阿托品压抑疗法与遮盖疗法治疗儿童屈光参差性弱视

目的:探讨阿托品压抑疗法与遮盖疗法治疗儿童屈光参差性弱视的疗效及对视功能的影响。方法:前瞻性研究。选取2018-02/2020-09本院收治的屈光参差弱视儿童患者158例,采用随机数字表法将弱视儿童分为两组：阿托品压抑疗法组优势眼治疗给予1%阿托品凝胶,临睡前滴一滴至结膜囊内,每周治疗2次者78例;遮盖疗法组弱视儿童每日遮盖优势眼大于2h治疗者80例。比较两组弱视儿童治疗6mo后立体视功能、对比敏感度、行图形视觉诱发电位检测,评估治疗效果及依从性。结果:阿托品压抑疗法组和遮盖疗法组总体依从性比较有差异(96.2%vs 73.8%,P<0.05),有效率比较无差异(79.5%vs 73.8%,P>0.05),立体视功能重建有效率比较有差异(74.4%vs 56.3%,P<0.05)。两组治疗6mo后在1、4、8、10、12c/d频率下对比敏感度较治疗前明显升高(均P<0.001),阿托品压抑疗法组在8、10、12c/d频率下对比敏感度高于遮盖疗法组(均P<0.05),P100波幅高于遮盖疗法组,P100潜伏期低于遮盖疗法组(P100波幅：12.96±2.10...     

隐形遮盖镜与压抑膜疗法治疗大龄单眼弱视的疗效比较

目的：比较隐形遮盖镜与压抑膜疗法治疗大龄弱视患者的疗效。

方法：前瞻性研究。选取2015-06/2016-12于我院就诊的10～14岁单眼弱视患者112例112眼,其中应用压抑膜疗法治疗者55例(A组),应用隐形遮盖镜疗法者57例(B组)。评估两组患者的治疗依从性和疗效,观察两组患者治疗前后矫正视力的变化情况。

结果：治疗3、6、12mo,A组患者治疗依从性(98.2%、96.4%、92.7%)与B组(94.7%、91.2%、89.5%)无明显差异(均P>0.05),但治疗有效率(27.8%、50.9%、76.5%)均明显低于B组(46.3%、71.2%、92.2%),且B组患者弱视眼矫正视力均优于A组(P<0.05)。治疗12mo,A组患者总治愈率和实际治愈率(52.7%和56.9%)均明显低于B组(71.9%和80.4%)。

结论：隐形遮盖镜疗法治疗10岁以上单眼弱视,弱视眼视力提高速度和治愈率均优于压抑膜遮盖疗法。     

阿托品抑制法与遮盖法治疗儿童弱视的比较

临床治疗弱视常用遮盖法 ,如患儿不配合可用压抑疗法。我们对 1 0 0例患儿行阿托品治疗或遮盖治疗 ,现将两组结果报告如下 :资料与方法1 一般资料　患儿 1 0 0人 ,按就诊顺序编号 ,分A、B两组 ,双号为A组 ,单号为B组 ,每组各 50人 ,年龄 2 5～ 7岁 ,两组平均年龄均为 4 5岁。A组斜视性弱视 1 2眼 ,屈光参差性弱视 3 8眼 ;B组斜视性弱视 1 1眼 ,屈光参差性弱视 3 9眼。均符合以下标准 :(1 ) 7岁以下 ,单眼弱视 ,为中心注视。(2 )矫正视力 ,弱视眼视力为 0 2～ 0 5,健眼视力≥ 0 8(对数视力表换算成小数记录法 ,以下同 )。(3 )无视力…     

