Strabismic amblyopia

This is the second of a two‐part survey of current literature concerning strabismic amblyopia. The aim of this review is to bring the optometric community up to date on the status of scientific research into strabismic amblyopia. Part 1 in this series discussed research into strabismic amblyopia from the viewpoint of psychophysical experiments, which investigate both spatial and temporal behavioural deficits accompanying strabismic amblyopia. These include deficits in contrast sensitivity, spatial localisation, fixation, ocular motility, accommodation, crowding, attention, motion perception and temporal processing. Part 2 concerns neural processing in regards to strabismic amblyopia. It discusses current understanding of more fundamental aspects of central processing of visual information and in particular current theories regarding neural sites and mechanisms involved in amblyopia.     

斜视性弱视伴偏中心注视眼的多焦视网膜电图表现

目的：探究斜视性弱视伴偏中心注视眼的多焦视网膜电图(mfERG)特征性变化。

方法：收集2018-01/2020-12在我院就诊的斜视性弱视伴偏中心注视患者20例作为研究组(4例为外斜视,16例为内斜视),同时收集屈光不正性弱视患者20例作为对照组。散瞳状态下检查mfERG,记录P1波的振幅密度和潜伏期。

结果：斜视组弱视眼多焦视网膜电图P1波振幅密度与対侧眼相比第一环(P=0.001),第二环(P<0.001),第三环(P=0.001),第四环(P=0.009),第五环(P=0.026)明显降低; 与对照组相比第一环(P=0.033),第二环(P=0.002),第三环(P<0.001),第四环(P=0.014)明显降低; 斜视组弱视眼潜伏期与対侧眼相比第一环(P=0.017)、第二环(P=0.001)有明显缩短,与对照组相比第二环(P=0.007)明显缩短。

结论：斜视性弱视伴偏中心注视眼的多焦视网膜电图P1波振幅密度越靠近黄斑中心凹下降越多,且与屈光不正性弱视眼相比下降更多。     

Haidinger刷联合后像及红光闪烁治疗偏心注视性弱视的疗效观察

目的:观察Haidinger刷联合后像及红光闪烁法对偏心注视性弱视的治疗效果。方法:242例偏心注视性弱视患者随机分成两组,治疗组116例116眼,采用Haidinger刷联合后像及红光闪烁法;对照组126例126眼,采用后像及红光闪烁法。连续在门诊治疗2mo。结果:治疗组有效率86.2%,对照组42.9%,两组之间的差异具有统计学意义(P<0.01)。结论:Haidinger刷联合后像及红光闪烁法对偏心注视性弱视有显著的增视作用。     

后像法治疗儿童旁中心注视弱视的疗效分析

目的:探讨儿童旁中心注视性弱视的治疗方法。方法:采用后像法矫治旁中心注视性弱视儿童60例。结果:分析各年龄段的治疗率,4～5岁组治愈率为44%(12/27);6～7岁组治愈率为30%(6/20);>8岁组7%(1/14),各组间差异具有统计学意义(P=0.045)。分析不同程度的旁中心注视弱视类型的治疗率,注视性质<3环组,治愈率为64%(7/11);3～5环组为50%(5/10);>5环组为18%(7/40),各组间差异有统计学意义(P=0.023)。结论:后像法治疗儿童旁中心注视性弱视有一定疗效。     

斜视弱视治疗中应注意的几个问题

近年来国内斜视、弱视的诊断与治疗水平不断提高。但在斜视、弱视治疗中尚存在一些需要进一步澄清和强调的问题,如斜视手术的目的是什么、斜视手术时机如何选择、如何规范弱视的诊断与治疗等。有些问题在一些眼科医师中还存在着比较模糊的认识。本文就相关问题进行阐述,并藉此与眼科同道探讨。     

Decreased Binocular Summation in Strabismic Amblyopes and Effect of Strabismus Surgery

