行重点观察，早期发现、了解视力下降的原因，及时治疗是非常重要的。     

儿童弱视715眼治疗效果的临床分析

目的：探讨儿童弱视临床特点和综合治疗效果。

方法：选取2015-07/2017-07我院确诊收治的弱视儿童393例715眼,建立弱视治疗档案,给予弱视综合疗法治疗,观察其治疗效果,并对其年龄、弱视类型、弱视程度、弱视注视性质和治疗依从性等影响疗效的临床特点进行分析。

结果：患儿393例715眼中,基本治愈者520眼(72.7%),进步者117眼(16.4%),无效者 78眼(10.9%),总有效率为89.1%。年龄、弱视类型、弱视程度、注视性质、治疗依从性等临床特点影响弱视治疗效果。

结论：儿童弱视的总体治疗效果较好。与患儿年龄、弱视类型、弱视程度、弱视注视性质和治疗依从性等临床特点关系密切。年龄偏大,弱视类型为屈光参差性弱视、斜视性弱视,弱视程度重、旁中心注视及依从性差的患儿治疗效果差。     

综合疗法治疗儿童弱视410例分析

目的探讨应用综合治疗法治疗儿童弱视的疗效。方法对410例(750只眼)弱视眼,行配镜遮盖及精细目力训练等。结果年龄越小,弱视程度越轻,坚持治疗时间越长,疗效越好。屈光不正弱视治疗率明显高于屈光参差和斜视性弱视,中心注视性弱视疗效优于旁中心注视性弱视。结论综合疗法的疗效与弱视的类型、程度、年龄、坚持治疗时间和注视性质密切相关,综合治疗法疗效好。     

综合疗法治疗儿童弱视100例远期疗效观察

目的:探讨综合疗法治疗不同类型儿童弱视的远期临床疗效。 方法：对100例190眼儿童按弱视类型、弱视程度、注视性质和年龄进行分类,并采用矫正屈光不正、遮盖疗法、家庭精细目力训练及红光治疗、综合治疗仪对其进行治疗,随访观察达5a以上。 结果：屈光不正性弱视治愈率最高,明显高于屈光参差性、斜视性弱视和遮盖性弱视,轻度弱视的治愈率明显高于中度和重度弱视。中心注视高于旁中心注视,弱视治疗的年龄越小,疗效越好,3~6岁组明显高于其他年龄组。 结论：弱视治疗的疗效与弱视类型、弱视程度、注视性质及开始治疗的年龄、家长及患儿的依从性有密切关系,用综合疗法治疗弱视可以提高其治愈率,并缩短疗程。     

综合疗法治疗儿童弱视1045眼疗效分析

本文选用综合疗法治疗儿童弱视共５７０例１０４５眼,总治愈率为７３．１１％。轻度弱视治愈率为８７．０７％,中度弱视治愈率为８１．１４％,重度弱视治愈率为４７．２２％,中心注视治愈率为７８．６５％,旁中心注视为１７．０２％。屈光不正性弱视治愈率为８２．７６％,屈光参差性为４３．０８％,斜视性为４６．１％,形觉剥夺性为２５％。本组治疗效果与弱视的类型、程度、注视性质及年龄均有着密切关系,弱视程度越轻效果越好。中心注视者疗效远高于旁中心者,各类型的弱视中以屈光不正性疗效最佳。并认为综合性治疗法优于其他单一方法     

儿童弱视68例传统治疗疗效分析

目的:探讨应用眼睫状肌麻痹验光配镜,遮盖,精细目力训练,黑白光栅等视觉刺激治疗,斜视手术矫正等传统治疗方法,对儿童弱视治疗的疗效。方法:分析68例108眼弱视儿童,分别按年龄、弱视程度、弱视类型、注视性质分组,经过传统的方法治疗后,视力提高情况。结果:年龄越小治愈率越高:3～5岁组高于6～8岁组和9～12岁组;弱视程度越轻治愈率越高:轻度弱视组高于中度弱视组和重度弱视组;中心注视高于偏中心注视;屈光不正性弱视高于屈光参差性弱视和斜视性弱视。结论:儿童弱视矫治的疗效与患儿的年龄、弱视的程度、弱视类型、注视性质有关。传统治疗对弱视儿童视力的提高,效果切实有效,因其操作简单、方便经济值得基层医院学习推广。     

