屈光不正性弱视儿童708例屈光状态分析

目的：：分析儿童屈光不正性弱视的屈光状态,了解儿童屈光不正性弱视的流行病学资料。方法：回顾2012-01/2013-12在我院小儿眼科与斜弱视专科确诊为屈光不正性弱视,并进行集中综合训练的弱视儿童708例1416眼,对其屈光状态进行流行病学分析。结果：弱视儿童708例1416眼中,远视190眼(13.42％),远视散光612眼(43.22％),近视18眼(1.27％),近视散光134眼(9.46％),混合散光462眼(32.63％)。不同年龄组的弱视儿童的屈光状态分布不同,差异具有统计学意义(P<0.05)。屈光不正引起的弱视大多为轻到中度弱视(1276眼,90.11％),重度弱视以远视性散光为主(82眼,5.79％),散光以顺规性为多(1046眼,86.59％)。结论：远视性屈光不正及混合散光为造成儿童屈光不正性弱视的主要类型,弱视程度与屈光状态、散光轴向有关。     

弱视儿童眼散光的临床研究

目的 探讨弱视儿童眼散光的分布规律、特征及与弱视的关系.方法 对门诊弱视儿童217例(257眼)进行散瞳检影验光,并对散光状况作统计分析.结果 不同年龄组散光类型中复性远视散光165眼,占64.20%,混合散光37眼,占14.40%.单纯远视散光21眼,占8.17%,复性近视散光19眼,占7.39%,单纯近视散光15眼,占5.84%.各年龄组散光眼散光程度1.25～2.00 DC占40.47%,0.50～1.00 DC占28.79%,2.25～3.00 DC占17.51%,≥3.25 DC占13.23%.顺规散光占90.66%逆规散光占7.00%,斜向散光占2.34%.双眼散光中,对称散光占75.70%,不对称散光占24.30%.结论 复性远视性散光是弱视儿重眼散光的主要类型,顺规散光为主,双眼散光以对称散光多见.散光是导致儿童弱视及影响弱视程度的重要因素.     

3～11岁视力低常儿童散光与弱视分析

目的探讨3~11岁儿童弱视散光类型、散光度分布、散光轴分布、双眼散光轴关系、散光轴与弱视的关系。方法对门诊3~11岁视力低常儿童266例(503只眼)散光状况进行统计分析。结果复性远视散光居多,占71.07%,依次为复性近视散光11.53%,混合散光8.95%,单纯远视5.17%,单纯近视散光3.18%。散光程度0.50~1.00DC占52.18%,依次为1.25~2.00DC占30.02%,2.25~3.00DC占10.54%,>3.00DC占6.76%。顺规散光占94.23%,逆规散光占2.19%,斜向散光占3.58%。双眼散光中,对称散光占95.43%,不对称散光占4.57%。双眼散光占89.46%,单眼散光占10.54%。结论远视性散光是儿童散光的主要类型,顺规散光为主,双眼散光以对称散光多见,散光与弱视关系密切,科学合理矫正儿童散光眼,有利于儿童弱视防治。     

674例3~6岁视力低常儿童屈光状态分析

目的分析3~6岁视力低常儿童的屈光状态分布并探讨不同屈光类型与弱视发生的关系。方法描述性研究。对674例（1 348眼）3~6岁裸眼视力低于正常（3岁≤20/40,4岁≤20/32,5岁及以上≤20/25）儿童进行阿托品散瞳后验光检查屈光状态及矫正视力。分析不同年龄段、弱视眼和非弱视眼的屈光状态分布,不同年龄段屈光参差分布以及屈光参差与弱视发生的关系。不同年龄段屈光分布的构成比及弱视发生率比较采用卡方检验。结果视力低常儿童中屈光分布以远视为主,近视发生率较低;随着年龄增加,远视所占比例逐渐降低,近视所占比例逐渐增加,差异有统计学意义（χ²=99.7,P＜0.001）。弱视眼和非弱视眼屈光分布差异有统计学意义（χ²=20.1,P=0.01）;弱视眼中前3位屈光类型分别为复性远视散光（59.4%）、单纯远视散光（17.8%）和混合性散光（15.8%）,而单纯近视眼中无弱视发生。双眼等效球镜度差值≥1 D时容易引起屈光参差性弱视,并且弱视发生率随屈光参差程度增大而升高（χ²=62.9,P＜0.001）。结论学龄前视力低常儿童的屈光状态分布以远视为主,远视性屈光不正、散光、屈光参差等屈光异常更容易引起弱视的发生。     