Purpose: Binocular summation (BiS) occurs when binocular visual function surpasses that of the better eye alone. We sought to evaluate whether strabismic amblyopia reduces BiS more than strabismus alone, and determine whether BiS improves in strabismic amblyopes after strabismus surgery. Methods: We prospectively recruited 15 patients with strabismic amblyopia who then underwent strabismus surgery. Thirty age-matched normal subjects and 30 non-amblyopic strabismic patients served as controls. Subjects underwent binocular and monocular visual acuity testing on high-contrast Early Treatment Diabetic Retinopathy Study (ETDRS) as well as 2.5% and 1.25% Sloan low contrast acuity (LCA) charts. BiS was calculated as the difference between better eye and binocular scores. Results: Strabismic amblyopes and strabismic controls did not significantly differ in preoperative BiS, but both had subnormal BiS preoperatively on LCA charts. Among 11 strabismic amblyopes with preoperative and postoperative BiS measurements, average postoperative BiS was not significantly different from preoperative. Improved LCA BiS postoperatively occurred in some patients and was associated with measurable preoperative stereoacuity (P=0.02), older age at strabismus onset (P=0.02), and larger preoperative angle of strabismus (P=0.0043).Conclusions: In this preliminary study, strabismic amblyopes experienced subnormal BiS, but amblyopia generally did not further impair BiS beyond that due to strabismus alone. Some strabismic amblyopes experienced improved low-contrast BiS after strabismus surgery. This suggests that further investigation in larger groups of patients should be undertaken to analyze a previously unrecognized functional benefit of strabismus surgery in strabismic amblyopes.     

斜视性弱视发病机制的研究进展

随着脑科学的蓬勃发展,弱视神经机制的研究进入到一个崭新阶段。研究证实:发育早期异常视觉经验可影响皮层神经元的空间特性,弱视视功能损害涉及多个脑区并与皮层神经元空间特性的异常密切相关,弱视是视觉神经通路多方位、多层次损害的综合。在此我们对斜视性弱视发病机制的研究进展作一综述。     

OCT对远视重度弱视患儿黄斑注视性质的观察

目的:通过OCT方法检查弱视患者的注视性质,思考和审视偏心注视的机制,指导弱视治疗.方法:对一组3~12岁儿童远视屈光性重度弱视患儿31例40眼治疗前后做黄斑光学相干断层扫描(OCT)检查,观察其注视性质的变化.结果:在31例40眼中,中心注视眼占63%,偏心注视眼占38%.单眼患者中心注视与偏心注视各占50%,双眼患者78%为中心注视,22%为偏心注视.治疗后15只偏心注视眼,分别在0.2~0.5视力之间全部转成中心注视,时间为1mo~2a.合并外斜和调节性内斜没有影响偏心注视转中心注视,且无论中心注视及偏心注视,其视力恢复对比观察,无明显差异.结论:采用OC T检查弱视眼注视性质客观、简便.在治疗过程中随着视力的提高,偏心注视转化为中心注视说明中心凹锥细胞功能被唤醒并且功能逐渐增强.     

An Audit of The Royal College of Ophthalmologists Strabismic Amblyopia Treatment Protocol: A Departmental Review

Introduction: Children presenting with strabismus and mixed (anisometropic/strabismic) amblyopia are managed by a local protocol as per guidelines from the Royal College of Ophthalmologists. Decisions regarding intervention for occlusion are currently delayed until a 22 week review allowing for refractive adaptation, with intermediate reviews at 6 and 14 weeks. Purpose: The purpose of this audit was to determine adherence to the protocol and the benefit of the 14 week review. Materials and Methods: We performed a prospective data collection of all children attending the orthoptic department with strabismus without pathology, both with and without unequal vision, from October 2007 to July 2008 managed using the protocol. Results: 26 patients were eligible. Mean age at presentation was 3.3 years (1.4 to 6.5). Cycloplegic spherical equivalent (SE) mean was 2.6 dioptres (?2.25 to +7.25). Five patients failed to comply with the protocol; one patient was listed surgery, four patients commenced premature occlusion. At presentation 8 patients had equal vision (defined as < 0.1 logMAR difference) between the two eyes or would only perform BEO vision, by week 14, over 60% were found to have a difference in vision between the eyes, despite refraction correction (mean 0.4 logMAR, range 0 to 1.4 logMAR). In a subgroup of patients (n = 8 at 6 weeks) with a small discrepancy of vision between the eyes (0.1 to 0.5 logMAR) there was no progressive worsening of vision during the period of observation and 50% of patients improved spontaneously, although two patients were lost to follow up. In the subgroup (n = 10 at 6 weeks) with a large discrepancy between the eyes (> 0.5 logMAR), all patients ultimately required occlusion, and there was minimal improvement in only three patients. Conclusion: Recorded vision at 6 weeks is more informative for making treatment decisions than that recorded at presentation. The 14 week review confers no benefit to those with reliable and improving visual acuity. Those patients presenting with a large discrepancy in visual acuity do not improve after 14 weeks and we feel that these patients could be occluded at 6 weeks. We propose a new algorithm for the treatment of this patient group.     

