智能视功能检查治疗仪治疗儿童间歇性外斜视

目的　探讨应用维视顿智能视功能检查治疗仪（以下简称维视顿）进行融合集合及立体视集合训练对间歇性外斜视患儿双眼视功能转归的影响。方法　回顾性病例分析。收集斜视角≤２５△的间歇性外斜视患儿６４例,根据治疗方法不同分为治疗组和对照组,每组３２例。治疗组应用维视顿进行融合集合及立体视集合训练,每天１次,２０ｄ后改为家庭版训练,融合范围及远立体视功能恢复正常后终止训练;对照组单纯配戴矫正眼镜治疗。随访２０～２４个月,观察两组斜视度、融合范围和远立体视锐度变化。结果　治疗前两组患儿一般状况差异均无统计学意义（均为Ｐ＞０．０５）。治疗组治疗前斜视度为－１９．２３△ ±０７６△,治疗后为－１０６３△ ±１．３２△,差异有统计学意义（Ｐ＜０．０５）;治疗后治疗组融合功能无丧失,对照组１２例（３７．５％）丧失;治疗组治疗后融合范围（分开和集合）较治疗前明显提高（均为Ｐ＜０．０５）,与对照组治疗后比较差异亦有统计学意义（均为Ｐ＜０．０５）;治疗组治疗后远立体视恢复率达８１．２５％,明显高于对照组的４６．８８％,差异有统计学意义（Ｐ＜０．０１）。结论　应用维视顿对儿童小度数间歇性外斜视患者进行融合集合及立体视集合训练,有助于提高融合功能和建立或强化立体视功能,有望达到功能性治愈。     

角膜塑形镜对近视性屈光参差儿童双眼视功能的影响

目的　探究角膜塑形镜（OK镜）对近视性屈光参差儿童双眼视功能的影响。方法　收集2018年至2019年于北京大学第三医院眼科视光中心就诊的60例近视性屈光参差儿童资料,随机分为OK组（配戴OK镜）和SP组（配戴普通框架眼镜）,每组各30例。基线时（配戴OK镜或框架眼镜前）和戴镜后6个月、12个月时,分别对受试儿童进行远距斜视度、远距融合范围、远近距立体视的检查。比较OK组和SP组儿童双眼视功能参数的差异,以及两组儿童双眼视功能参数随戴镜时间的变化情况。结果　与基线时相比,戴镜后6个月、12个月时,OK组儿童的远距融合范围、远距集合范围显著减小,近距立体视显著提高（均为P<0.05）,而远距斜视度、远距融合点、远距散开范围、远距立体视差异均无统计学意义（均为P>0.05）。与基线时相比,戴镜后6个月、12个月时,SP组儿童的近距立体视均显著提高（均为P<0.05）,而远距斜视度、远距融合点、远距融合范围、远距集合范围、远距散开范围、远距立体视差异均无统计学意义（均为P>0.05）。OK组和SP组儿童基线时和戴镜后6个月时的远距斜视度、远距融合范围、远距融合点、远距集合范围、远近距立体视差异均无统计学意义（均为P>0.05）。戴镜后12个月时,OK组儿童的远近距立体视均优于SP组（均为P<0.05）,而两组儿童其余指标差异均无统计学意义（均为P>0.05）。结论　近视性屈光参差儿童配戴OK镜后,远距融合范围减小,近距立体视提高。与框架眼镜相比,OK镜改善近视性屈光参差儿童远近距立体视的作用更好。     