单眼先天性白内障术后弱视的治疗

目的探讨完全遮盖疗法及完全压抑疗法、单镜及双镜矫正对单眼先天性白内障术后弱视患儿的治疗效果。方法将58例患儿随机分为4组A组采取完全压抑疗法,对弱视眼行双镜矫正;B组采取完全压抑疗法,弱视眼给予单镜矫正;C组及D组均采用遮盖疗法,C组弱视眼以双镜矫正,D组以单镜矫正。结果治疗后视力提高≥2行者,A组75%,B组36%,C组73%,D组31%;双镜矫正与单镜矫正比较差异有显著性(P<005);而完全压抑疗法与完全遮盖疗法比较差异无显著性(P>005)。结论无论何种方法,只要达到解除主导眼对弱视眼的抑制,视力就可能提高;双镜矫正更符合人工晶体眼的生理特点,故治疗效果更为明显。     

部分调节性内斜视术后弱视复发的治疗

目的探讨遮盖法、远距离压抑疗法对部分调节性内斜视弱视复发的治疗效果.方法对28例术前诊断为部分调节性内斜视术后弱视复发的患儿,随机分为两组,分别以遮盖法及压抑主眼看远行弱视治疗,观察治疗后3个月、6个月、1年的视力及眼位.结果遮盖法与压抑主眼看远相比,视力提高在3个月及6个月时差异有显著性(P＜0.05);在1年差异无显著性(P＞0.05).眼位变化在3个月及6个月时差异无显著性(P＞0.05);在1年差异较明显(P＜0.05).结论遮盖法与压抑主眼看远相比视力恢复快,但遮盖时间过长,部分患儿出现斜视度增加;压抑主眼看远,弱视的治疗时间长,但眼位较为稳定.对于术后两眼屈光参差不大、轻度弱视的患儿,可选择遮盖法,使治疗时间缩短;而对于术后两眼屈光参差较大、中度弱视的患儿,可选择压抑主眼看远,眼位更为稳定.     

压抑疗法与完全遮盖法对健眼屈光影响初探

目的 研究弱视治疗中压抑疗法与完全遮盖疗法对御良屈光状态的影响.方法 回顾性总结2002年5月至2005年5月间在我院进行弱视治疗的单眼弱视病例中压抑疗法组49人和完全遮盖疗法组70人的双眼屈光度变化情况.压抑疗法组平均年龄为5.2岁,追踪观察24个月,压抑眼和弱视眼的屈光度每年分别下降0.59D、0.60D,完全遮盖疗法组平均年龄为4.8岁,遮盖眼和对侧眼的屈光度每年分别下降0.89D和0.58D.把两组数据分别带人SPSS10.0统计软件,进行统计学分析,结果完全遮盖疗法组屈光度变化两眼之间有明显差异(P<0.05);压抑疗法组屈光度变化的两眼之间没有明显差异(P>0.05).结论 长期的完全遮盖疗法有可能加快弱视儿童被遮盖眼远视屈光度下降的速度,使屈光参差增大,对健眼屈光度为低度远视、正视或近视的患者,要密切观察健眼的屈光状态,弱视治疗时尽量减少遮盖时间,以免健眼由于视觉剥夺而发生近视.     

阿托品联合短时遮盖治疗学龄儿童屈光参差性弱视的临床分析

目的:探讨阿托品联合短时遮盖治疗学龄儿童屈光参差性弱视的疗效。方法:回顾性分析学龄期屈光参差性弱视治疗12mo病例97例97眼。A组:周一至周五每日遮盖3～4h,周六、周日每日遮盖8～12h;优势眼滴阿托品眼液2次/d,连续用药3d后改为1次/d,连续用药20d,停药7d。B组:采用全日遮盖,要求每日遮盖优势眼不少于8h。结果:两组治愈率比较,差异有统计学意义,A组疗效优于B组(χ2=3.992,P<0.05)。中、重度屈光参差性弱视A组疗效优于B组,差异有统计学意义(中度弱视χ2=6.46,P<0.05;重度弱视P=0.0292)。结论:阿托品联合短时遮盖有利于提高学龄期屈光参差性弱视患儿治疗依从性,提高治愈率。     