视力低常儿童的屈光状态与弱视分析

目的 分析矫正视力正常眼和弱视眼的屈光状态差异,评价不同屈光状态对儿童视力的影响.方法 回顾分析540名(1080只眼)裸眼视力低常儿童的屈光状态.结果 矫正视力正常眼和弱视眼的屈光不正均以复性远视散光为主,弱视眼中的散光眼构成比和程度均高于正常眼,弱视眼的远视程度明显高于正常眼(P<0.01).结论 复性远视散光、中...     

逆规散光对弱视治疗效果的影响

目的 :探讨顺规散光和逆规散光是否影响屈光参差性弱视的治疗效果。方法 :对 6 2例屈光参差引起的单眼弱视患者进行分析。按照散光类型将患者分为 7组 ,分别是 :单纯 /复性远视顺规散光组 (Ⅰ )、单纯 /复性远视逆规散光组 (Ⅱ )、单纯 /复性近视顺规散光组 (Ⅲ )、单纯 /复性近视逆规散光组 (Ⅳ )、混合性顺规散光组 (Ⅴ )、混合性逆规散光组 (Ⅵ )、斜轴散光组 (Ⅶ ) ,比较各组弱视治疗的所需时间及治疗前后的视力情况。结果 :远视顺规散光 (Ⅰ )与远视逆规散光 (Ⅱ )比较 ,后者需要弱视治疗时间较长 ,获得的矫正视力较低 ,差异均有较显著性 (t分别为 5 .3和 14 .5 ,P <0 .0 1)。近视顺规散光 (Ⅲ )与近视逆规散光 (Ⅳ )比较 ,同样也是顺规散光组弱视治疗时间较长 ,获得的矫正视力较低 ,差异也有显著性 (t分别为 10 .4 6和 10 ,P <0 .0 1)。结论 :逆规散光是弱视治疗效果的重要影响因素 ,弱视治疗对于存在近视或远视性逆规散光的病例作用甚微 ,且在视力发展时期 ,近视力损害可能比远视力损害更具有导致弱视的危害性。     

唐山市学龄前儿童屈光状态异常与弱视调查

目的对唐山市学龄前儿童视力及其屈光状态进行调查,以期早期发现屈光异常和弱视并及时进行干预。方法抽取唐山市15所幼儿园3～6岁儿童4850名,进行视力、屈光度状态的检测,并对结果进行统计分析。结果测定4850名3～6岁儿童的远视力,视力低常者1280名,视力低常率为26.4%,其中复性远视散光占52.0%,混合性散光占17.4%,复性近视散光占11.1%。弱视儿童180名（3.7%）,主要是屈光不正性弱视（64.4%）。不同年龄组儿童的视力低常率和弱视患病率差异无统计学意义（χ^2=2.77,P〉0.05）。结论唐山市学龄前儿童屈光异常的主要类型为复性远视散光和混合性散光,弱视的主要类型为屈光不正性弱视,早期筛查有利于早期发现屈光异常和弱视并及时进行干预。     

学龄前儿童视力低常眼的静态屈光分析

目的了解学龄前儿童视力低常眼的静态屈光,分析视力与屈光关系。方法对象为幼儿园普查及视光门诊就诊视力低常的〉3~6岁学龄前儿童1000名（1934只眼）,进行眼科常规检查,重点包括远近视力,并进行1%阿托品眼膏散瞳验光。结果学龄前儿童视力低常眼的静态屈光中屈光不正类型以复性远视散光为主,程度以轻度多见;在屈光不正性弱视中,远视性弱视占主要部分。结论学龄前儿童视力低常眼的静态屈光主要为远视类屈光不正,确定学龄前儿童的视力低常是生理性还是病理性不能仅据视力。静态屈光测定是定性视力、确定屈光是否异常的必不可少的选择。     