儿童间歇性外斜视术后早期双眼视功能恢复及影响因素

目的：探讨间歇性外斜视儿童眼位成功矫正后早期的双眼视功能恢复情况及其影响因素。方法：前 瞻性临床研究。收集2019年7月至2020年7月期间于温州医科大学附属眼视光医院的间歇性外斜视 术后1个月眼位矫正成功的患者177例,年龄7~14（9.97±2.16）岁。采用配对t检验、Pearson相关性 检验和多元线性回归分析评估术后1个月的眼位和双眼视功能参数,及其与术前临床特征之间的相 关性。结果：患者术后1个月斜视角均符合正位标准,与术前斜视角有显著差异（远距：-2.80 △±3.96 △ vs.-33.67 △±9.17 △,t=-41.83,P<0.001;近距：-4.05 △±4.68 △vs.-38.50 △±9.09 △,t=-44.27,P<0.001）。 远距（2.59±0.38 vs.2.80±0.25,t=7.30, P<0.001）和近距（2.19±0.36 vs.2.36±0.44,t=5.68,P<0.001） 立体视较术前获得明显改善,分别有16.4%和22.0%患者获得远距和近距正常的立体视功能。术后 远距知觉性融像功能较术前获得明显改善（χ2=8.08,P=0.004）,而近距结果与术前比较无差异明显统 计学意义。术后1个月时的远距和近距立体视功能与术前年龄、屈光参差度、远距和近距立体视功 能呈显著正相关（远距：r=0.15,P=0.043;r=0.19,P=0.012;r=0.28,P<0.001;r=0.22,P=0.004;近距： r=0.23,P=0.002;r=0.34,P<0.001;r=0.15,P=0.043;r=0.49,P<0.001）。结论：间歇性外斜视儿童眼 位成功矫正后,术后早期立体视和知觉性融像功能较术前明显改善。术后立体视功能状态与手术年 龄、屈光参差量、术前立体视功能有一定的相关性。     

间歇性外斜视患者的屈光状态对立体视功能影响的研究

目的 分析合并不同屈光状态的间歇性外斜视患者立体视功能的差异。设计 回顾性病例系列。研究对象 北京同仁医院2014年7月至2015年8月间歇性外斜视需要进行手术治疗的238例患者。方法 将患者按照屈光状态分为远视组（双眼等效球镜均≥+1.00 D）、正视组（-1.00 D＜双眼等效球镜＜+1.00 D）、近视组（双眼等效球镜均≤-1.00 D）和屈光参差组（双眼等效球镜相差≥1.00 D）,用同视机检查患者的远立体视,颜少明《立体视觉检查图》检查近立体视,比较分析四组患者的远近立体视功能状况。主要指标 远立体视功能和近立体视功能。结果 （1）238例间歇性外斜视患者平均看近斜视度（45.71±18.81）△,平均看远斜视度（43.98±19.55）△,远视组、正视组、近视组和屈光参差组保留远立体功能的比率分别为23.3%、15.5%、19.7%、 18.8%,各组之间远立体视功能比较差异无统计学意义;保留近立体视功能的比率分别为66.7%、79.8%、81.6%、64.6%,屈光参差组的近立体视功能丢失最多,近视组的近立体视功能丢失最少,屈光参差组与近视组的近立体视功能有统计学差异（P=0.033）。（2）间歇性外斜视合并屈光参差的检出率为20.1%,其中近视性屈光参差所占比例（12.6%）最高,远视性屈光参差所占比例（1.3%）最低。（3）间歇性外斜视合并屈光参差的患者中,有、无远立体视的患者双眼等效球镜差值分别为（2.35±0.75）D和（2.34±1.75）D,两组间差值比较无统计学意义（P=0.21）;无近立体视患者双眼等效球镜的差值（3.11 D±2.29 D）明显大于有近立体视患者的双眼等效球镜差值（1.93 D±0.83 D）,两组的差值间比较有统计学意义（P=0.002）。结论 对于斜视角度较大的间歇性外斜视患者,不同的屈光状态对远立体视功能影响不大,屈光参差加重对近立体视功能的损伤,屈光参差度越大,近立体视功能损伤越重。（眼科, 2016, 25： 396-399）     