眼罩遮盖法与阿托品疗法治疗屈光不正性弱视疗效观察

目的:观察眼罩遮盖法与阿托品疗法治疗弱视的疗效有无差异。方法:160例(320只弱视眼)患儿随机分组,比较两种方法对视力的提升效果及双眼视功能的改善情况。结果:眼罩遮盖法组与阿托品疗法组使弱视眼视力进步的有效率及立体视锐度差异有统计学意义。结论:在某种情况下阿托品疗法更有利于患儿视力提升及双眼视恢复。     

阿托品联合短时遮盖治疗弱视的疗效观察

目的 探讨阿托品联合短时遮盖治疗弱视的疗效,方法回顾性分析随机抽取的弱视治疗病例99例110只眼.18个月观察期内按遮盖治疗方式分为三组:A组:每天遮盖不少于8h;B组:周一至周五每日遮盖3-4h,周六、周日每天遮盖8h;C组:优势眼每日滴阿托品眼液一次,连续用药15d.停药15d,并每日遮盖优势眼4h.结果 中度、重度弱视,屈光参差性弱视C组疗效优于A组,差异有统计学意义(中度弱视t=2.2272,P<0.05;重度弱视t=2.8111,P<0.01;屈光参差性弱视t=2.9722,P<0.01).视力提高程度C组高于A组,差异有统计学意义.疗程上C组较A、B组缩短,差异有统计学意义(B组与C组:X2=9.413.P<0.01:A组与C组:X2=14.7489,P<0.01).结论 阿托晶联合短时遮盖有利于提高弱视治疗依从性,缩短疗程.提高治愈率.     

探讨遮盖法在弱视治疗中的意义

目的:观察遮盖法治疗弱视的效果,同时分析不同遮盖时间、年龄差异、发病原因及弱视程度的疗效特点从而探讨其在弱视治疗中的临床意义。方法:回顾性研究,自2005-06/2008-06就诊于我院斜弱视门诊患儿107例143眼,男(45例69眼),女(62例74眼)。平均年龄5.3岁,其中斜视性弱视26眼,屈光参差性弱视37眼,屈光不正性弱视80眼,轻度弱视43眼,中度弱视81眼,重度弱视19眼。根据治疗方法不同随机分组为完全遮盖组、4h遮盖组、单纯配镜矫正组。随访1a中观察并记录3组患儿最佳矫正视力,视力提高行数及弱视治愈率。结果:遮盖组视力平均提高2.4行,单纯戴镜组视力平均提高1.7行,遮盖组较对照组视力提高明显(P<0.05)。视力提高达0.8以上治愈率为遮盖组(11眼,11.5%),对照组(4眼,8.5%),遮盖组治愈率明显高于对照组(P<0.05)。间断遮盖和全日遮盖两种方法对轻度和中度弱视组视力提高无统计学差异(轻度χ2=0.84,P=0.77;中度χ2=0.91,P=0.57),重度弱视组患者全日遮盖较间断遮盖视力明显提高(χ2=13.57,P<0.05)。间断遮盖4h组在3,6,12mo视力平均分别为0.41,0.56,0.67;全日遮盖组在3,6,12mo视力平均分别为0.38,0.68,0.72,其中第6mo全日遮盖组视力改善较间断遮盖组明显增高趋势但无统计学意义(χ2=2.0,P=0.60)。结论:遮盖法是弱视治疗中常用且有效的治疗方法,对于轻中度弱视可采用间断遮盖的方法,重度弱视采用全天遮盖的方法,维持患者的依从性是治疗的关键。     

