不同年龄段急性获得性共同性内斜视的临床特征

目的：分析不同年龄段急性获得性共同性内斜视(AACE)患者的临床特征。

方法：回顾性临床病例研究。连续纳入2015-01/2022-12在北京大学人民医院手术的非Ⅰ型(AACE)患者112例。收集的患者信息包括：性别、年龄、发病年龄、手术年龄、发病持续时间(手术与发病的时间间隔)、屈光度、发病前6 mo每日近距离用眼时间、术前及术后1 mo三棱镜斜视度及Titmus近立体视。将患者按年龄分为<18岁组22例，18-45岁组67例，>45岁组23例。比较各组患者的临床资料特点。

结果：共纳入患者112例，其中男56例，女56例，手术年龄为29.50(19.25，41.75)岁，近视患者97例(86.6%)。发病前6 mo每日近距离用眼时间>8 h患者93例(83.0%)。年龄<18岁组患者发病持续时间为1.00(0.50，1.00)a，右眼屈光度为-0.75(-3.19，-0.56)D，左眼为-1.25(-2.81，-0.75)D，术前看近斜视度为30.00(18.50，80.00)PD，看远斜视度为 35.00(23.75，80.00)PD，较其余两组比较均有差异(均P<0.05)。18-45岁组患者术前看近斜视度为20.00(14.00，30.00)PD ，看远斜视度为25.00(20.00，35.00)PD，两者均较年龄>45岁组大(均P<0.05)。年龄>45岁组术后1 mo看近斜视度为-4.50(-7.50，0)PD ，术后1 mo看远斜视度为4.50(0，9.50)PD ，较其余两组更小(均P<0.05)。>45岁组患者手术成功率最高(100%)。术前立体视>45岁组比<18岁组患者更好(P<0.05)，术后1 mo立体视18-45岁组、>45岁组均好于<18岁组(均P<0.05)。

结论：AACE手术患者主要在18-45岁，斜视度特点为看远斜视度比看近大。术前年龄<18岁的患者斜视度较成人更大，但术后早期立体视较成人差。对于18-45岁AACE患者可适当增加手术量(5-10 PD)，低龄远视、术前双眼视功能尚未建立的儿童，适当保守设计。     

急性共同性内斜视的临床特征分析及手术治疗体会

目的 探讨急性共同性内斜视的临床特点、手术治疗方案及效果.方法 对在我院诊治的16例急性共同性内斜视患者进行回顾性研究.结果 16位患者平均年龄为(21.38±6.65)岁(10～34岁),发病前患者平均每日近距离(≤30 cm)用眼时间为(9.13±1.59)h,持续时间为(6.06±2.07)个月,平均等效球镜右眼...     

急性共同性内斜视的手术治疗

目的 探讨急性共同性内斜视的手术治疗及效果.方法 对29例急性共同性内斜视患者进行回顾性研究,手术采用单眼或双眼内直肌后徙、单眼内直肌后徙加外直肌截除、双眼内直肌后徙加单眼或双眼外直肌截除,手术量较普通内斜视略大.同视机及颜氏立体图检查术前及术后双眼视觉和立体视.结果 29例患者术后眼位矫正满意,患者复视消失.双眼单视功能改善,术后1个月融合范围平均20.57°± 3.93°,与术前比较差异有显著统计学意义(t=3.396,P<0.01);术后1 a融合范围平均26.91°±4.09°,与术后1个月比较差异有统计学意义(t=1.971,P<0.05).结论 急性共同性内斜视在保守治疗3～6个月后尽早实行手术治疗,达到斜视和复视消失及功能治愈目的 .[眼科新进展2009;29(6).466-167]     