学龄前儿童弱视及斜视的调查

目的早期发现并及时治疗弱视、斜视及其他眼病,减少可预防盲及低视力。方法济南市部分幼儿园内随机检查健康3～6岁6085例学龄前儿童,检查其标准远视力、近视力、屈光、眼位、眼前节及眼底。结果3～6岁儿童远视力低常率为12．16%,近视力低常率为4．40%；弱视患病率为5．23%,其中初次发现者占86．48%；共发现斜视患儿96例,其治疗率仅为14．58%。结论近视力可作为发现患儿视力不佳的线索之一,发现后重点核实其远视力。我市3～6岁儿童的弱视斜视的漏诊漏治情况相当严重,对幼儿尽早进行眼科普查意义重大,保健预防及宣教工作亟待加强。     

屈光手术在成人斜视弱视领域中的应用

屈光手术包括角膜屈光手术和眼内屈光手术,不仅仅用来矫正单纯的屈光不正,其在治疗斜弱视领域也担任着重要角色。本文系统介绍了屈光手术在治疗儿童以及成人屈光参差性弱视以及调节性内斜视方面的一些研究进展,尤其是在治疗成人屈光参差性弱视和调节性内斜视方面,显示出独特的疗效,本文对此进行综述。     

Treatment for amblyopia with rotating gratings and subsequent occlusion: a controlled study

In a controlled study, the amblyopic eye of a group of 12 patients was stimulated in accordance with the original method of Campbell et al. (1978), using gratings, and a control group of 10 patients with black and white pictures. As in other controlled studies, no specific benefits ensued from the use of gratings. In both groups only slight visual improvements resulted, probably due to the repeated testing of visual acuity and nonspecific effects of short-term occlusion. A clear improvement in visual acuity and fixation behaviour was only observed after subsequent long-term occlusion.Presented in part to the Deutsche Ophthalmologische Gesellschaft in Kiel, September 1980.Supported by the Deutsche Forschungsgemeinschaft, SFB 7o, B4.     

远方视力训练法治疗斜视性弱视临床研究

目的:总结远方视力训练法治疗单眼斜视性弱视的疗效。方法:对240例患病儿童进行前瞻性研究,随机分组,与传统遮盖疗法进行对比,随访3mo。结果:远方视力训练法促进弱视眼视力提高显著优于传统遮盖法。与传统遮盖疗法在治愈率(18%)、显效率(60%)及有效率(93%)方面对比均有统计学意义。结论:远方视力训练法是治疗单眼斜视性弱视行之有效的新方法。     

斜视性弱视手术后视功能恢复情况的短期疗效研究

目的:了解斜视手术后3mo内对斜视性弱视眼的视功能恢复情况的研究。方法:对2006-06/2008-03在我院行斜视手术的合并有弱视的98例患儿,年龄3.5～15(平均7)岁,其中共同性外斜76例,共同性内斜22例,手术前后用国际标准视力表进行视力的检测、同视机进行双眼视功能检查以及睫状肌麻痹下屈光状态的检查,采用自身对照的方法,将术后1wk;1,3mo的弱视眼视力、双眼视功能以及屈光状态与术前对比,统计学采用两因素方差分析(two-way ANOVA)。结果:术后1wk弱视眼视力较术前提高有显著性差异(P<0.05),双眼融合范围较术前提高有显著性差异。立体视觉的产生在术后1mo较术前有显著性差异。术后1mo的屈光状态与术前相比无统计学差异。结论:斜视性弱视经过斜视手术后可以迅速改善斜视性弱视眼的注视性质,使弱视眼视力和双眼视功能在术后1wk即可得到有效的提高,屈光状态无明显改变,眼位的正常是恢复视功能的关键。     

废用性斜视的临床分析

目的：了解废用性斜视的临床特征。方法：对118例废用性内斜视及175例废用性外斜视临床资料进行分析。结果：废用性斜视以单眼注视功能丧失为特征。弱视是引起视力障碍最多见的疾病。在废用性斜视的发生过程中,视力发育障碍在先,斜视发生在后。结论：废用性斜视有独特的临床特征,可以在共同性继发性斜视中独立分类诊断。     