光学药物压抑疗法对儿童单眼弱视的疗效

目的对比分析光学药物压抑疗法与遮盖疗法对儿童斜视性或屈光参差性弱视的疗效。方法前瞻性临床研究。收集2013年1月至2015年3月在我院诊断为斜视性或屈光参差性弱视的儿童患者,根据采用的弱视治疗方法不同分为遮盖疗法组（遮盖组）与光学药物压抑疗法组（压抑组）。根据弱视程度不同又分为轻度、中度、重度弱视进行分析。对随访12个月以上患者的弱视治疗效果进行分析比较。2组弱视程度比较采用Wilcoxon秩和检验,组间的有效率和治愈率比较采用χ²检验。结果共纳入斜视性或屈光参差性弱视患者85例（85眼）,其中遮盖组52例（52眼）,压抑组33例（33眼）。遮盖组治愈率60%,压抑组治愈率64%,2组治愈率差异无统计学意义（χ²=0.137,P=0.711）。遮盖组有效率88%,压抑组有效率85%,2组有效率差异无统计学意义（χ²=0.234,P=0.629）。轻度、中度、重度弱视患者中,遮盖组与压抑组有效率差异均无统计学意义。遮盖组52只弱视眼均转为注视眼,压抑组进行药物压抑治疗3~6个月后,29只弱视眼转为注视眼,4只未转为注视眼,后改为遮盖疗法。结论与传统遮盖疗法相比,光学药物压抑疗法对于儿童斜视性或屈光参差性弱视的治疗效果相近。     

The Effect of Amblyopia Therapy on Ocular Alignment

PURPOSE: We sought to describe the change in ocular alignment at 2 years after treatment of amblyopia in children younger than 7 years of age at enrollment. METHODS: A randomized clinical trial of patching versus atropine for 6 months followed by standard clinical care for 18 months was conducted in 357 children with anisometropic, strabismic, or combined amblyopia (20/40-20/100) whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment was evaluated at enrollment and after 2 years of follow-up. RESULTS: At enrollment when tested at distance fixation, 161 (45%) children were orthotropic, 91 (25%) had a microtropia (1-8 Delta), and 105 (29%) had a heterotropia >8 Delta. Of the 161 patients with no strabismus, similar proportions of patients initially assigned to the patching and atropine groups developed new strabismus by 2 years (18% vs. 16%, P = 0.84). Of these cases of new strabismus, only 2 patients in the patching group and 3 patients in the atropine group developed a deviation that was greater than 8 Delta. Microtropia at enrollment progressed to a deviation greater than 8 Delta with similar frequency in both treatment groups (13% vs. 15%, P = 1.00). Of the 105 patients with strabismus greater than 8 Delta at enrollment, 13% of those in the patching group and 16% of those in the atropine group improved to orthotropia without strabismus surgery. Strabismus surgery was performed in 32 patients during the 2-year study period. CONCLUSIONS: Patients who had amblyopia treatment with patching or atropine for 6 months followed by standard clinical care were found to have similar rates of deterioration and improvement of ocular alignment. When parents begin amblyopia treatment for children without strabismus, they should be warned of the possibility of development of strabismus, although it is most often a small angle deviation. Strabismus resolved after amblyopia therapy in some cases.     

Comparative efficacy of penalization methods in moderate to mild amblyopia

PURPOSE: To compare the efficacy and sensory outcome of pharmacologic and optical penalization in the treatment of moderate to mild amblyopia. DESIGN: Randomized clinical trial. METHODS: In an institutional setting, two- to 10-year-old children with strabismic or anisometropic amblyopia (visual acuity in the amblyopic eye at least 20/60) who were cooperative to measure visual acuity using the logarithm of the minimum angle of resolution (logMAR) crowded Glasgow acuity cards were randomized into two groups of therapy (n=35 in each group), 1% atropine, and optical penalization with positive lenses, after stratification by cause of amblyopia. Visual acuity was tested by the logMAR crowded Glasgow acuity cards, after retinoscopic refraction, and deviation angle were measured by the simultaneous prism and cover or Krimsky test. Stereoacuity was determined using the Titmus fly test and Randot preschool or Randot circles stereoacuity test. Change in visual acuity of the amblyopic eye and in interocular difference of visual acuity after six months of amblyopia therapy was the main outcome measure; stereoacuity at six months of therapy was a secondary outcome measure. RESULTS: Thirty-one and 32 children completed the outcome examination in the atropine and optical penalization group, respectively. Average improvement in visual acuity of the amblyopic eye was larger in the atropine than in the optical penalization group (3.4 and 1.8 logMAR lines, respectively), as well as average improvement in interocular difference of visual acuity (2.8 and 1.3 logMAR lines, respectively). Better stereoacuity, but nonsignificantly different, was detected in the atropine group. CONCLUSIONS: Atropine penalization may be considered more effective than optical penalization with positive lenses.     