不同屈光状态急性共同性内斜视患者的临床特征及治疗体会

目的:分析不同屈光状态急性共同性内斜视患者的临床特征及治疗情况。方法:回顾分析2020-01/2022-01我院收治的非Ⅰ型急性共同性内斜视患者110例,根据治疗前屈光状态分为非近视组(30例,等效球镜>-0.5D)和近视组(80例,等效球镜≤-0.5D),分析两组患者治疗前斜视度、AC/A值、视功能情况及手术方式和术后复发情况等。结果:非近视组患者裸眼视近斜视度[(47.13±23.54)^△]与视远斜视度[(48.90±22.59)^△]无差异(P>0.05);近视组患者裸眼视近斜视度[(40.49±26.09)^△]小于视远斜视度[(50.09±25.41)^△](P<0.001);两组患者相同距离斜视度无差异(P>0.05)。非近视组患者AC/A值(5.40±2.23)大于近视组(3.14±3.10)(P<0.05)。近视组患者近立体视优于非近视组(P<0.05)。非近视组手术方式多样,近视组多采用外直肌缩短和/或内直肌后退术。结论:不同屈光状态均可发生急性共同性...     

共同性内斜视患者的屈光状态统计分析

目的 分析共同性内斜视患者的屈光状态，探讨共同性内斜视的发病原因。方法 对我院1990-2003年经住院治疗的774例共同性内斜视患者的屈光状态进行统计分析。结果 774例共同性内斜视患儿，平均年龄10．32岁。远视者483眼，构成比为62．40％；近视者131眼，构成比为16．93％；12岁以前年龄组中发生远视470眼（占87．69％），5岁以前219眼（占97．77％）；12岁以后年龄组中，发生远视13眼（占5．46％）；12岁以前组发生近视者25眼（占4．66％），12岁以后组的近视构成比为44．54％；重度内斜视组中，中、高度远视占58．13％。结论 （1）共同性内斜视患者，远视屈光不正者比正常人群远视患病率高；（2）内斜视斜视角大的中、高度远视比例明显高于中度和轻度内斜视组（P〈0．01）；（3）调节性内斜视伴发的远视屈光多为中、高度远视，较其他类型内斜视差异有非常显著性（P〈0．01）；平均屈光度为＋4，72D，明显高于非调节性内斜视（P〈0．01）；（4）先天性内斜视患者的远视屈光度平均为＋3．65D，明显高于非调节性内斜视组（P〈0．01）。且半数以上为中、高度远视，亦高于非调节性内斜视组（P〈0．01），推测屈光不正所引起的调节作用在先天性内斜视的病因中可能起一定的作用；（5）非调节性内斜视伴有远视者占41．17％，多为轻、中度远视，平均屈光度为＋1．96D；（6）共同性内斜视伴有近视者占22．54％，较正常人群近视患病率高，且中、高度近视超过半数，这一关系值得重视；（7）共同性内斜视12岁以前组远视屈光状态高于12岁以后组（P〈0．01）；近视屈光状态低于12岁以后组（P〈0．01）。     

不典型急性获得性共同性内斜视的临床分析及手术疗效观察

目的:分析病因不典型急性获得性共同性内斜视（AACE）的临床特点、可能病因及手术疗效。方法:病例对照研究。收集2019年1至12月在天津市眼科医院确诊为AACE并行斜视矫正手术治疗的12例患者资料,其中男性7例,女性5例,年龄（28±7）岁,12例患者均伴有复视主诉,发病时长（8.83±3.71）个月,均行眼部常规检查...     

低龄儿童共同性内斜视手术治疗探讨

共同性内斜视是儿童最多见的斜视类型。因其发病早 ,对双眼视觉发育影响严重。其治疗目的是矫正眼位 ,恢复双眼视功能。多数需在基础麻醉下手术 ,故掌握手术时机及手术定量是手术成功的关键。本文观察了 6 2例低龄 (≤ 7岁 )儿童共同性内斜视矫正术后双眼视觉及眼位恢复情况 ,分析各种因素对疗效的影响 ,以探讨其手术时机、手术方式、手术定量及术后管理。对象和方法(1)对象 :本组患者 6 2例中 ,男 2 8例 ,女 34例。手术年龄 2～ 7岁 ,平均 4 .2岁。先天性内斜视 13例 ,部分调节性内斜视 2 8例 ,非调节性内斜视 2 1例。(2 )全部手术患者均用…     

急性共同性内斜视手术治疗探讨

目的 探讨急性共同性内斜视的诊断及处理.方法 选取2003～2009年经治疗的12例5～12岁诉有复视、斜视度为25△～60△、双眼存在立体视觉的急性共同性内斜视病人先排除了神经系统疾病后,行常规内斜矫正术并作回顾性分析.结果 术后随访6～18个月,所有病人眼位被矫正,复视消失,立 体视觉维持并改善到40".结论 急性...     