间歇性外斜视患者眼球旋转状态与近立体视功能关系研究

目的 通过观察间歇性外斜视患者眼球旋转状态与近立体视功能的关系,探讨眼球旋转状态对立体视功能的影响.方法 临床回顾性研究.筛选110例2013年1月至2014年1月在天津市眼科医院就诊的间歇性外斜视患者,采集眼底相照片,根据眼底相将眼球分为眼球旋转（内旋、外旋）和正常,并通过CDA计算视盘-黄斑中心凹夹角FDA.分析眼球旋转状态与近立体视功能的关系.结果 在110例间歇性外斜视患者中眼球旋转有25例,间歇性外斜视患者FDA与正常对照组对比存在差异有统计学意义（P＜0.05）.存在眼球旋转的间歇性外斜视患者的立体视功能低于无眼球旋转患者的立体视功能,两者存在差异统计学意义（P＜0.05）.间歇性外斜视患者主导眼客观旋转度与立体视功能具有显著相关性（r =0.311,P=0.001）.结论 间歇性外斜视患者眼球旋转状态与立体视功能损伤具有一定相关性,可以辅助评价间歇性外斜视严重程度.     

婴幼儿期外斜视的手术时机及远期疗效

目的探讨婴幼儿期发病的外斜视手术时机及远期疗效。方法回顾性研究。收集3岁以内发病,外斜视术后随访2年以上的111例患者的临床资料。应用二元logistic回归模型分析可能影响术后眼位及双眼视功能结果的因素,包括发病年龄,手术年龄,斜视类型,术前远、近立体视功能,术后眼位。结果卡方检验及Spearman 相关分析显示：间歇恒定分组与术后远期眼位有关（χ²=4.125,P<0.05）;间歇恒定分组（χ²=3.951,P<0.05）及术后眼位（χ²=4.269,P<0.05）与术后远立体视重建有关;间歇恒定分组与术后近立体视功能重建有关（χ²=6.988,P<0.01）。经二元logistic回归分析显示：间歇恒定分组与术后远期眼位有关（OR=0.445,P<0.05）;术前远立体视功能是影响术后远立体视功能恢复的主要因素（OR=10.500,P<0.01）;术前近立体视、间歇恒定分组与术后近立体视功能重建有关（OR=11.480、0.175,P<0.05）。结论婴幼儿期发病的外斜视应在双眼视功能破坏前尽早手术矫正。术前远、近立体视功能的损害和斜视融合控制能力的减弱可以作为判断手术时机的参考指标。     

双眼外直肌倾斜后徙术治疗集合不足型间歇性外斜视的疗效

目的：探讨双眼外直肌倾斜后徙术治疗集合不足型间歇性外斜视的疗效及安全性。

方法：选取2017-10/2019-11在我院就诊的集合不足型间歇性外斜视患者29例行双眼外直肌倾斜后徙术治疗,术后随访6mo,观察斜视度的变化、手术正位率、双眼视功能及并发症情况。

结果：本组患者术前看近斜视度-41.72±3.35PD,看远斜视度-23.28±9.75PD,看近-看远斜视度差值16.90±2.47PD,术后6mo分别为-5.97±4.85、-2.66±4.78、3.28±1.10PD,手术总体正位率76%。术后6mo,Ⅰ、Ⅱ级视功能恢复比例均较术前提高(P<0.05),远立体视、近立体视恢复较术前均无显著差异(P>0.05)。所有患者术后均未出现A-V综合征、眼球运动受限、限制性斜视、垂直斜视、旋转复视等并发症,部分患者术后出现短暂水平复视,均在术后2～3wk内消失。