阿托品压抑疗法和遮盖疗法在小儿弱视治疗中比较

目的 比较阿托品压抑疗法和遮盖疗法在治疗小儿弱视中的疗效.方法 将54例弱视患儿随机分为两组,分别给予阿托品压抑治疗和遮盖治疗.结果 遮盖组、压抑组治疗前后视力比较及两组治疗后视力比较均有显著差异,具有统计学意义.结论 压抑疗法比遮盖疗法更为有效,且有更好的接受性和依从性.     

智能化多维训练系统在大龄弱视儿童中的疗效观察

目的:通过对增视能智能化多维训练系统(简称增视能)和综合治疗方法治疗大龄弱视儿童(10～14岁)的疗效进行对比观察,探索大龄儿童弱视有效的治疗方法。方法:应用增视能和综合治疗对196例300眼(各150眼)大龄儿童弱视进行随机分组治疗,增视能组给予视觉刺激、视觉精细等不同训练方案;综合治疗组采用遮盖、精细目力训练、CAM视觉刺激、红光闪烁、后像、光刷等治疗。对比两种方法在弱视治疗1a后的最佳矫正视力。对最佳矫正视力达0.6时无双眼视的患儿增视能组行多维三级功能训练,综合训练组行视加-400型弱视治疗仪附加的三级功能训练,观察6mo后双眼视功能变化情况。结果:轻度弱视大龄儿童增视组和综合治疗组治愈率相近,差异无统计学意义(P>0.05),中、重度弱视大龄儿童增视能组的弱视治疗总有效率明显高于综合疗法组,两组差异有统计学意义(P<0.05)。在最佳矫正视力达0.6时没有双眼视觉功能的患儿,三级视功能训练6mo后,增视能组获得近立体视有效率高于综合治疗组,差异有统计学意义(P<0.05)。结论:增视能智能化多维训练系统是治疗中、重度大龄儿童弱视的有效方法。     

阿托品在大龄弱视儿童治疗中的应用

弱视是影响儿童视觉发育最常见的眼病。弱视的患者不仅单眼或双眼视力明显低下,更重要的是有可能失去双眼平衡及立体视。三百多年来,遮盖法作为治疗弱视的经典疗法广泛应用于临床。但遮盖一眼后,一方面不利于双眼立体视的建立,可能形成遮盖性弱视;另一方面,年龄虽然是影响弱视治疗效果的重要因素,但患者治疗的依从性对疗效的影响也至关重要。基于上述原因,遮盖疗法对大龄弱视儿童的治愈率及治疗的疗程受到相应的制约。因此,阿托品疗法(尤其是光学药物压抑疗法)被一些患者,特别是大龄弱视儿童(7岁以上)广泛接受。因为它既能给患儿一个被迫依从的治疗过程又能压抑主眼,同时给双眼共同视物的机会,以利于双眼视功能的建立。并且这种治疗方法有效地解决了患者因为美容或其他原因不愿意接受遮盖的问题。下面我们就阿托品压抑疗法在大龄儿童(7岁以上)弱视治疗中的应用进行综述。     

Comparison of the efficacies of patching and penalization therapies for the treatment of amblyopia patients

AIM: Tocompare the efficacies of patching and penalization therapies for the treatment of amblyopia patients.METHODS:The records of 64 eyes of 50 patients 7 to 16y of age who had presented to our clinics with a diagnosis of amblyopia, were evaluated retrospectively. Forty eyes of 26 patients who had received patching therapy and 24 eyes of 24 patients who had received penalization therapy included in this study. The latencies and amplitudes of visual evoked potential (VEP) records and best corrected visual acuities (BCVA) of these two groups were compared before and six months after the treatment.RESULTS:In both patching and the penalization groups, the visual acuities increased significantly following the treatments (P<0.05). The latency measurements of the P100 wave obtained at 1.0°, 15 arc min. Patterns of both groups significantly decreased following the 6-months-treatment. However, the amplitude measurements increased (P<0.05).CONCLUSION: The patching and the penalization methods, which are the main methods used in the treatment of amblyopia, were also effective over the age of 7y, which has been accepted as the critical age for the treatment of amblyopia.     

