脑瘫患儿伴发视觉障碍的临床研究

目的：了解脑瘫患儿常见的视觉障碍情况,为临床早期行眼部筛查、诊断及治疗提供依据,促进脑瘫患儿的视觉康复。

方法：对223例确诊为脑瘫的患儿行眼部常规检查,包括眼位及眼球运动检查,间接检眼镜或Retcam Ⅱ检查眼底,散瞳验光检查了解屈光状态,闪光视觉诱发电位(F-VEP)检查了解视觉通路传导,记录并分析常见的视觉障碍。

结果：脑瘫患儿223例中,主要的视觉障碍表现为斜视、屈光不正及闪光视觉诱发电位的改变,部分患儿还同时伴有不同类型的眼底病变。其中有174例伴有不同类型的斜视,内斜最常见为121例,外斜次之为36例,垂直性斜视者15例,眼球震颤者2例。129例247眼存在屈光不正,复性远视散光118眼,单纯远视51眼,混合散光33眼,复性近视散光19眼,单纯远视散光21眼,单纯近视散光4眼,单纯近视1眼。194例381眼存在闪光视觉诱发电位的异常,主要表现为P2波的潜伏期延长,振幅降低。51例伴有不同类型的眼底改变,视神经萎缩及眼底出血最为常见。

结论：脑瘫患儿常常伴发不同类型的视觉功能障碍,严重影响了患儿的视觉质量及全身康复,重视眼部常规检查及视觉训练,对患儿视觉系统的正常发育及脑瘫的全面康复具有重要的意义。     

智障儿童眼部筛查结果与分析

目的 通过对温州地区特殊学校就读的智障儿童进行眼部健康筛查,了解智障儿童的眼部健康问题,分析相关因素,以提供相应的视觉矫正和治疗措施,及探索如何为智障儿童的眼部健康提供有效的服务.方法 调查研究.对在温州地区特殊学校就读的342名智障儿童进行眼部健康筛查,内容包括：一般信息、视力检查、眼位检查、色觉检查、眼前段检查、内眼检查以及屈光不正检查.采用Excel软件对数据进行整理、归纳和求百分比.并针对存在的视觉问题作出相应的分析和医学处理.结果 筛查患儿智力残疾为轻度至中度,心理与情绪等适应能力轻度或中度障碍,能参与部分社区活动.眼科检查发现,正视眼占46.6%,屈光不正均以低度屈光不正状态为主,大部分能通过眼镜矫正达到5.0 眼位检查显示正位眼占67.2%,隐斜视占12.9% 色觉正常者占81.9%,色觉存在明显异常者占6.4% 外眼及眼前段检查未发现明显异常者占92.7% 内眼检查未发现明显异常者占81.1%.这些患儿眼部的异常主要是眼球震颤（占50.0%）和白内障（占28.3%）.结论 智障儿童的眼部问题现患率比普通儿童高,但还是以屈光不正、眼球震颤、白内障等为主,大多为可矫正和可康复的,可以通过眼镜、手术或视觉康复等提高视功能.     

脑瘫患儿的视觉功能综合评估

目的：采用多项客观指标综合评估脑瘫患儿视觉功能,探讨脑瘫患儿的视觉障碍的临床特点。方法：对43例86眼眼部有视觉障碍脑瘫患儿进行眼追随实验、视动性眼震、屈光、眼底、斜视、图形视觉诱发电位(pattern visual evoked potential,P-VEP)及头颅磁共振成像( magnetic resonance imaging,MRI)等客观指标检查;对脑瘫患儿的视觉功能进行综合评估,分析不同性质脑瘫患儿的视觉障碍发生特点和可能机制。结果：(1)43例86眼合并视觉障碍患儿中,25例50眼(58.1%)脑瘫患儿发现屈光不正;24例48眼(55.8%)患儿存在斜视;12例24眼(27.9%)患儿伴有眼球震颤;19例38眼(44.2%)眼底视神经萎缩或者发育异常;35例70眼(81.4%)患儿VEP表现为异常;其中痉挛型脑瘫患儿中视觉障碍发生率与其他各组差异有显著统计学意义(P<0.01);(2)脑瘫患儿中内斜视发生者为16例32眼(37.2%),外斜视发生者为6例12眼(14.0%),垂直斜视发生者为2例4眼(4.7%)。痉挛性脑瘫中斜视最多见,发生者为13例26眼(30.2%),并都表现为内斜视,而肌张力低下型及其他型脑瘫容易并发外斜视;(3)在患屈光不正的脑瘫患儿中,远视为23例46眼(53.5%),近视为8例16眼(18.6%),散光为16例32眼(37.2%),屈光参差为14例28眼(32.6%);(4)脑瘫患儿VEP多表现为增幅下降,潜伏期延长,波形分化较差;其中痉挛性脑瘫VEP异常发生率高;(5)枕叶皮层受损和脑室周围白质软化( periventricular leukomalacia, PVL)伴发视觉障碍的发生率最高,PVL与枕叶皮层组发生率差别没有统计学意义(P>0.05),皮质损害脑瘫患儿无眼球震颤发生。结论：脑瘫患儿的视觉障碍在临床常见,各类型脑瘫患儿视觉障碍发生率有差别并有着不同临床特点;客观综合指标评估方法对脑瘫患儿视觉功能评估准确可靠。     