成人急性共同性内斜视的临床观察

目的 对成人急性共同性内斜视进行回顾性研究，获取诊断、治疗的共性。方法 对成人急性共同性内斜视病人15例进行内直肌徙后的调整缝线手术，术后常规进行1～2周同视机训练，收集资料，进行数据统计、分析。结果 （1）看远斜度大于看近。（2）实际手术量比共同性内斜大。（3）术后双眼视功能恢复好。（4）大部分病人复视消失。（5）内直肌止端靠前。结论 急性共同性内斜视大部分可通过手术矫正达到复视消失、功能治愈的目的，手术量的计算与其他共同性内斜视不同。     

Clinical Characteristics and Surgical Effects of Type Ⅲ Acute Acquired Concomitant Esotropia

Objective: To investigate the clinical characteristics and surgical effects in type Ⅲ acute acquired concomitant esotropia (AACE Ⅲ). Methods: This was a retrospective self-control study. Thirty-one AACE Ⅲ patients, aged 14 to 39 years, who underwent routine strabismus surgery at the Affiliated Eye Hospital of Nanjing Medical University, were enrolled from July 2016 to July 2019. The following data were collected: Onset time, binocular ametropia, time of near work, the attachment point of the internal rectus muscle, pre- and postoperative deviation, fusion range, and distance and near stereopsis. The followup period ranged from 6 months to 12 months (7.4±2.6 months). A Wilcoxon signed rank test was used to compare the difference in esodeviation and binocular fusion range before and after strabismus surgery. Preand postoperative distance stereopsis were analyzed by the traditional paired Chi square test, while pre- and postoperative near stereopsis was analyzed by the enhanced paired Chi square test. Results: Among the 31 patients with AACE Ⅲ, 3 patients (10%) had high myopia, 25 patients (81%) had moderate myopia, 2 patients (6%) had low myopia, and only one patient (3%) had emmetropia. All patients had performed nearwork with an average time of 7.8±1.1 hours per day. The average distance between the attachment point of the internal rectus muscle and the corneal limbus was 4.9±0.1 mm. The median pre-operative esodeviation at near (33 cm) was 35 PD, and at distance (6 m) was 40 PD. The difference between them was statistically significant (Z=-3.136, P=0.002). In this study, all patients underwent a successful strabismus operation and at the time of the final follow-up, whether it was at 33 cm or 6 m, the median degree of postoperative strabismus was 0 PD. Compared with the pre-operative degree of strabismus at the same distance, the postoperative degree was significantly smaller (both Z=-4.865, both P<0.001). The median of pre- and postoperative binocular fusion range was 14° and 19°, respectively, and the difference between them was statistically significant (Z=-3.149, P=0.002). Compared with distance and near stereopsis before strabismus surgery, 16(84%) patients recovered distance stereopsis and 19(95%) patients recovered near stereopsis after the surgery. Both distance and near stereopsis significantly improved when comparing stereopsis before and after surgery. The difference was statistically significant (χ2 =14.063, 24.000, respectively; P<0.001, P=0.001, respectively). Conclusions: Prolonged near work, the forward attachment point of the internal rectus muscle and moderate myopia appear to be important risk factors for AACE Ⅲ. Strabismus surgery to establish the proper angle can significantly diminish the degree of esotropia and improve the binocular fusion range and stereopsis in AACE Ⅲ patients.     