Functional differences between free alternators and non-alternators successfully treated for strabismic amblyopia

Visual acuity was examined in patients successfully treated for strabismic amblyopia, and with equal refractive error in the two eyes (no more of 4 diopters of hyperopia). Patients able to freely alternate fixation showed equal visual acuity in the two eyes without optical correction. An optical correction in front of the ex-amblyopic eye was needed, in order to achieve equal visual acuity in patients unable to freely alternate fixation. No correction was necessary for the sound eye. This difference is attributed to a residual anomaly of accomodation of the ex-amblyopic eye. It is concluded that the concept of cure of strabismic amblyopia based on the attainment of equal visual acuity needs re-evaluation.     

屈光参差性弱视与斜视性弱视临床疗效的比较

目的:分析比较屈光参差性与斜视性弱视的治疗效果。方法:前瞻性研究。2018-07/2020-01在我院门诊确诊的并首次接受治疗的单眼弱视患者46例,平均年龄9±3岁,其中男26例,女20例,按照临床诊断分为斜视性弱视组(无屈光不正),共23例,平均年龄9±3岁,其中男12例,女11例。以及屈光参差性弱视组,共23例,平均年龄9±3岁,其中男14例,女9例。对两组患者采用遮盖及精细训练治疗弱视,于治疗前及治疗后采用国际标准视力表检测视力、用Titmus图谱行立体视锐度的检测。比较两组患者经弱视治疗前后最佳矫正视力及立体视恢复的差异。结果:治疗前两组患者弱视眼的最佳矫正视力无差异(t=-0.475,P>0.05),但斜视性弱视患者的立体视功能明显低于屈光参差性弱视患者(t=-3.919,P<0.001);通过2mo的治疗,两组患者最佳矫正视力提高值有明显差异(t=-2.946,P<0.01),而两组患者立体视提高值无差异(t=1.305,P>0.05);通过6mo的治疗,两组患者最佳矫正视力提高差值有明显差异(t=-2.353,P<0.05),两组患者立体视提...     

斜视弱视患者的双眼视觉状况及其矫治

本文在复习正常双眼视觉的概念及检查双眼视觉的常用方法和双眼视觉正常范围的基础上,介绍了单眼深度感知和双眼立体视觉近年来神经生理学及神经解剖学的研究进展,即单眼深度线索和双眼深度线索获得的深度感知在顶叶皮层的CIP区（顶尾侧）被整合,强调了单眼及双眼均可感知立体视觉。重点阐述斜视、弱视患者双眼单视及双眼立体视觉受到损害的状况,以及应用脱抑制训练、融合训练、立体视训练等方法矫治双眼视觉缺陷的结果。     

A case of amblyopia with contralateral optic nerve hypoplasia

We describe an unusual case of unilateral optic nerve hypoplasia (ONH) in a patient with contralateral anisometropic/strabismic amblyopia. A seven‐year‐old boy presented with visual acuities of 6/12 R and 6/18 L and eccentric fixation in the left eye. Cycloplegic retinoscopy was R +1.50/‐0.50 × 180 and L +5.25 DS. Funduscopy revealed optic nerve hypoplasia of the right eye. The patient fixated with his better‐seeing right eye, despite the optic nerve hypoplasia. His reduced vision may be attributed to optic nerve hypoplasia in the right eye and amblyopia in the left. Although optic nerve hypoplasia can occur with ipsilateral amblyopia, we believe this is the first reported case of unilateral optic nerve hypoplasia in the fellow eye of an amblyopic patient.     

儿童单眼弱视182例临床疗效观察

目的观察单眼弱视的疗效,探讨其最佳治疗方案。方法追踪观察门诊治疗的182例单眼弱视,对弱视类型、程度、注视性质与疗效的关系进行统计分析。结果屈光参差性弱视治愈率76.86%(93/121);单纯斜视性弱视治愈率10.53%(2/19);斜视合并屈光参差性弱视治愈率7.14%(3/42);轻度弱视治愈率88.00%(22/25);中度弱视治愈率66.97%(73/109);重度弱视治愈率6.25%(3/48);中心注视性弱视治愈率73.60%(92/125);非中心注视性弱视治愈率10.53%(6/57);其中弱视类型、弱视程度及注视性质各组间疗效有显著统计学意义(P<0.01)。结论单眼弱视以屈光参差性弱视疗效好,斜视伴屈光参差的弱视治疗效果最差。