高龄老年人472眼屈光状态的临床分析

目的:探讨高龄老年人眼视力状况及屈光分布,做好高龄老年人的视力保健。方法:标准照明下查70岁以上高龄老年人472眼远视力,作仔细的眼部和屈光状态的检查并矫正其视力。结果:全组472眼中屈光不正468眼(99.2%),全组以近视居多,且随着年龄递增,近视所占比例逐渐增大。散光415眼(87.9%),70～80岁组以远视散光为主,80岁以上则以近视散光为主,全组散光以近视性逆规散光眼所占比例最大,共172眼(36.4%),远视散光眼散光度数集中在0.50～1.00D,近视散光和混合性散光眼度数集中在1.25～2.00D。全组裸眼视力随年龄增加而降低,各年龄组矫正视力均有明显提高。结论:高龄老年人由于眼睑和晶状体等的老年性改变,其屈光状态向近视性逆规散光发展,成为影响其视力的主要原因,尚未行白内障摘除之高龄老年人,定期检查其屈光状态并做必要的屈光矫正能明显提高高龄老年人的视力。     

学龄前儿童散光眼特征分析

目的探讨学龄前视力低常儿童散光眼的主要类型、程度、轴向的分布规律及与弱视的关系。方法对我市幼儿园3—7岁儿童弱视筛查中发现的视力低常者进行散瞳验光,从中检出482例889只散光眼进行统计分析。结果复性远视散光最多,占66．03％,混合散光次之,占13．95％,单纯远视散光9．11％,复性近视散光8．77％,单纯近视散光2．14％;散光程度0．50DC～1．00DC占47．58％,1．25DC～2．00DC占36．22％,2．25DC～3．00DC占12．82％,3．25DC～4．00DC占3．15％,〉4．25DC占0．22％;顺规散光占91．34％,逆规散光占8．21％,斜向散光占0．45％。所有散光眼中,弱视504眼,占56．69％。结论散光是学龄前儿童视力低常的常见原因之一,复性远视散光是其主要类型且以〈2．00DC为主,散光轴向多为顺规散光。散光与弱视密切相关,合理矫正儿童眼散光,是治疗弱视的关键。     

学龄前视力低常儿童散光眼分布特征

目的调查3-7岁儿童散光的发生情况,探讨散光的类型、分布规律以及矫正视力情况。方法对456例3-7岁视力低常伴散光儿童（865眼）散瞳验光所得散光情况进行统计分析。结果双眼散光占89．69％,单眼散光占10．31％;双眼散光中对称性散光占86．80％,不对称散光占13．20％;复性远视散光占68．67％,混合散光占16．99％,单纯远视散光占11．79％,复性近视散光占2．20％,单纯近视散光占0．35％;散光程度在0．50-1．00D者占31．68％,1．25-2．00D者占46．36％,2．25-3．00D者占15．61％,〉3．25D者占6．35％;矫正视力≥0．9者占23．82％,矫正视力≤0．8者占76．18％。结论3-7岁学龄前视力低下散光儿童865只眼中双眼多见。散光类型以复性远视散光为主,散光轴向分布以顺规散光为主,散光程度多在3．00D以下,中重度散光是弱视形成的主要原因．廊早期筛杏视力低常儿啻．尽早合弹矫正儿童散光眼。     

不同屈光状态弱视儿童治疗效果的临床分析

目的：探讨不同屈光状态儿童弱视治疗的临床效果。方法回顾弱视儿童86例（150眼）,其中远视性弱视77眼,近视性弱视38眼,混合散光性弱视35眼,比较评价三组治疗效果。结果远视性弱视组治愈68眼（88.3%）,近视性弱视治愈24眼（63.2%）,混合散光性弱视治愈11眼（31.5%）,三组治愈率有明显差异,P〈0.05。结论远视性弱视治疗效果明显好于近视性和混合散光性弱视。     

Against-the-rule (ATR) astigmatism as a predicting factor for the outcome of amblyopia treatment

PURPOSE: To evaluate whether with-the-rule (WTR) or against-the-rule (ATR) astigmatism influences the treatment outcome of anisometropic amblyopia. DESIGN: A cohort study. METHODS: Retrospective study of patients with unilateral amblyopia due to anisometropia without strabismus. Ninety-eight patients with simple, compound, mixed, oblique myopic, and hyperopic astigmatism were divided into seven groups based on the type of astigmatism. The groups were reviewed as to the amount of anisometropia, duration of occlusion, and best-corrected visual acuity (BCVA) before and after treatment. RESULTS: There was statistically significant longer duration of occlusion and less lines gain of BCVA among patients with hyperopic ATR astigmatism compared with patients with hyperopic WTR astigmatism (P =.0143 and P =.0000, respectively) and myopic ATR patients compared with myopic WTR patients (P =.0392 and P =.0192, respectively). For the same parameters, group differences were also statistically significant when all hyperopic or myopic simple/compound/mixed ATR patients were compared with all hyperopic or myopic simple/compound/mixed WTR patients (P =.0015 and P =.0000, respectively). CONCLUSION: The outcome of amblyopia treatment seems to be less favorable in patients with either hyperopic or myopic ATR astigmatism. Near vision impairment may be more amblyogenic than distance vision impairment during visual development.     