Simultaneous Development of Acute Acquired Concomitant Esotropia in Two Siblings during the COVID-19 Pandemic: A Case Report

Aim:To report a case of two siblings who near–simultaneously developed a large angle concomitant esotropia during the COVID–19 pandemic, and to describe their treatment and outcomes.Method:A 5–year–old boy and his 11–year–old sister were presented to the hospital eye service in early 2021, having both developed acute–onset large angle esotropia within three months of each other. Neither had any significant past medical, ophthalmic, or family history. The siblings lived in the same household, and both experienced lifestyle changes as a result of the UK lockdown in response to COVID–19.Results:Each sibling was treated with right medial rectus recession (5.5 mm) and right lateral rectus resection (7 mm), and at a three–month follow–up, both were minimally esophoric with restored binocularity.Conclusion:The unusual and abrupt changes in lifestyle imposed by the COVID–19 pandemic highlight the likelihood of an environmental aetiology for some forms of esotropia and raise the possibility that extended screen time may be a contributory factor.     

双鼻侧遮盖法辅助治疗儿童共同性内斜视的效果

目的：观察双鼻侧遮盖法辅助治疗儿童共同性内斜视的效果。方法：前瞻性临床研究。纳入2019年 1─7月期间在厦门市儿童医院经阿托品眼膏散瞳验光连续配戴远视全矫眼镜6～9个月后仍有+20△ 以上内斜视的3～10岁非调节性内斜视或部分调节性内斜视患儿21例。给予双鼻侧遮盖辅助治疗。 每个月定期复查观察患儿视力及斜视度的矫正情况。数据采用重复测量方差分析进行分析。结果： 遮盖前斜视度为（+33±13）△;遮盖3个月后斜视度为（+21±15）△,其中矫正显效3例,有效11例, 无效7例;遮盖6个月后斜视度为（+18±12）△,其中矫正显效5例,有效13例,无效3例。3个时间点 斜视度比较,总体差异有统计学意义（F=8.316,P=0.001）。结论：双鼻侧遮盖法可以有效地辅助治 疗儿童共同性内斜视。     

Effect of Binasal Occlusion in Children with Concomitant Esotropia

Objective: To investigate the effect of binasal occlusion in the treatment of children with concomitant esotropia. Methods: In this propective clinical study, 21 children aged 3 to 10 years with nonaccommodative esotropia or partly accommodative esotropia who had more than +20△ esotropia after full refraction correction for 6 to 9 months at Xiamen Children's Hospital from January 2019 to July 2019 were examined. All the children were given binasal occlusion. Vision function and strabismic degree were re-examined every month. Data were analyzed by single factor analysis of variance. Results: The average strabismus was +33△±13△ before binasal occlusion. After binasal occlusion for 3 months, average strabismus was +21△±15△. Three cases were markedly corrected, 11 cases were effectively corrected, 7 cases were invalid. After binasal occlusion for 6 months, average strabismus was +18△±12△. Five cases were markedly corrected, 13 cases were effectively corrected, 3 cases were invalid. The difference was statistically significant (F=8.316, P=0.001). Conclusions: Binasal occlusion can effectively assist the treatment of concomitant esotropia in children.     

急性共同性内斜视的临床特点和非手术治疗的疗效评估

目的 探讨急性共同性内斜视的临床特点,并评估非手术治疗的临床疗效。方法 回顾性系列病例研究。收集2015年8月至2017年11月在中国人民解放军武汉总医院眼科确诊的急性共同性内斜视患者18例。收集完整的临床资料,包括患者基本资料、神经内科会诊情况,眼前节及眼底、远近斜视度、双眼视觉状态、头颅影像学检查。随访2~8个月,平均3.9个月。采用配对t检验进行统计分析。结果 患者年龄21~52（29.7±10.3）岁。戴镜看远斜视度为+9^△~+60^△（+36±13）^△;看近斜视度为+7^△~+45^△（+28±12）^△。看远斜视度大于看近,差异有统计学意义（t=6.32,P<0.001）。所有患者全身查体、中枢神经系统及内分泌系统检查均未见异常。在屈光矫正的基础上,使用底朝外三棱镜按照1:1的比例分别加到左右眼上。3例在随访期间不接受三棱镜矫正,改行斜视手术;其余患者均坚持戴镜,末次随访未诉戴镜看远复视明显,戴镜看远斜视度+6^△~+23^△,看近斜视度+4^△~+18^△。11例表示满意,4例认为一般,3例不满意。结论 急性共同性内斜视主要发生在近视人群,看远斜视度大于看近斜视度。三棱镜验配对于改善大部分急性共同性内斜视患者看远复视及斜视具有较好疗效,达到了治疗目的且避开了因患者处于发病早期斜视度数尚不稳定带来的手术治疗的风险,但长期疗效还需进一步观察。     