结论：双眼外直肌倾斜后徙术能减少看近、看远斜视度及看近-看远斜视度差值,未发现明显并发症,是一种安全有效的治疗集合不足型间歇性外斜视的手术方式。     

笔尖训练与双眼视觉训练治疗间歇性外斜视术后欠矫的疗效对比

目的：比较笔尖训练法和双眼视觉训练法治疗间歇性外斜视患者术后轻度欠矫的疗效。方法：前瞻性队列研究。纳入在南京医科大学附属儿童医院眼科接受间歇性外斜视手术治疗并于2015 年6 月至2016年6月发生术后轻度欠矫（-8△～-15△）的患者54例。将患者分为笔尖训练组和双眼视觉训练组。笔尖训练为将笔尖由远移近到鼻根至出现复视后再退回，患者反复训练，20 个周期为1 组，连续做3 组，共约15 min，每天2 次，每周训练5 d，持续6 个月；双眼视觉训练组患者进行每周1 次，每次60 min的医院内训练，以及每周5 次，每次15 min的家庭训练，持续6 个月。所有患者均于训练前，训练1个月、3个月和6个月时接受看远斜视度、看近斜视度和看远立体视检查。数据采用独立样本t检验、重复测量两因素方差分析、卡方检验进行分析。结果：54例患者中，26例进行笔尖训练，28例进行双眼视觉训练。训练前笔尖训练组和双眼视觉训练组的看远、看近斜视度差异无统计学意义；训练3 个月时，笔尖训练组看远、看近斜视度均大于双眼视觉训练组，差异有统计学意义（t=3.44，P<0.001；t=2.55，P=0.01）。双眼视觉训练组训练1个月和3个月时看远斜视度差值、看近斜视度差值均大于笔尖训练组，差异有统计学意义（t=-3.17，P=0.003；t=2.32，P=0.02）。训练1个月、3个月时，2 组看远立体视差异无统计学意义；训练6 个月时，双眼视觉训练组看远立体视优于笔尖训练组，差异有统计学意义（t=9.33，P<0.001），训练6 个月时，双眼视觉训练组正常立体视获得率高于笔尖训练组，差异有统计学意义（χ2=5.02，P=0.03）。结论：笔尖训练和双眼视觉训练均能降低间歇性外斜视术后欠矫患者斜视度，效果一致，但双眼视觉训练对欠矫患儿立体视功能的恢复优于笔尖训练。     

知觉学习训练重建共同性外斜视术后立体视功能的作用

目的：采用知觉学习训练方法对斜视矫正术后无立体视功能或者立体视功能不能恢复至正常的共同性外斜视患者进行训练，探讨知觉学习训练在斜视术后立体视功能重建中的作用。方法：前瞻性研究。选择2009年8月至2011年8月在安徽医科大学第一附属医院行斜视矫正术后眼位正位的共同性外斜视患者23例，均为术后3个月以上Titmus立体图检查立体视功能未达到正常者。采用心理物理学中的知觉学习方法进行立体视功能训练，观察训练前后视差辨别正确率、立体视锐度的变化。训练前后的数据比较采用配对t检验。结果：23例患者中有2例不能完成训练任务，21例患者顺利完成训练，平均训练（6.9±3.8）d，经知觉学习训练后立体视功能较训练前明显改善，差异具有统计学意义（t=8.228，P < 0.001）。视差辨别正确率检测显示，受试者在视差分别为320″、440″、580″时，训练后应答正确率高于训练前应答正确率，差异均具有统计学意义（t=-3.102，P=0.01；t=-2.360，P=0.02；t=-2.177，P=0.03）。结论：知觉学习训练可有效重建共同性外斜视术后患者的立体视功能，但具体机制有待进一步研究。     

视感知觉检查系统对共同性外斜视术后立体视功能重建的相关预测因素

目的：引入视感知觉可塑性评分检查训练系统,评价该检测方法在临床应用中预测共同性外斜视术 后立体视恢复状况的准确度以及灵敏度和特异度。方法：前瞻性临床研究。连续收集2017年1─9月 在北京同仁医院诊断为共同性外斜视且进行手术治疗的患者136例,在术后1周接受视感知觉可塑 性评分检查。采用秩相关分析手术年龄、病程时长、术前斜视角度、术后1周斜视角度等因素与可 塑性评分相关性。所有患者均从术后1周开始进行视感知觉训练,分别于术后1、3、6个月进行远、 近立体视功能检测,制作ROC曲线,评价可塑性评分对术后不同时间点远、近立体视功能恢复预测 的准确度及灵敏度和特异度。采用Delong test将可塑性评分以及传统临床指标对半年立体视功能的 恢复状况的预测效能进行比较。结果：间歇性外斜视患者109例（80.2%）,恒定性外斜视27例（19.9%）。 可塑性评分分别与年龄、术前斜视度、斜视病程、外斜视类型、术后1周斜视度相关（r=-0.3、-0.2、 -0.3、0.4、-0.3,均P<0.05）。可塑性评分在术后半年内不同时间点对立体视功能均具有预测能力, 其中对术后6个月远、近立体视功能恢复正常均具有中等程度的预测意义,曲线下面积（AUC）均 >0.7,P<0.001。传统临床指标中,术前近立体视功能对术后半年近立体视功能有较低的预测能力 （AUC=0.63<0.7,P=0.009）;术前看远斜视角度对术后6个月远、近立体视功能能否完全恢复正常具 有较低的预测能力（AUC=0.66<0.7,P=0.02）,但这些指标与可塑性评分的预测能力相比,差异无统 计学意义（Z=1.2、1.4,P>0.05）。结论：视感知觉检查训练系统中,可塑性评分可以有效地预测共同 性外斜视患者术后远、近立体视功能的恢复状况,为术后患者制定进一步的诊疗策略提供依据。     