痉挛性脑瘫患儿72例眼部检查分析

目的:了解脑瘫患儿的眼部情况。方法:对72例脑瘫患儿进行眼部常规检查,对眼位、眼底、屈光状态、立体视等情况进行临床分析。结果:脑瘫患儿合并斜视、眼底异常、屈光不正、立体视异常等多种眼部疾病。结论:应重视脑瘫患儿斜视、屈光不正的早期治疗,提高患儿视觉质量。     

MTI摄影筛查仪筛查婴幼儿斜视和屈光不正分析

目的 探讨MTI摄影筛查仪在眼科门诊对婴幼儿进行斜视和屈光不正筛查的价值。方法 对门诊的226例婴幼儿进行了筛查，阳性结果的病例再进行眼科常规检查，二者进行对比。结果 儿童合作率为100％，筛查结果异常率达22．84％，其中屈光不正占16．99％，斜视占5．75％。预测阳性率分别为斜视100％、远视100％、近视76．92％、散光88．88％、屈光参差87．50％。结论 MTI摄影筛查仪对婴幼儿斜视和屈光不正有很高的预测阳性率，它与眼科常规检查的结合可以提高防治弱视的效率。     

SpotTM视觉筛查仪在儿童斜视筛查中的应用

目的：探讨SpotTM在儿童斜视筛查中的可配合性及在斜视性弱视危险因素筛查中的筛查效率。方法：横断面研究。2015 年7-10 月在天津和平新世纪妇儿医院保健科体检的389 例儿童先后进行SpotTM及小儿眼科医师检查,依据SpotTM内设眼位异常推荐值确定出需要转诊的儿童,小儿眼科医师依据2013 年美国斜视与小儿眼科协会规定的视觉筛查转诊指南确定出具有斜视性弱视危险因素的儿童,最终评估SpotTM在斜视性弱视危险因素筛查中的敏感度、特异度、阳性预测值及阴性预测值。结果：389 例儿童入组,平均年龄（6.0±2.3）岁。97.4%的儿童能配合SpotTM检查,无法配合SpotTM检查直接转诊的10例儿童中7例患有眼部疾病。小儿眼科医师确定38例（9.8%）具有斜视性弱视危险因素;经SpotTM筛查,确定需转诊的眼位异常者49 例（12.6%）。SpotTM在斜视性弱视危险因素筛查中敏感度71.0%,特异度93.7%,阳性预测值55.3%,阴性预测值96.8%。结论：大多数儿童可配合SpotTM的检查,SpotTM在斜视性弱视危险因素的筛查中具有一定的临床应用价值。     

脑瘫患儿常见视觉障碍的临床分析

目的：了解脑瘫患儿常见的斜视、视神经萎缩等视觉障碍情况,及其与脑瘫分型的关系。方法：对265例确诊为脑瘫的患儿行眼科常规检查,包括眼位及眼球运动、眼球震颤、裂隙灯眼前节、散瞳后眼底情况检查。结果：脑瘫儿童265例中,女95例,男170例;痉挛型173例,不随意运动型28例,肌张力低下43例,混合型18例,共济失调3例。纳入本研究的脑瘫患儿视觉障碍包括斜视、先天性白内障、视神经萎缩或其他眼底病变。有视觉障碍的脑瘫患儿127例（47．9％）,男79例,女48例;其中斜视110例（41．5％）：内斜46例（41．8％）,外斜54例（49．1％）,垂直斜视10例（9．1％）;眼球震颤者18例;先天性白内障患儿3例6眼;视神经萎缩者42例76眼（15．8％）,单眼8例,男25例46眼,女17例30眼。结论：脑瘫患儿常伴随着不同程度的视觉障碍,由于患儿的表达受限,造成不能及时发现和治疗眼部疾患,影响其视功能恢复和全身康复,重视脑瘫患儿早期眼部检查和治疗,可很大程度提高其生活质量和社会适应性。     

