双眼外直肌后徙术与常规疗法治疗斜视临床疗效比较

目的:比较双眼外直肌后徙术与常规疗法治疗斜视的临床疗效。方法:选取2016年6月-2017年6月笔者医院收治的128例斜视患者,按治疗方式不同分成对照组和研究组,每组各64例。其中对照组患者行常规单眼外直肌后徙联合内直肌缩短术(R&R),研究组患者行双眼外直肌后徙术(BLR-rec)。术后对患者随访1年,观察术后眼位正位率、欠矫率、过矫率,视觉功能恢复情况以及并发症发生率。结果:研究组患者正位率为89.06%高于对照组的68.75%,差异有统计学意义(P<0.05)。术前,对照组和研究组患者视近度、视远度和平均斜视度比较,两组患者融合功能和立体视功能占比比较,差异均无统计学意义(P>0.05)。术后,两组患者的斜视度较治疗前均出现了明显下降(P<0.05),且研究组治疗后斜视度下降幅度明显大于对照组(P<0.05);两组患者视觉功能恢复率均明显增加(P<0.05),且研究组恢复率明显大于对照组(P<0.05)。研究组并发症发生率明显低于对照组(P<0.05)。结论:双眼外直肌后徙术较单眼外直肌后徙联合内直肌缩短术有更好地临床效果,且安全性更高,值得临床推广。     

压贴三棱镜治疗获得性斜视的临床疗效观察

目的:探讨对麻痹性斜视出现的复视用压贴三棱镜的非手术治疗及疗效观察。方法:对麻痹性斜视14例患者,通过眼部检查、验光配戴框架眼镜,有上睑下垂的患者,配戴自制支架框架眼镜,反复测量斜视度后,压贴相应度数的膜状三棱镜矫正复视,检查同视机Ⅰ级视功能。结果:患者14例中复视完全消失9例,5例明显好转,6例有代偿头位的,头位消失,8例有同视机Ⅰ级视功能。结论:对于麻痹性斜视不适合做手术的患者,用压贴三棱镜,可以有效改善患者复视及代偿头位,能改善患者生活质量,又不影响原发病的治疗。     

Diffusion tensor imaging of horizontal extraocular muscles in patients with concomitant and paralytic esotropia

AIM: To assess metrics of diffusion tensor imagining (DTI) in evaluating microstructural abnormalities of horizontal extraocular muscles (EOM) in esotropia.METHODS: Six adult concomitant esotropia patients, 5 unilateral abducent paralysis patients and 2 healthy volunteers were enrolled. Conventional magnetic resonance imaging (MRI) and DTI were performed on all subjects using 3T MR scanner. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of medial and lateral rectus muscles were measured and compared between patients group and control group.RESULTS: Medial rectus MD and RD within the adducted eye of concomitant patients was significantly greater than that in unilateral abducent paralysis patients (0.259×10-2 mm2/s vs 0.207×10-2 mm2/s, P=0.014; 0.182×10-2 mm2/s vs 0.152×10-2 mm2/s, P=0.017). Both strabismus patients showed a significantly decreased MD and AD than that obtained in normal controls for lateral rectus muscles (P<0.05). Medial rectus MD of the adducted eye in concomitant strabismus patients was significantly decreased than that in healthy controls (0.259×10-2 mm2/s vs 0.266×10-2 mm2/s, P=0.010). Lateral rectus AD of the adducted eye in concomitant strabismus patients was significantly decreased as compared with that in healthy controls (0.515×10-2 mm2/s vs 0.593×10-2 mm2/s, P=0.013). No statistically significant differences were present between the adducted and fixating eyes in concomitant strabismus patients.CONCLUSION: DTI represents a feasible technique to assess tissue characteristics of EOM. The effects of eye position changes on DTI parameters are subtle. Decreased MD and RD could be evidence for remodeling of the medial rectus muscle contracture. Lower medial and lateral recuts MD of concomitant esotropia patients indicates a thinner fibrous structure of the EOM. Lower MD and AD should be general character of esotropia.     