成人外斜视术后双眼视觉重建及其影响因素

目的探讨成人外斜视术后双眼视觉重建及其影响因素。方法回顾性病例研究。收集发病年龄相对明确的术前无双眼视功能的成人外斜视患者54例,按发病年龄9岁之前或之后分为BVM（before visual maturity,<9岁者）组及AVM（after visual maturity,≥9岁者）组,分别于术前及术后6周用同视机测远双眼视觉,用颜氏《数字化立体视图》测近立体视觉。采用χ²检验分析比较2组患者术后双眼视功能的变化;采用logistic回归分析发病年龄、手术年龄、术前斜视度数、外斜视类型对术后立体视的影响。结果术后远双眼视觉重建率：I级：AVM组77%,BVM组33%（χ²=10.240,P<0.01）;Ⅱ级：AVM组77%,BVM组33%（χ²=10.240,P<0.01）;III级：AVM组47%,BVM组17%（χ²=5.400,P<0.05）。近立体视重建率：AVM组73%,BVM组29%（χ²=10.461,P<0.01）。Logistic多因素回归分析显示,发病年龄及手术年龄是影响术后远（OR=6.046,P<0.05;OR=0.140,P<0.01;）、近立体视（OR=10.825,P<0.05;OR=0.189,P<0.05）重建的重要因素,而术前斜视度数及外斜视类型对术后远、近立体视的重建无显著影响。结论成人外斜视术后也可获得一定程度的双眼视功能,甚至是立体视功能。发病年龄及手术年龄可影响术后立体视的获得,其中发病年龄起关键作用。为了提高术后双眼视觉的重建,成人外斜视手术宜早不宜晚。     

对小度数集合不足型间歇性外斜视手术疗效分析

目的 探讨单纯单眼内直肌截除术和2.5～3.0mm单眼外直肌后徙+单眼内直肌截除术对视近时斜视度在15△～25△之间的小度数集合不足型间歇性外斜视的手术疗效.方法 对10例患者行2.5～3.0mm单眼外直肌后徙+单眼内直肌截除术(A组),15例患者行单纯单眼内直肌截除术(B组),术后分别比较两组患者视远和视近的斜视度以及视远和视近的斜视度的差值,并比较两组患者术后的正位率、恢复双眼视例数和恢复近立体视例数.术后随访6至12个月.结果 两组术前和术后视远和视近的斜视度以及视远和视近的斜视度的差值比较经t检验差异均有统计学意义(t=1.73～9.73,P＜0.05),A、B两组术后正位率、术后恢复双眼视的例数和恢复立体视例数经x2检验差异具有统计学意义(x2=3.84～5.11,P＜0.05).结论 (1)2.5～3.0mm单眼外直肌后徙+内直肌截除术和单纯单眼内直肌截除术治疗视近时斜视度15△～25△的小度数集合不足型间歇性外斜视均有效.(2)在缩小视近和视远斜视度的差值、术后正位率、恢复双眼视和立体视功能方面,2.5～3.0mm单眼外直肌后徙+内直肌截除术优于单纯单眼内直肌截除术.