不同类型弱视儿童视网膜结构和视觉诱发电位及立体视功能的差异性分析

目的:分析不同类型弱视儿童的视网膜结构和功能、视觉诱发电位及立体视功能的差异性。方法:选取2014-05/2018-05在我院眼科治疗的中度弱视儿童92例136眼为观察组(屈光参差性31例31眼,屈光不正性35例70眼,斜视性26例35眼),另选取在我院眼科检查视力正常的儿童29例58眼为对照组。采用光学相干断层扫描(OCT)成像仪检测黄斑中心凹厚度、视盘周围及各象限视网膜神经纤维层(RNFL)厚度,采用视觉眼电图检测视网膜功能变化,观察视觉诱发电位P100波幅值及潜伏期的特点,并进行立体视觉检查。结果:屈光参差性、屈光不正性弱视儿童黄斑中心凹厚度、视盘周围及各象限RNFL厚度均明显高于对照组和斜视性弱视儿童(P<0.01)。与对照组相比,屈光参差性弱视儿童视觉眼电图光峰电位偏低,光峰时间延长,屈光不正性弱视儿童中近视儿童暗谷电位偏高,Arden比和Gliern比减小(均P<0.01)。三种类型弱视儿童视觉诱发电位P100波幅值均明显低于对照组,且1°和15′空间频率潜伏期明显延迟(均P<0.01)。屈光不正性弱视儿童交叉视差、非交叉视差、近零视差、远立体视功能正常眼数显著高于斜视性弱视儿童(P<0.0167),但与屈光参差性弱视儿童上述各项指标无差异。结论:屈光参差性弱视、屈光不正性弱视儿童视网膜结构存在明显异常,且P100波潜伏期延迟;斜视性弱视对立体视功能影响最大,而屈光不正性弱视影响最小。     

屈光不正与立体视觉

屈光不正与立体视觉尹苏建报告１２６例屈光不正患者的立体视觉检查结果如下。临床资料屈光不正患者１２６例，男５７例，女６９例，年龄１２～５８岁。眼部常规检查无器质性病变及斜视。双眼矫正视力≥１．０，其中近视眼９８例（－０．７５Ｄ～－１１．００Ｄ）；远视眼...     

儿童屈光矫正专家共识（2017）

近十年来,全球的近视和高度近视均呈现快速增长趋势,其中儿童青少年近视呈现发病早、进展快、高度近视比例增加的趋势。根据Holden等[1]2015 年发表在世界卫生组织（WHO）上的报道,2010 年全球近视人群18.93 亿,占27%,高度近视人群1.70 亿,占2.8%,特别是在东亚地区,如中国、日本、韩国和新加坡,近视患病率接近50%,远远高于澳洲、欧洲、北美和南美地区。按目前的患病率预测,至2050 年,全球近视人群将达到49.49 亿（52%）,高度近视人群达到9.25 亿（10%）。Rudnicka等[2]的调查发现,东亚15岁人群近视患病率高达69%,因此,必须及早进行干预,有效减少近视所导致的眼部并发症和视力丧失,减轻由此而造成的社会负担和经济负担。 在人的屈光发育过程中,从出生至3 岁是一生中屈光度数变化最快的时期,初生婴儿中,大部分为+1.50～+2.00 D的低度远视,伴随着成长,角膜曲率逐渐平坦,眼轴逐渐延长,至学龄期逐步完成正视化的过程,期间部分儿童开始出现近视并逐渐加深[3]。因此,0～3岁,是视觉发育最关键的时期,0～12 岁则为敏感期,对敏感期的儿童进行科学的屈光检查,并及早、准确矫正屈光不正,定期随访,将有助于减少屈光不正未矫正及近视增长过快所导致的眼部并发症,降低高度近视致盲的风险。经过大量的调查研究,结合国内的情况,参考美国眼科学会（AAO）相关的视光临床实践指南及大量文献,形成此儿童屈光矫正专家共识,旨在为儿童屈光不正矫正提供指导性意见。     