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。     

先天性特发性眼球震颤合并水平斜视的手术治疗

目的:探讨先天性特发性眼球震颤合并水平斜视的手术治疗方法。方法:对27例合并水平斜视的先天性特发性眼球震颤患者,采用主导眼中间带移位术联合斜视眼斜视矫正术。结果:在27例患者中,所有患者主导眼第1眼位视力均提高2行以上,22例代偿头位消失,明显改善5例,术后25例患者眼位映光基本正位(±5°以内),2例患者眼位映光在±5°～±10°,部分患者双眼视功能较术前有所好转。结论:对合并水平斜视的先天性特发性眼球震颤行主导眼中间带移位术联合斜视眼斜视矫正术,不仅能改善原在位视力,矫正代偿头位和斜视,还有利于双眼视的建立。     

马来西亚视网膜母细胞瘤 64例临床分析

目的:分析马来西亚两所三级医院收治的视网膜母细胞瘤的人口统计学、临床特征和分布情况。方法:对10a来在马来西亚理科大学医院和吉隆坡医院被诊断为视网膜母细胞瘤的病历进行回顾性研究,分析内容包括性别、年龄、种族、临床特征、眼眶和脑CT扫描所见、腰椎穿刺和骨髓抽吸结果,两家医院资料采集的形式相同。结果:共有64例患者被两家医院收治,男女性别几乎无差异,就诊年龄3～84(平均24.2)月龄,其中53例(82.8%)年龄<36月龄,单眼发病39例(60.9%),最常见的表现依次为白瞳症(46例,71.8%)和眼球突出(21例,32.8%)。对患病儿童同胞的常规筛查发现视网膜母细胞瘤2例。本组病例发生颅内扩散8例(12.5%),骨髓转移6例(9.3%)。结论:白瞳症是马来西亚视网膜母细胞瘤最常见的表现形式,病变局限于眼内者40例(62.5%),眼外者(眶内,颅内和远处转移)24例(37.5%)。     

巴基斯坦海德拉巴地区连续性斜视17例手术治疗临床观察(英文)

目的:观察接受斜视手术的连续性斜视患者的临床过程和治疗效果。方法:连续性斜视患者(<45岁)分为两组:其中第1组为内斜视患者;第2组为外斜视患者。我们使用棱镜屈光度(PD)来测量患者的偏斜角,对第一次手术后的患者在随访期间(6mo内)进行保守疗法。同时选择随访6mo后偏斜角仍超过15PD的斜视患者进行再次手术。本实验所有参与对象均进行了强制性检查。所有二次手术患者均在全身麻醉下进行,并于术后3,15d;3,6mo进行追踪随访。结果:在整个研究期间有28.8%的患者发展成为连续性斜视。所有斜视患者主视眼(固视眼)的二次手术均在一次手术后6～9mo内进行。经过二次手术干预后,在随访期间两组患者均获得了很好的治疗效果,同时并未出现过矫的趋势。结论:在二次手术过程中我们需谨慎肌肉矫正以避免日后过矫。     

Strabismus and employment: the opinion of headhunters

Purpose: The aim of this study was to determine the influence of strabismus on an individual’s ability to find employment based on the opinion of Swiss headhunters. Methods: Forty Swiss headhunters retrieved from a Swiss online telephone directory were interviewed using a validated questionnaire in order to determine if strabismus would have an impact on a person's ability to find employment. Photographs of a strabismic man and woman as well as of other computer‐generated facial anomalies could be downloaded from the Internet during the interview. Results: 72.5% of headhunters judged that strabismic individuals would have more difficulties in finding a job than orthotropic persons. These difficulties were judged to be stronger in women than in men (P = 0.006), and in exotropic compared to esotropic persons (P = 0.01). Asked about seven facial anomalies, exotropia was found to have the third and esotropia the fourth (women) or fifth (men) most strongly negative impact on finding employment, after having strong acne and a visible missing tooth. Headhunters judged that persons with strabismus are significantly perceived as less attractive and less intelligent by potential employers. Conclusion: Visible strabismus negatively influences individuals’ ability to find a job and therefore has an impact on their economic status. Successful strabismus surgery realigns the visual axes, producing a normal facial appearance and therefore eliminating the negative impact of strabismus on employability.     

微型计算机在斜视检查中的应用Parks三步法

将Parks三步法应用微型计算机彩色图形处理技术进行单条垂直作用肌不全麻痹的诊断。可在2分钟内显示和打印出结果。并能够显示和打印出每一步的图形和结果分析,便于随时对照检查,其方法简便、诊断准确。     

BOTULINUM TOXIN IN OPHTHALMOLOGY

Alan B. Scott selected, researched and developed Type A Botulinum toxin for clinical use in ophthalmology. This unique drug has proved invaluable for treatment of a number of conditions which are difficult to treat in ophthalmology and in a variety of other disciplines. The indications, methods and problems of its use are described and the results of treatment of 133 patients are discussed. Up to December 1986 over 13 000 patients have been treated in a multicentre international trial without significant complications.