Abstract：

Objective To evaluate the surgical results of unilateral medial rectus muscle resection and 2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection for the intermittent exotropia of the convergence insufficiency type with small-diopter exodeviation of 15 △ to 25 △ at near.Methods Ten cases received 2.5mm-3.0mm unilateral lateral muscle resection with unilateral medial rectus muscle resection (group A),15 cases received unilateral medial rectus muscle resection (group B).The distance and near deviations and differences in the deviations were compared separately for the two groups;besides,the positioning rates,number of patients with restoration of binocular and stereoscopic visions were compared in the two groups after surgery.They were followed-up for 6 to 12 months after surgery.Results There was statistically significant difference (t =1.73-9.73,P ＜0.05) in the angle at near and distance,the angle near-distance difference.There also was statistically significant difference (x2=3.84-5.11,P ＜0.05) in the orthophoria rate,biocular vision recovery,stereopsis recovery after operation were compared between group A and B.Conclusions Both of the unilateral medial rectus muscle resection and 2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection are an effect surgical treatment for the intermittent exotropia of the convergence insufficiency type with small-diopter exodeviation of 15△ to 25△ at near.2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection is superior to unilateral medial rectus muscle resection in reducing the angle difference of near-diatance,orthophoria rate,biocular vision recovery,stereopsis recovery.     

Unilateral recession-resection in children with exotropia of the convergence insufficiency type

PURPOSE: The surgical success rates for intermittent exotropia of the convergence insufficiency type have been reported to be variable, and most were studied retrospectively in adults. The purpose of this study was to evaluate prospectively the long-term surgical results of unilateral lateral rectus (LR) muscle recession and medial rectus (MR) muscle resection in children with intermittent exotropia of the convergence insufficiency type. METHODS: A total of 14 children with intermittent exotropia greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. The amounts of resection and recession were based on near and distance deviation, respectively. Minimum follow-up was 1 year (mean 26.6 months; range, 12-68 months) after surgery. The paired t-test was used to compare preoperative and postoperative measurements of the angle of deviation at distance and near, near-distance difference. RESULTS: Significant postoperative reduction was achieved in terms of mean distance exodeviation, from 22.5 PD to 9.1 PD (P=0.000), and mean near exodeviation from 33.8 PD to 13.6 PD (P=0.000). Mean near-distance difference reduced from 11.3 PD preoperatively to 4.6 PD postoperatively (P=0.000). Fresnel prism was used temporarily to treat postoperative esotropia in only one patient for postoperative 6 months. CONCLUSIONS: Unilateral surgery biased to MR strengthening more than LR weakening in children with intermittent exotropia of the convergence insufficiency type, was found to successfully reduce both distance and near deviation and to collapse near-distance differences with a low risk of long-term postoperative esotropia.     

两种术式治疗基本型间歇性外斜视的比较

目的 比较双眼外直肌后徙术与单眼一退一截术治疗基本型间歇性外斜视的手术疗效.方法 对行双眼外直肌后徙(A组)和单眼一退一截(B组)手术治疗的49例基本型间歇性外斜视病例进行了回顾性分析.A组26例,B组23例.采用三棱镜加交替遮盖法测定患者戴镜注视6m和33cm调节性视标的第一眼位斜视度,根据看远斜视度手术,所有手术均由同一医生完成.术后平均随访(13.8±9.4)月,疗效评价标准以眼位≤±8Δ为正位.结果 A组眼位正位率为53.8%,B组眼位正位率为82.6%,A、B两组眼位正位率的差异具有统计学意义(x2=4.59 P=0.032),B组眼位正位率高于A组.结论 基本型间歇性外斜视应首选单眼一退一截手术.     

The long-term result of slanted medial rectus resection in exotropia of the convergence insufficiency type