杭州市下城区50岁及以上人群眼病流行病学调查

目的：调查杭州市下城区50岁及以上人群眼部疾病的患病情况及盲和中、重度视力损伤的患病率及病因。方法：横断面调查研究。于2015年4-8月期间采用整群随机抽样方法,从杭州市下城区8个街道共抽取50岁及以上人群2 953例,对其进行视力、屈光状态、眼压等检查,分析不同年龄、性别和受教育程度人群盲和中、重度视力损伤的患病率及病因。各数据间的比较采用 χ 2 检验和趋势χ 2 检验。结果：共2 363例接受并完成了检查,受检率为80%,人群中盲和中、重度视力损伤的患病率为1.6%（38例）,并随着年龄增长而上升（ χ 2 =38.094,P < 0.001）;文化程度越低,盲的患病率越高（ χ 2 =39.497,P < 0.001）。导致盲和中、重度视力损伤的主要原因有眼底异常（30眼,39.5%）、白内障（26眼,34.2%）、青光眼（12眼,15.8%）等。人群中眼病患病率由高到低依次为未矫正的屈光不正（2 048例,86.7%）、白内障（1 065例,44.7%）、翼状胬肉（219例,9.3%）、年龄相关性黄斑变性（81例,3.5%）、青光眼（52例,2.2%）、斜视（46例,2.0%）、糖尿病视网膜病变（39例,1.7%）。结论：杭州市下城区50岁及以上人群常见的眼部疾病是未矫正的屈光不正、白内障。盲和中、重度视力损伤的患病率较低,其中眼底异常、白内障是导致盲和中、重度视力损伤的主要原因。     

Periventricular leukomalacia: an important cause of visual and ocular motility dysfunction in children

The immature visual system in infants born preterm is vulnerable to adverse events during the perinatal period. Periventricular leukomalacia affecting the optic radiation has now become the principal cause of visual impairment and dysfunction in children born prematurely. Visual dysfunction is characterized by delayed visual maturation, subnormal visual acuity, crowding, visual field defects, and visual perceptual-cognitive problems. Magnetic resonance imaging is the method of choice for diagnosing this brain lesion, which is associated with optic disk abnormalities, strabismus, nystagmus, and deficient visually guided eye movements. Children with periventricular leukomalacia may present to the ophthalmologist within a clinical spectrum from severe cerebral visual impairment in combination with cerebral palsy and mental retardation to only early-onset esotropia, normal intellectual level, and no cerebral palsy. Optimal educational and habilitational strategies need to be developed to meet the needs of this group of visually impaired children.     

Visual and perceptual characteristics,ocular motility and strabismus in children with periventricular leukomalacia

The immature visual system is vulnerable to adverse events. Periventricular leukomalacia (PVL), an end-stage lesion after hypoxia-ischemia at gestational age 24–34 weeks affecting the visual radiation, has become a principal cause of visual impairment in children. Cerebral visual dysfunction caused by PVL is characterized by delayed visual maturation, subnormal visual acuity, crowding, visual field defects, and visual perceptual-cognitive problems. Magnetic resonance imaging is the method of choice for diagnosing this brain lesion, which is associated with optic disk abnormalities, strabismus, nystagmus, and deficient visually guided eye movements. Children with PVL may present to the ophthalmologist within a clinical spectrum from severe visual impairment in combination with cerebral palsy to only early-onset esotropia, normal intellectual level and no cerebral palsy. Optimal educational and habilitational strategies need to be developed to meet the needs for this group of children.     

Visual and perceptual characteristics,ocular motility and strabismus in children with periventricular leukomalacia

The immature visual system is vulnerable to adverse events. Periventricular leukomalacia (PVL), an end-stage lesion after hypoxia-ischemia at gestational age 24-34 weeks affecting the visual radiation, has become a principal cause of visual impairment in children. Cerebral visual dysfunction caused by PVL is characterized by delayed visual maturation, subnormal visual acuity, crowding, visual field defects, and visual perceptual-cognitive problems. Magnetic resonance imaging is the method of choice for diagnosing this brain lesion, which is associated with optic disk abnormalities, strabismus, nystagmus, and deficient visually guided eye movements. Children with PVL may present to the ophthalmologist within a clinical spectrum from severe visual impairment in combination with cerebral palsy to only early-onset esotropia, normal intellectual level and no cerebral palsy. Optimal educational and habilitational strategies need to be developed to meet the needs for this group of children.     