Amblyopia treatment and quality of life: the child’s perspective on atropine versus patching

ABSTRACT

Background: The impact on children of patching versus atropine treatment for amblyopia was assessed using children’s perspective Health-Related Quality of Life (HRQoL) scores in 5 to 7-year olds.

Methods: Forty-six children on the threshold of commencing either patching or atropine treatment for amblyopia were recruited. Treatment was prescribed for uniocular amblyopia of visual acuity (VA) 0.2 logMAR or worse. After four weeks of their chosen treatment, each child completed the Child Amblyopia Treatment Quality-of-Life Questionnaire (CAT-QoL). The Pediatric Quality of Life Inventory (PedsQL?), Young Child (5–7) Self-Report version, was completed before and after four weeks of treatment. Quality of life scores were compared between the two treatment groups.

Results: Sixty-one percent (n = 28) of participants were male and 56.5% (n = 26) were white British. The CAT-QoL has a range of 0–16, with 16 being the worst quality of life. No significant difference was found between the patching group (n = 30, mean age 69.7 months) and the atropine group (n = 16, mean age 69.3 months) for CAT-QoL quality of life scores (Patch median = 6.3, Atropine median = 5.6, U = 199, p = .341, 95% CI of the median difference of ?2.3 to 0.9). The Young Child (5–7) Self-Report version of the PedsQL? has a ‘total score’ range of 0–100, with 0 being the worst quality of life. There was also no significant difference in PedsQL? quality of life total scores (Patch median = 80, Atropine median = 83.33, U = 239.5, p = .991, 95% CI of the median difference ?13.33 to 10) after four weeks of treatment.

Conclusion: Amblyopic children reported that patching and atropine treatments did not have a significant impact on their quality of life. Patching and atropine should continue to be offered as first-line treatments for amblyopia, as children appear to tolerate both well and do not favor one over the other.     

大龄弱视儿童治疗的临床评价

目的评价12岁以上大龄儿童弱视治疗效果,探讨视觉发育期后视觉可塑性。方法收集在我院门诊就诊的3岁～17岁弱视患者65例,3～12岁为A组共35人,〉12岁为B组共30人,之前均未进行过弱视治疗。观察大龄弱视儿童的治疗效果并探讨年龄、弱视类型、弱视程度及注视性质等因素与疗效的相关性。结果 B组基本治愈为16眼（53.3%）,治愈时间平均2.4年。两组在治愈率和治疗时间上差异均有统计学意义（P〈0.05）。结论超过视觉发育期的大龄弱视患儿经过合理治疗,仍有可能获愈,故对年长弱视儿童也不应轻易放弃。     

儿童弱视训练失败的原因分析及对策

目的:分析儿童弱视训练失败的原因,探讨提高弱视训练效果的对策。方法:2003/2005年在我院初诊并进行治疗的79例137眼5~10岁的屈光性弱视患儿,戴镜后综合弱视治疗,采用集体性/家庭性训练方式,观察治疗6mo后视力变化情况。结果:治疗6mo后,有效率68%;不同性别患儿间疗效无显著性差异,但集体式训练效果明显优于家庭式训练(P<0.01),双眼弱视患儿效果优于单眼弱视患儿(P<0.01)。结论:在弱视治疗中应全力作好患儿的工作,取得患儿的配合。尤其是单眼弱视的患儿,防止其敷衍治疗。如果家庭训练一段时间无效,应该尽快转入集体性训练方式中。