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。     

儿童弱视326例的综合治疗效果

目的：探讨儿童弱视综合疗法治疗的疗效观察。 方法：儿童弱视326例485眼，根据弱视程度、弱视类型、注视性质、屈光状态，采取遮盖、压抑、精细目力训练、CAM视觉刺激、红光闪烁、后像、光刷、同视机治疗。 结果：视力增进2行或2行以上者483眼（99．6％）；其中治愈381眼（78．6％）；无效2眼（0．4％）；总有效率99．6％。综合疗法治疗儿童弱视，提高了有效治愈率，弱视程度越轻治疗效果越好。中心注视疗效明显高于旁中心注视，两组治愈率有显著统计学意义（P〈0．01）。各类弱视中以屈光不正性弱视疗效最佳，形觉剥夺性疗效最差。 结论：综合治疗儿童弱视是最理想、最有效的方法，见效快、疗效显著、值得临床推广。     

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...     

综合疗法治疗儿童弱视410例分析

目的探讨应用综合治疗法治疗儿童弱视的疗效。方法对410例(750只眼)弱视眼,行配镜遮盖及精细目力训练等。结果年龄越小,弱视程度越轻,坚持治疗时间越长,疗效越好。屈光不正弱视治疗率明显高于屈光参差和斜视性弱视,中心注视性弱视疗效优于旁中心注视性弱视。结论综合疗法的疗效与弱视的类型、程度、年龄、坚持治疗时间和注视性质密切相关,综合治疗法疗效好。     

综合疗法治疗大龄儿童弱视观察

国外学者用药物治疗弱视的临床研究已取得初步疗效。我们用口服复方苄丝肼联合遮盖、光电疗法等对大龄儿童弱视进行治疗,报告如下。1　资料与方法1.1　临床资料　1997～2 0 0 2年在我院门诊治疗的61例( 10 8眼) 7～15岁的大龄弱视儿童,采用1%阿托品滴眼液或眼膏散瞳验光并处方配镜矫治。其中屈光不正性弱视5 8眼,屈光参差性弱视19眼,斜视性弱视3 1眼。轻、中、重度弱视分别为2 6、68和14眼。患者中2 5例( 4 6眼)为综合治疗组,男11例,女14例;其中轻、中、重度弱视分别为12、2 4和10眼。屈光不正性弱视2 5眼,屈光参差性弱视10眼,斜视性弱视11…     

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…     

综合治疗儿童屈光不正性弱视远期疗效分析

目的探讨儿童屈光不正性弱视的治疗方法及远期疗效。方法回顾分析319例（579眼）弱视患者，初诊时经阿托品散瞳检影验光，每半年至1年重新验光，配戴合适的眼镜，辅以红光闪烁、光栅、后像、光刷治疗，单眼弱视或双眼视力相差2行以上者辅以遮盖治疗、7岁以上大龄儿童不接受遮盖治疗者给予药物压抑并配合思利巴口服3个月。结果319例（579眼）随访平均5年（3~7年）。基本治愈530眼（91.54%），进步49眼（8.46%）。屈光不正性弱视的治疗效果与开始就诊时的年龄、弱视的程度、注视性质、依从性有密切关系，即弱视程度越轻、年龄越小、依从性越好效果越好，中心注视者疗效明显高于旁中心注视者。结论儿童屈光不正性弱视采用综合治疗，可以取得较满意的效果。     

强化遮盖综合治疗儿童单眼弱视疗效分析

目的探讨强化遮盖综合疗法治疗儿童单眼弱视的疗效。方法对确诊为儿童单眼弱视的216例216眼门诊儿童患者,按弱视病因,分别给予以强化遮盖治疗为主,联合屈光矫正、红光闪烁、后像等综合治疗,随访观察12~36个月,分析其疗效。结果 216例216眼,治愈率67.13%,进步28.70%,无效4.17%;初诊年龄越小,治疗效果越好;屈光不正性弱视、轻度弱视、中心注视性弱视治疗效果更好。结论弱视的疗效与患儿的年龄、弱视的类型、弱视的性质、弱视的程度密切相关,强化遮盖综合疗法治疗儿童单眼弱视疗效显著。     