大龄儿童单眼弱视的疗效观察

目的探讨大龄儿童单眼弱视的疗效及其相关影响因素。方法10~15岁大龄儿童单眼弱视患儿67例(67眼),经综合疗法治疗弱视,观察其治疗效果,并对弱视类型、弱视程度、注视性质等相关影响因素进行分析。结果大龄儿童单眼弱视67例(67眼)治愈率(包括基本治愈+治愈率)为58.21%(39/67),进步26.87%(18/67),无效14.92%(10/67),总有效率为85.07%(57/67)。屈光参差性弱视、斜视性弱视和形觉剥夺性弱视的治愈率分别为71.74%、33.33%和0%,不同类型弱视之间的疗效差异有统计学意义(P<0.01)。轻度弱视、中度弱视和重度弱视的治愈率分别为85.71%、57.14%和27.27%,不同程度弱视之间的疗效差异有统计学意义(P<0.01)。结论大龄儿童单眼弱视疗效较好,应予积极治疗,其疗效与弱视类型、弱视程度、注视性质密切相关,屈光参差性弱视、弱视程度轻及中心注视者疗效好。     

儿童弱视326例的综合治疗效果

目的：探讨儿童弱视综合疗法治疗的疗效观察。 方法：儿童弱视326例485眼，根据弱视程度、弱视类型、注视性质、屈光状态，采取遮盖、压抑、精细目力训练、CAM视觉刺激、红光闪烁、后像、光刷、同视机治疗。 结果：视力增进2行或2行以上者483眼（99．6％）；其中治愈381眼（78．6％）；无效2眼（0．4％）；总有效率99．6％。综合疗法治疗儿童弱视，提高了有效治愈率，弱视程度越轻治疗效果越好。中心注视疗效明显高于旁中心注视，两组治愈率有显著统计学意义（P〈0．01）。各类弱视中以屈光不正性弱视疗效最佳，形觉剥夺性疗效最差。 结论：综合治疗儿童弱视是最理想、最有效的方法，见效快、疗效显著、值得临床推广。     

儿童远视性弱视与屈光状态的关系分析

目的探讨远视性弱视儿童远视度数与弱视、斜视的关系。方法对远视性弱视儿童300例（550眼）使用阿托品散瞳验光,检查结果进行统计学处理。结果远视性弱视儿童的远视度数由低至高依次为外斜视组、无斜视组、内斜视组。球镜度数越高,弱视程度越高,无斜视组中度弱视比轻度弱视球镜度数高,差异有高度显著性,轻度弱视比中度弱视的柱镜度数高,差异有显著性;重度弱视只有1例。内斜视组中度弱视比轻度弱视的球镜度数高,差异有高度显著性;重度弱视球镜度数比中度弱视低,与斜视和注视性质有关;外斜视组中度弱视比轻度弱视球镜度数高,差异有显著性。结论远视性弱视儿童远视度数与弱视程度有一定关系,但重度弱视还与视觉抑制和中心旁注视关系更为紧密;中高度远视是内斜视的主要原因;远视散光是弱视的重要原因。     

Visually evoked response (VER) in amblyopia: A diagnostic and prognostic indicator?

A study comprising 15 cases of anisometropic amblyopia and 15 cases of strabismic amblyopia was undertaken to analyse the alterations in the visually evoked response (VER) in amblyopia. Ten normal cases were taken to standardize the technique. A Nicolet Clinical Averager CA₁₀₀ was used to record the VER. A full ophthalmic check up including cycloplegic refraction, visual acuity recording and fixation pattern by visuscope was carried out in all the cases.