不同术式治疗垂直分离性斜视的临床疗效分析

目的探讨治疗垂直分离性斜视（DVD）的最佳手术方式。方法对43例（72眼）DVD根据不同的术前检查结果选择不同的术式。有下斜肌亢进者首选下斜肌切断加转位,根据亢进程度不同决定下斜肌在转位之前的截除量。无下斜肌亢进者首选上直肌后退术。双眼DVD不伴有下斜肌功能亢进者,且上斜程度相等者行双跟上直肌等量后徙术;双眼上斜程度不等者行双眼上直肌不等量后徙,或先行上斜明显眼手术,改期行另眼手术;合并水平斜视者尽可能同时完成,否则先矫正水平斜视,半年后矫正DVD。结果52眼疗效良好（72．22％）,16眼好转（22．22％）,4眼（5．56％）无效,1眼（1．38％）退上直肌和双眼外直肌后出现继发内斜视和对侧眼下斜肌亢进。结论对不同类型的DVD采用不同的术式可获得良好的疗效。     

Unusual Presentation of Spasm of Near Reflex Mimicking Large-Angle Acute Acquired Comitant Esotropia

We report the case of an 11-year-old boy who presented with sudden esotropia, binocular diplopia, and blurred vision. The patient was neurologically normal. He had a large, constant, comitant, alternating esotropia associated with minimal accommodative spasm. Ocular motility and pupillary reactions were normal. He was diagnosed to have spasm of the near reflex presenting as acute onset of esotropia. The esotropia was persistent despite treatment and eventually resolved with prolonged cycloplegic therapy. This unusual case illustrates that spasm of the near reflex can have unique and variable presentations. Spasm of the near reflex needs to be considered in the differential diagnosis of every case of acute, acquired, comitant esotropia. This is the first case of spasm of the near reflex where persistent esotropia is reported in the absence of any neurological disorder.     

Short-Term Motor and Sensory Outcomes in Acquired Nonaccommodative Esotropia of Childhood

Information on the management of acquired nonaccommodative esotropia (ANAET) of childhood is incomplete. Most prior reports combine the results of patients with both accommodative and nonaccommodative esodeviations. The primary objective of this study was to describe the early postoperative motor and sensory results of children with acquired nonaccommodative esotropia.

The medical records of 72 consecutive children with ANAET who underwent surgical correction at East Tennessee State University College of Medicine from August 1, 1995 through October 1, 2001 were retrospectively reviewed.

The median age at surgery for the 72 study patients was 43.8 months with a median angle of deviation of 30 prism diopters (PD) at both distance and near. Ten patients (13.9%) required a second surgical procedure while one patient (1.4%) required a third. The cumulative probability of a second surgery within two years of the first procedure was 24% (95% CI 4–43%). During a median postoperative follow-up period of 7.1 months, 64 (88.9%) patients were within 8 PD of orthotropia on the last postoperative examination. Normal postoperative stereoacuity was achieved in several children whose deviation began after 30 months of age, as well as in one child who was misaligned for at least two years prior to surgery.

Although the postoperative follow-up on these patients with acquired nonaccommodative esotropia managed without prism adaptation is short, the motor results are similar to other studies on patients with acquired esotropia, with sensory outcomes superior to those obtained in children with congenital esotropia.