综合疗法治疗儿童弱视100例远期疗效观察

目的:探讨综合疗法治疗不同类型儿童弱视的远期临床疗效。 方法：对100例190眼儿童按弱视类型、弱视程度、注视性质和年龄进行分类,并采用矫正屈光不正、遮盖疗法、家庭精细目力训练及红光治疗、综合治疗仪对其进行治疗,随访观察达5a以上。 结果：屈光不正性弱视治愈率最高,明显高于屈光参差性、斜视性弱视和遮盖性弱视,轻度弱视的治愈率明显高于中度和重度弱视。中心注视高于旁中心注视,弱视治疗的年龄越小,疗效越好,3~6岁组明显高于其他年龄组。 结论：弱视治疗的疗效与弱视类型、弱视程度、注视性质及开始治疗的年龄、家长及患儿的依从性有密切关系,用综合疗法治疗弱视可以提高其治愈率,并缩短疗程。     

大龄弱视儿童258例综合疗效分析

目的分析大龄儿童弱视治疗疗效及其因素。方法调查总结2008至2010年在我院接受治疗的患者258人（422只眼）,其中10~11岁226只眼,12~13岁126只眼,14~15岁70只眼,通过屈光矫正、遮盖、压抑、红光闪烁、后像等综合疗法进行治疗,并行2~3年随访观察,观察其疗效。结果 258例大龄儿童弱视的治愈率达65.88%、进步30.33%、无效3.79%。结论综合疗法规范治疗大龄儿童验光疗效肯定,值得推广,其疗效与弱视的类型、程度、年龄及中心注视性质密切相关。     

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.     

Long term visual outcome in amblyopia treatment

AIM: To evaluate long term visual outcome of treatment for amblyopia. METHODS: In a previous study, 44 children with unilateral amblyopia caused by strabismus or anisometropia were enrolled in a prospective study investigating the results of treatment. All children were regularly examined up to at least 8 years of age and outcome was evaluated. All subjects were invited to a re-examination and in total 26 subjects attended. Two of these were excluded because of insufficient records. The final sample consists of 24 subjects. Mean follow up time was 10.4 (SD 1.9) years. RESULTS: For the amblyopic eyes, 17% deteriorated in visual acuity, 50% were stable, and 33% gained in visual acuity. For the non-amblyopic eyes, 8% lost one line in visual acuity, 38% were stable, and 54% gained in visual acuity. No eye in any subject shifted more than 0.2 logMAR units. The increase in visual acuity for the non-amblyopic eyes was significant, while the increase for the amblyopic eyes was not. All straight eyed anisometropic amblyopes showed a distinct decrease in magnitude of anisometropia. CONCLUSIONS: Visual acuity was essentially stable in the amblyopic eyes 10 years after cessation of treatment in the studied population.     

Visual acuity after cycloplegia in children: implications for atropine penalization.

BACKGROUND: Atropinization of the sound eye is an alternative to patching in the treatment of amblyopia. Whether atropine treatment can induce a switch in fixation depends on the refractive error of the sound eye, visual acuity of the amblyopic eye, distance from the fixation target, and presence of any optical correction or penalization. General guidelines are needed on the basis of refractive error and visual acuity in the amblyopic eye to predict which patients may potentially benefit from atropine penalization. METHODS: Refractive error and visual acuity at distance (6 m) and/or at near (33 cm) were recorded in a normal eye of 126 consecutive children (mean age, 8.2 years), 30 to 60 minutes after receiving cyclopentolate 1%. Visual acuity was plotted versus refractive error at distance and at near, and best-fit curves were calculated. RESULTS: There was a consistent, reproducible relationship between refractive error and visual acuity after cycloplegia at both distance and near in healthy children. CONCLUSIONS: The results of this study can be used to quickly determine whether atropine penalization has the potential for success on the basis of a patient's visual acuity in the amblyopic eye and refractive error in the sound eye. When adequate hyperopia is present in the sound eye, one should consider testing for fixation preference or initiating a therapeutic trial of atropine. Those children with insufficient hyperopia in the sound eye relative to visual acuity in the amblyopic eye can be spared the time, expense, and potential side effects of atropine penalization.     

Psychometric视力表对弱视儿童视力的评估作用

目的评价Psychometric视力表在弱视儿童诊治中的应用价值．拥挤现象对正常视力儿童和弱视儿童的影响是否相同。方法我院门诊5～15岁儿童113人，男65人，女48人，平均年龄（7.42±2．03）岁，用标准对数视力表和包含拥挤现象的Psychometric视力表分别检查左右眼的两种视力，比较正常眼和弱视眼两种视力的差别。结果正常视力儿童和弱视儿童的两种视力差异都有显著性（P〈0．05）。对数视力比P视力高。弱视儿童的两种视力差别比正常儿童大。不同弱视类型之间视力差别不大．不同弱视程度之间两种视力有差别。结论儿童都受拥挤现象的影响，但是弱视儿童的拥挤现象更明显。拥挤现象影响程度与弱视程度有关。与弱视类型关系不大。Psychometric视力表适合弱视患者的视力检查。     

Long-term changes in visual acuity and refractive error in amblyopes.