PURPOSE: To evaluate the long-term results of slanted medial rectus (MR) resection for intermittent exotropia (X(T)) of the convergence insufficiency type. METHODS: In all, 10 patients with an X(T) greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. Patients received slanted bilateral MR resection. The upper edge of the MR was resected according to the distance exodeviation and the lower edge of the MR was resected according to near exodeviation. The postoperative follow-up period was between 6 and 62 months with a mean of 38.9 months. The paired t-test was used to compare: mean distance angle of deviation preoperatively and postoperatively; mean near angle of deviation preoperatively and postoperatively; and mean near-distance exodeviation difference preoperatively and postoperatively. RESULTS: Bilateral slanted MR resections reduced mean exodeviation at distance from 23.0+/-7.2 to 16.3+/-5.4 PD (P=0.03); mean exodeviation at near from 34.3+/-7.7 to 24.6+/-6.9 PD (P=0.01); and mean near-distance difference from 11.4+/-2.6 to 8.3+/-3.5 PD (P=0.04). At the final follow-up examination, all patients demonstrated an exodeviation of 10 PD or more at distance and near, and the exodeviation difference between distance and near deviation was within 10 PD in five of the 10 patients. Three patients had an esodeviation at distance after surgery, but all resolved within 4 weeks. CONCLUSIONS: Bilateral slanted MR resections in patients with X(T) of the convergence insufficiency type resulted in undercorrection in all patients.     

ReSTOR多焦点人工晶状体植入术后全程立体视觉质量分析

目的 比较双眼植入ReSTOR＋3D多焦点人工晶状体（MIOL）与单焦点人工晶状体（SIOL）术后的近、中、远视力和立体视觉质量.方法 前瞻性对照研究.选择接受白内障超声乳化吸除联合人工晶状体植入术的患者共46例（92眼）,年龄45～67岁.按植入人工晶状体的不同分为两组：ReSTOR＋3D（AcrySof ReSTOR SN6AD1）MIOL组23例（46眼）,AcrySof IQ（AcrySof IQ SN60WF）SIOL组23例（46眼）,均非同期手术.患者分别于第二只眼术后3个月时检查裸眼及配戴最佳远距离矫正眼镜时的近、中、远视力和立体视锐度,并对术后患者主观立体视觉质量进行问卷调查.样本均数的比较采用配对t检验,样本率之间比较采用x2检验.结果 术后3个月,裸眼近、中视力及最佳矫正近、中距离视力比较,MIOL组明显优于SIOL组,差异均有统计学意义（x2分别为26.2、23.7、29.3、25.0,P均＜0.05） 裸眼远视力及最佳矫正远视力比较,两组差异均无统计学意义（P＞0.05）.裸眼及最佳矫正下的立体视锐度比较：MIOL组的近立体视锐度明显优于SIOL组,差异均有统计学意义（x2分别为26.3和23.5,P均＜0.05） MIOL组的中距离立体视锐度亦优于SIOL组,差异有统计学意义（x2分别为15.2和12.6,P均＜0.05） 而两组的远立体视锐度比较,差异均无统计学意义（P＞0.05）.MIOL组对近、中距离立体视觉质量的满意度为4.05±0.25和4.25±0.25,均高于SIOL组,差异有统计学意义（t分别为5.4和5.1,P均＜0.05） 而两组对远距离立体视觉质量的满意度差异无统计学意义（P＞0.05）.结论 ReSTOR＋3D MIOL的近、中距离视力和立体视锐度明显优于SIOL,可为患者提供更好的立体视觉质量,患者术后对近、中距离立体视觉质量的满意度更高.     

Effects of slanted bilateral lateral recession vs conventional bilateral lateral recession on convergence insufficiency intermittent exotropia: a prospective study

AIM: To observe the surgical effects of slanted bilateral lateral recession (S-BLR) versus conventional bilateral lateral recession (C-BLR) in convergence insufficiency intermittent exotropia (CI-IXT). METHODS: Using a randomized, double-blind, prospective design, 22 patients with CI-IXT who were admitted to Renmin Hospital of Wuhan University from July 2019 to December 2020 were included. Patients were randomly divided into either S-BLR or C-BLR group for their subsequent strabismus surgery. All patients were followed up for 12mo. Near deviation, distant deviation, and near-distance difference (NDD) were measured in all patients. RESULTS: Twelve months after surgery, NDD improvement was 10 (8, 13) prismatic degrees (PD) in S-BLR group and 3 (1, 6) PD in C-BLR group (P=0.011). The near deviation of S-BLR group was 0 (-2, 2) PD, while that of C-BLR group was -4 (-6, -3) PD (P=0.005). Before and after surgery, the difference in the distant deviation between the two groups was not statistically significant. There was no statistically significant difference in near stereopsis between the two groups (P=0.380) at 12mo. The success rate at 12mo after operation was 90.91% and 72.73% in the two groups (P=0.280). CONCLUSION: CI-IXT patients treated with S-BLR have better surgical outcomes than those treated with C-BLR, which indicates S-BLR is a safe and effective operation pattern.     