In normal cases the amplitude and implicit time of VER showed no statistically significant difference between the two eyes. However, a wide inter-subject variability was observed. the maximum amplitude was seen with a check size of 60′. In amblyopic eyes (both strabismic and anisometropic) there was a significant reduction in the amplitude and a significant increase in the implicit time when compared to the normal fellow eye. A significant amplitude difference of more than 5 μV, as also a significant increase of implicit time (more than 10 msec) was noticed only when the visual acuity was below 6/18. Recording of VER in amblyopic eyes with visual acuity less than 6/60 mostly resulted in no discernible pattern. A non-recordable pattern on VER in amblyopic eyes signifies a poor visual acuity and possibly suggests a bad prognosis for the treatment of amblyopia.     

Studies on ‘meridional amblyopia’ by VECP after pattern reversal stimulation

With the aim of investigating the so-called ‘meridional amblyopia’, the authors compared the meridional sensitivity of astigmatic subjects between the two principal meridians (meridional ratio), using the Visually Evoked Cortical Potentials (VECP) after pattern reversal stimulation. The following results were obtained: Unilateral cases with amblyopia showed a higher meridional ratio than bilateral cases with amblyopia. In unilateral as well as in bilateral cases with amblyopia, the meridional ratio decreased along with optical correction and occlusion therapy, and finally it became within a normal range. It is suggested that meridional amblyopia should be regarded either as anisometropic amblyopia or ametropic amblyopia.     

共同性斜视矫正术后双眼总和图形视觉诱发电位的对比分析

目的：通过分析共同性斜视矫正手术前后双眼总和图形视觉诱发电位的变化,探讨共同性斜视手术时机及其在斜视性弱视治疗中的作用。 方法：回顾性分析18岁以内在院接受共同性斜视矫正术治疗,且术后斜视矫正正位（斜视度≤±10△）的病历资料67例。按手术前斜视类型、接受手术时年龄、弱视程度分组,对各组术前、术后1,3 mo分别进行双眼总和P-VEP检测。结果以双眼反应/单眼反应（ B/M）比值作为评价指标。 结果：所有病例术后1 mo B/M值均升高,差异有显著统计学意义（P〈0.01）。其中（1）内斜视组术后3mo的B/M值升高较外斜视组明显（P〈0.05）;（2）≤6岁组,术后3mo B/M值升高较〉12岁组明显（P〈0.05）。（3）重度弱视组术后1mo的B/M值升高较轻度弱视组明显（P〈0.05）;术后3mo,重度弱视组B/M值升高较轻度、中度弱视组明显（P〈0.01）。 结论：经过弱视治疗后视力仍难以提高的共同性斜视患者建议6岁前行斜视矫正手术,特别是重度弱视及内斜视患儿（调节性内斜视除外）。早期手术有利于弱视的进一步治疗及双眼视功能的恢复。     

Amblyopia in 4-year-old children treated with grating stimulation and full-time occlusion; a comparative study.

We have compared the effects on visual acuity and binocular functions of grating stimulation (CAM therapy) and full-time occlusion in 38 4-year-old, previously untreated amblyopic children. The patients were divided into subgroups with regard to amblyopia type and fixation pattern. We found that grating stimulation was slightly better than occlusion in improving visual acuity of anisometropic amblyopes with central fixation, but that both types of therapy were equally effective in strabismic amblyopia with central fixation and in amblyopia with eccentric fixation. However, maximal treatment effects were not reached with grating stimulation alone, as shown at follow-up after continued conventional therapy. Grating stimulation may be regarded as a valuable method at the initiation of treatment, particularly in anisometropic amblyopia, but it has to be supplemented with occlusion, which still must be regarded as the prime form of amblyopia therapy.     

Fixation Characteristics of Severe Amblyopia Subtypes: Which One is Worse?