PURPOSE: To report long-term changes in visual acuity and refractive error for strabismic, anisometropic, and isoametropic amblyopes. METHODS: Records of patients with strabismic amblyopia, anisometropic amblyopia, and isoametropic amblyopia who were treated from 1983 to 1993 were reviewed. Excluded were patients having ocular or neurological diseases, developmental delay, and follow-up <4 years after treatment cessation. Data included best-correctable visual acuity and spherical equivalent refractive error of the amblyopic and the nonamblyopic eye at pretreatment, posttreatment, and long-term follow-up. RESULTS: Records for 61 patients met the inclusion criteria. For strabismic amblyopia (n = 22), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.36 and 0.05 logarithm of the minimum angle of resolution (logMAR) units after a mean treatment time of 1 year. At long-term follow-up (mean = 9.3 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR and visual acuity in the nonamblyopic eye improved 0.10 logMAR units. For anisometropic amblyopia (n = 26), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.30 and 0.02 logMAR units, respectively, after a mean treatment period of 1.1 year. At the long-term follow-up visit (mean = 7.1 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR unit and in the nonamblyopic eye improved 0.03 logMAR unit. Repeated-measures analysis of variance showed no significant effect of type of amblyopia on visual acuity of the amblyopic eye and a significant effect of visit due to treatment but not regression. The changes in visual acuity in the nonamblyopic eye from the pretreatment to the follow-up visit were significant and interacted with type, the changes being larger in strabismic amblyopia. For strabismic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +2.15 D and +1.85 D, respectively, initially to +0.45 D and +0.58 D, respectively, at the follow-up visit. For anisometropic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +1.04 D and +0.12 D, respectively, initially to +0.23 D and -0.94 D, respectively, at the follow-up visit. The effect of visit on amblyopic and nonamblyopic refractive errors was significant. For isoametropic amblyopia (n = 13), visual acuity in both right and left eyes initially was 0.39 logMAR unit and improved to 0.14 logMAR unit in each eye after a mean follow-up of 8.9 years. Refractive error in the right and the left eyes changed from -1.22 D and -1.14 D, respectively, to -2.68 D and -2.56 D, respectively, at follow-up. These differences were all significant. CONCLUSIONS: After treatment and with long-term follow up, visual acuity regresses but not significantly in the amblyopic eye in strabismic amblyopia and anisometropic amblyopia. At the same time, visual acuity in the nonamblyopic eye improves slightly. Visual acuity also improves significantly over time in isoametropic amblyopia. The refractive error of both amblyopic and nonamblyopic eyes tends to show a myopic shift regardless of the type of amblyopia.     

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.     

Risk factors for treatment failure of anisometropic amblyopia.

PURPOSE: This study sought to explore factors which might predict the lack of vision improvement following therapy of anisometropic amblyopia. METHODS: We retrospectively reviewed the records of 104 children aged 3 to 8 years who had anisometropic amblyopia with a difference in the refractive power between the two eyes of at least 1 diopter, a difference in corrected visual acuity between the two eyes of at least 3 logMAR units, visual acuity in the amblyopic eye of 20/50 or worse, and no ocular structural abnormalities. Patients were treated with either patching or atropine penalization therapy. Patients with strabismus were included. Treatment failure was defined in two ways: (1) functional failure indicating a final visual acuity in the amblyopic eye worse than 20/40 and (2) relative failure indicating less than three lines of logMAR visual acuity improvement regardless of final vision. RESULTS: Failure risk factors were as follows: age above 6 at the onset of treatment (adjusted odds ratio [OR] (95% confidence limits [CL] = 4.69 [1.55, 14.2]), the presence astigmatism of more than 1.50 diopters in the amblyopic eye (adjusted [OR] (95% CL) = 5.78 [1.27, 26.5]), poor compliance with treatment (adjusted [OR] (95% CL) = 5.47 [1.70, 17.6]), and initial visual acuity in the amblyopic eye of 20/200 or worse (adjusted [OR] (95% CL) = 3.79 [1.28, 11.2]). Strabismus was not found to be a significant risk factor. Neither the type or amount of refractive error nor the difference in the refractive power between the two eyes was a significant risk factor for treatment failure. CONCLUSION: Eyes with poor initial visual acuity, the presence of significant astigmatism, and age over 6 years were less likely to achieve successful outcome. The clinical profile of patients with anisometropic amblyopia may be useful in predicting response to therapy, but compliance with treatment has a major effect on response to therapy.     