Preoperative prism adaptation in acquired esotropia with convergence excess.

PURPOSE: The prism adaptation test (PAT) is used preoperatively to determine the surgical target angle for acquired esotropia. We assessed the surgical outcomes for children with convergence-excess esotropia (near esotropia greater than distance esotropia by 10 prism diopters [PD] or more) whose target angle was based on the results of the PAT geared to the near deviation. METHODS: We reviewed the charts for all of one surgeon's patients who underwent the PAT for near convergence-excess esotropia and who were followed-up for at least 6 months after surgery. Patients who wore prisms were classified as PAT responders (esotropia <= 8 PD at distance and near with four-dot fusion at near) or nonresponders (exotropia at distance or lack of four 4-dot fusion at near). Responders underwent surgery for the adapted angle at near. The nonresponders who had exotropia at distance had surgery for an angle between the near and distance angles. Nonresponders with esotropia angles <= 8 PD at distance and near underwent surgery for the total near deviation. RESULTS: Fifty-four (83%) of the 65 children were PAT responders. Thirty-nine (72%) of the 54 responders and 6 (55%) of 11 nonresponders had excellent results (heterotropia <= 8 PD at distance and near with four-dot fusion at near). All 13 responders whose angles built with prism had excellent results. Among 61 patients who had an esotropia <= 8 PD at near with prisms preoperatively, only 4 (6.6%) developed overcorrections at distance by the latest follow-up examination; 3 were responders and 1 a nonresponder. CONCLUSIONS: PAT for the near deviation in children who have convergence-excess esotropia is a useful test in estimating the target angle for surgery. Responders whose angles built with prism had a particularly high success rate. Surgery geared to the near-adapted angle has a low risk of creating an overcorrection in the distance regardless of the response to PAT.     

基本型间歇性外斜视患者的斜视控制能力与融合性辐辏和分开运动的关系

背景 间歇性外斜视是介于外隐斜和恒定性外斜视之间的一种斜视类型.间歇性外斜视患者融合性辐辏和分开运动的评估对了解患者控制隐斜或间歇性偏斜的能力是非常重要的. 目的 分析基本型间歇性外斜视患儿融合性辐辏运动和分开运动与外斜视控制之间的关系. 方法 采用系列病例观察研究方法,纳入2013年7月至2014年2月在北京同仁医院就诊的基本型间歇性外斜视患儿63例.采用三棱镜加交替遮盖法测定患儿双眼偏斜角度;采用修正纽卡斯尔控制分数(RNCS)方法评估外斜视的控制能力并进行评分;采用1 Δ～40Δ的水平三棱镜排镜及调节性视标检测融合性辐辏和分开运动的破裂点、恢复点和恢复易度检测.采用Spearman秩相关分析法评估融合性辐辏和分开运动的测量参数与间歇性外斜视控制分数之间的关系.结果 患儿右眼和左眼的平均屈光度分别为(-1.95±1.63)D和(-2.01±1.73)D,受检眼视远和视近时斜视度分别为(36.67±15.69)Δ和(38.25±14.83)Δ,差异均无统计学意义(t =-0.13、-0.57,均P＞0.05).患儿视远及视近时融合性辐辏运动的破裂点与外斜视控制分数之间均呈明显负相关(rs=-0.41,P=0.03;rs=-0.56,P＜0.01);而视远及视近融合性分开运动的破裂点与外斜视控制分数之间均无明显相关性(rs =0.05,P=0.78;rs=0.04,P=0.75).无论辐辏融合还是分开融合,融合恢复易度与外斜视控制分数之间均无明显相关性(均P＞0.05).结论 融合性辐辏运动破裂点的检测能较好地提示间歇性外斜视的严重程度,有可能作为间歇性外斜视的手术治疗指征之一.