翼状胬肉逆行切除术1例

目的：探讨屈光不正性弱视的程度、类别、治疗年龄与疗效的关系,为临床治疗提供参考。

方法：屈光不正性弱视患儿186例272眼,随机分为远视性弱视组、近视性弱视组和散光性弱视组进行综合治疗,并对弱视程度和治疗年龄进行疗效比较。治疗包括配戴合适眼镜、遮盖健眼或交替遮盖、精细目力作业训练及弱视治疗仪的应用。

结果：远视性弱视患者基本治愈率最高(78.5%),近视性弱视(64.6%),散光性弱视(52.6%),有显著性差异(P<0.05)。远视性弱视、轻度弱视及发病年龄小的弱视治疗效果好(P<0.05)。

结论：屈光不正性弱视的治疗效果与屈光状态、弱视程度、年龄有关。     

儿童弱视愈后防治的对策

儿童弱视愈后转归,不只是弱视复发,还会发生调节性近视和形成真性近视,应引起小儿眼科界的注意.儿童弱视愈后复发应区分为:基本治愈后弱视复发、痊愈后弱视复发、脱镜后弱视复发."愈前反弹"不属于弱视复发,这样的分类法对儿童弱视的防治是有其实用价值的.在对儿童弱视的治疗和追踪观察中,结合儿童视力、屈光和眼轴发育的特点,提出了儿童弱视愈后脱镜指标为:(1)双眼裸眼远近视力≥1.0,6mo以上者;(2)眼位正常或斜视性弱视治愈后残余斜视度﹤5°者;(3)远视屈光度≤+1.00DS;(4)远视散光度≤+0.50DC.治愈后的弱视儿童必须达到上述4项指标方可摘掉眼镜.我们对儿童弱视的研究进展进行综述,并提出了防治的对策.     

Five-year refractive changes in an older population: the Blue Mountains Eye Study

PURPOSE: To examine 5-year changes in refractive error and astigmatism in an older population. DESIGN: Population-based cohort study. PARTICIPANTS: The Blue Mountains Eye Study examined 3654 residents aged 49 years or older from 1992 to 1994. After excluding 543 persons who died since baseline, 2335 (75.1%) attended 5-year examinations from 1997 to 1999. METHODS: Both examinations included a detailed eye assessment, with subjective refraction performed according to a modified Early Treatment of Diabetic Retinopathy Study protocol. MAIN OUTCOME MEASURES: Spherical equivalent (sum of sphere + cylinder) was used as the measure of refractive error. Only phakic eyes with best-corrected visual acuity >20/40 were included (n = 3701). RESULTS: Similar changes in refractive error were observed for the two eyes. Symmetric changes were found in 72% of participants when the difference between eyes was within 0.5 diopters (D) and in 91% when the difference was within 1.0 D. The 5-year change in spherical power was in a hyperopic direction for younger age groups and in a myopic direction for older subjects, P < 0.0001. The gender-adjusted mean change in refractive error in right eyes of persons aged 49 to 54, 55 to 64, 65 to 74, and 75 years or older at baseline was +0.41 D, +0.30 D, +0.05 D, and -0.22D, respectively. Refractive change was strongly related to baseline nuclear cataract severity; grades 4 to 5 were associated with a myopic shift (-0.33 D, P < 0.0001). Education level and age of onset of myopia, but not gender or diabetes, also predicted refractive change. The mean age-adjusted change in refraction was +0.14 D for hyperopic eyes, +0.32 D for emmetropic eyes, and +0.15 D for myopic eyes. The mean change in cylinder power over the 5-year period was small, irrespective of baseline refraction. The axis of astigmatism remained stable in most cases (64%), whereas 12% changed to "against the rule" and 11% to "with the rule." CONCLUSIONS: This report has documented refractive error changes in an older population and confirmed reported trends of a hyperopic shift before age 65 years and a myopic shift thereafter associated with the development of nuclear cataract.