Profile of amblyopia in a hospital referral practice

OBJECTIVE: Evaluation of the clinical profile and distribution of different sub-types of amblyopia in a referral eye hospital in India. METHODS: This was a prospective hospital-based observational study, evaluating the clinical profile of patients with amblyopia presenting to a referral strabismology practice. The examination included assessment of the visual acuity, the refractive status, the fixation pattern, the grade of binocularity, and evaluation of the associated strabismus, if any before treatment was started. RESULTS: The average age of the patients at presentation was 7.97?6.18 years with 81 out of 683 patients (11.8%) presenting above the age of 20 years. The best-corrected visual acuity (BCVA) was less than 6/60 in the amblyopic eye in 121 out of 733 eyes (16.5%). Strabismic amblyopia was the most common sub-type of amblyopia seen (274/733 eyes, 37.38%). Though patients with anisometropic amblyopia presented at a later age (average of 10.03+/-6.92 years), they had better visual acuity, binocular functions, and centricity of fixation at all ages, relative to other sub-types of amblyopia. The BCVA did not show any co-relation with the age of presentation [co-relation co-efficient (CF) of 0.074], refractive status of the amblyopic eye (CF of 0.078), the type of amblyopia (CF of 0.196), or the type of strabismus present (CF of 0.079). However, a very significant co-relation was seen between the BCVA and the fixation pattern of the amblyopic eye (CF of 0.817). CONCLUSIONS: Lack of knowledge and awareness about amblyopia and its appropriate timely management has been the main cause for the late presentations and significant visual impairment associated with the condition.     

Does amblyopia have a functional impact? Findings from the Dunedin Multidisciplinary Health and Development Study

Background: Existing data on the functional impact of amblyopia are conflicting. The functional impact of amblyopia is a critical component of the viability and effectiveness of childhood vision screening programmes and treatment regimes. Design: Prospective longitudinal birth cohort (the Dunedin Multidisciplinary Health and Development Study). Participants: One thousand thirty‐seven children born in Dunedin, New Zealand, between April 1972 and March 1973, assessed from ages 3 to 32 years. Methods: Comparison of study members with no amblyopia, recovered amblyopia, possible amblyopia or amblyopia according to both classic (6/12 visual acuity or worse in at least one eye, or a two‐line or greater differential between the visual acuity in both eyes) and modern (6/9 visual acuity or worse in at least one eye) definitions of amblyopia. Main Outcome Measures: Childhood motor development, teenage self‐esteem and adult socioeconomic status (assessed by occupation, education, reading ability and income). Results: There was no evidence of poorer motor development, lower self‐esteem or reduced adult socioeconomic status in study members with amblyopia or recovered amblyopia when compared with those with no amblyopia. Conclusions: Amblyopia or having recovered amblyopia does not functionally impact on childhood motor development, teenage self‐esteem or adult socioeconomic status within this cohort. The wide range of visual deficits and adaptations that are known to occur in amblyopic vision do not translate into important ‘real life’ outcomes for the study members with amblyopia or recovered amblyopia. The age‐related cumulative lifetime risk of bilateral visual impairment in amblyopia will be assessed in future studies.     

Contrast sensitivity in amblyopia: the fellow eye of untreated and successfully treated amblyopes.

PURPOSE: We sought to investigate contrast sensitivity on the fellow eyes of amblyopic and successfully treated amblyopic subjects. METHODS: Contrast sensitivity was tested monocularly on both eyes of 48 amblyopic patients (mean age, 11.51 years) and of 22 successfully treated amblyopic subjects (visual acuity 20/20 in each eye; mean age, 11.22 years). Inclusion criteria were visual acuity in the amblyopic eye 20/40 or better (mild amblyopia) and 20/20 or better in the fellow eye, steady fixation, no signs of congenital, latent or manifest/latent nystagmus on clinical examination. Twenty normal subjects (20 eyes) were used as age-matched controls. RESULTS: Contrast sensitivity functions from the fellow eye of the 48 amblyopic patients, even those who had never been treated with occlusion therapy before, were significantly decreased (P < 0.001) compared with control subjects. Both the previously amblyopic and the fellow eye of the 22 "cured" amblyopic subjects demonstrated significantly lower values (P < 0.001) compared with control patients. CONCLUSIONS: We suggest that the nonamblyopic, "normal" eye of amblyopic patients behaves abnormally when evaluated for contrast sensitivity functions. Neither the previously amblyopic nor the fellow eyes of successfully treated subjects were comparable with controls. Occlusion therapy may not be implicated for depressed contrast sensitivity of the fellow eye in amblyopia. The assessment of contrast sensitivity can provide important information on the visual function and the influence of occlusion therapy in amblyopia.