Risk factors of ophthalmic disorders in children with developmental delay

Purpose: To identify diagnoses that increase the risk of ophthalmic disorders in developmentally delayed children. Methods: A cross‐sectional study of 1126 Danish children with developmental delay (IQ ≤ 80), aged 4–15 years [mean age 10 years 1 month; standard deviation (SD) 3 years 2 months; 702 boys, 424 girls]. Ophthalmological and paediatric data were obtained from 719 children. The relative risks (RRs) of ophthalmic disorders were calculated for low IQ, low birth weight, low gestational age, asphyxia, cerebral palsy (CP), epilepsy, neuroradiologically verified cerebral abnormalities, Down’s syndrome and other genetic syndromes. Results: Adjusted RR showed that visual impairment was correlated to CP [RR 2.3, 95% confidence interval (CI) 1.3–4.2], epilepsy (RR 2.5, 95% CI 1.5–4.2), verified cerebral changes (RR 1.9, 95% CI 1.1–3.3) and Down’s syndrome (RR 2.7, 95% CI 1.2–6.3). Adjusted RR showed that refractive errors were correlated to CP (RR 1.5, 95% CI 1.1–2.1) and Down’s syndrome (RR 2.2, 95% CI 1.5–3.2). Adjusted RR showed that strabismus was correlated to cerebral changes (RR 1.8, 95% CI 1.2–2.5). Conclusion: The RR of ophthalmic disorders in developmentally delayed children is increased if the child has CP, epilepsy, verified cerebral abnormalities or a genetic syndrome; referral for ophthalmological evaluation should be performed on suspicion of these conditions.     

Prevalence and outcomes of childhood visual disorders

PURPOSE: This population-based study examines the prevalence of childhood visual disorders: amblyopia (strabismus, refractive errors) and organic disease. It also assesses treatment outcomes, visual impairment and residual amblyopia. METHODS: 1582 children were retrospectively analysed on treatment completion (age 8-9 years). Significant visual disorders included: esotropia, exotropia, anisometropia (hyperopia > or = 1.50DS, astigmatism > or = 1.00DC, myopia > or = 1.50DS), ametropia (hyperopia > or = 1.50DS, astigmatism > or = 1.0DC, myopia > or = 0.75DS) and organic defects. RESULTS: 198 children (12.5%) had a significant visual disorder: strabismus (3.98%), eso:exo rate 5:1, anisometropia (2.34%), ametropia (5.82%), organic defects (0.38%). Organic disease caused visual handicap (< 6/18 in better eye) in 0.13%. Amblyopic visual impairment (6/18; 6/24-6/60) occurred in 1.13%; 2.02% had residual amblyopia (6/12 or worse). CONCLUSIONS: Childhood visual disorders are a common problem. Unfavourable visual outcomes in esotropia are related to two sub-groups and particularly with poor concordance to treatment. Suggested strategies to improve outcomes include health promotion, an "Amblyopia Nurse" and a "Patch Club".     

Ophthalmological follow-up at 2 years of age of all children previously screened for retinopathy of prematurity: is it worthwhile?

PURPOSE: To evaluate the extent to which ophthalmological follow-up at 2 years of age of children born before 32 weeks gestation identifies obvious visual problems, strabismus and significant ametropia (target conditions). METHODS: Of 172 children born during a period of 2.5 years from January 2000, 142 underwent an ophthalmological examination at a median age of 2.33 years. This included evaluation of visual behaviour, cover testing and autorefractometry in cycloplegia. For children with the target conditions, we investigated whether the child had been followed in the eye clinic or referred before 2 years of age, or whether the abnormality was detected as a result of the follow-up examination. RESULTS: None of the target conditions were found in 117 children. None of four children with obviously abnormal visual behaviour, two of 10 children with strabismus and four of 11 with large refractive errors were detected in the follow-up examination. Thus the target conditions were detected at the follow-up examination in only six of 142 children (4.2%). CONCLUSIONS: Although ophthalmic abnormalities are common in children born prematurely, most of them are identified because high-risk children are followed regularly in eye clinics and because parents and primary health care personnel detect strabismus. Ophthalmological follow-up of all children born before 32 weeks appears not to be worthwhile and is therefore only recommended for high-risk children.