Purpose: To determine differences in macular sensitivity and fixation patterns in different subtypes of severe amblyopia. Methods: This case-control study enrolled a total of 73 male adults, including 18 with pure strabismic severe amblyopia, 19 with pure anisometropic severe amblyopia, 18 with mixed (strabismic plus anizometropic) severe amblyopia, and 18 healthy controls. MP-1 microperimetry was used to evaluate macular sensitivity, location of fixation, and stability of fixation. Results: Mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in all amblyopia subtypes when compared with healthy controls. Intergroup comparisons between amblyopia subtypes revealed that mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in pure strabismic and mixed amblyopic eyes when compared with pure anisometropic amblyopic eyes. Conclusions: Strabismus seems to be a worse prognostic factor in severe amblyopia than anisometropia in terms of fixation characteristics and retinal sensitivity.     

Risk of amblyopia recurrence after cessation of treatment.

BACKGROUND: Although amblyopia can be successfully treated with patching or atropine, there have been few prospective studies of amblyopia recurrence once treatment is discontinued. METHODS: We enrolled 156 children with successfully treated anisometropic or strabismic amblyopia (145 completed follow-up), who were younger than 8 years of age and who received continuous amblyopia treatment for the previous 3 months (prescribed at least 2 hours of daily patching or prescribed at least one drop of atropine per week) and who had improved at least 3 logMAR levels during the period of continuous treatment. Patients were followed off treatment for 52 weeks to assess recurrence of amblyopia, defined as a 2 or more logMAR level reduction of visual acuity from enrollment, confirmed by a second examination. Recurrence was also considered to have occurred if treatment was restarted because of a nonreplicated 2 or more logMAR level reduction of visual acuity. RESULTS: Recurrence occurred in 35 (24%) of 145 cases (95% confidence interval 17% to 32%) and was similar in patients who stopped patching (25%) and in patients who stopped atropine (21%). In patients treated with moderately intense patching (6 to 8 hours per day), recurrence was more common (11 of 26; 42%) when treatment was not reduced prior to cessation than when treatment was reduced to 2 hours per day prior to cessation (3 of 22; 14%, odds ratio 4.4, 95% confidence interval 1.0 to 18.7). CONCLUSIONS: Approximately one fourth of successfully treated amblyopic children experience a recurrence within the first year off treatment. For patients treated with 6 or more hours of daily patching, our data suggest that the risk of recurrence is greater when patching is stopped abruptly rather than when it is reduced to 2 hours per day prior to cessation. A randomized clinical trial of no weaning versus weaning in successfully-treated amblyopia is warranted to confirm these observational findings.     

Amblyopia in unilateral congenital ptosis: early detection by sweep visual evoked potential

Background: Fixation preference assessment is a clinical tool widely used to determine amblyopia in young infants and children. It is our clinical experience that this tool underestimates amblyopia. The purpose of this study was to compare the results of sweep visual evoked potentials to fixation preference assessment in cases of unilateral ptosis. Methods: Sweep visual evoked potentials were performed in 17 children with unilateral ptosis thought to have equal acuity by fixation preference asessment. Binocular and monocular sweep visual evoked potentials were recorded to square-wave gratings of 80% contrast counterphase modulated at 6 Hz. A range of spatial frequencies from 1 to 30 cycles per degree were presented over a 10-s period. Resolution acuity was determined as the zero-microvolt intercept of linear regression analysis on the visual evoked potential amplitude versus spatial frequency. Results: Nine of the 17 children had interocular resolution acuity differences ranging from 0.8 to 2 octaves by sweep visual evoked potential testing. This correlates to a Snellen equivalent interocular difference of 2 to 7 lines and clinical amblyopia. Conclusion: This study confirms our clinical impression that children who are unable to preform recognition acuity tasks and are thought to have equal vision by fixation preference assessment often have 2 or more lines of Snellen acuity difference (amblyopia) when they are finally old enough to be tested by Snellen methods. It also implies that amblyopia precedes refractive errors and strabismus in unilateral ptosis cases. Clinical methods to determine amblyopia other than fixation preference assessment need to be explored with a view to earlier detection, better definition and treatment of amblyopia.