老年人麻痹性斜视的临床诊治

目的:分析探讨老年人麻痹性斜视的病因诊断及治疗预后。方法:检查斜视患者的33cm和5m眼位、九个方位的眼肌运动情况;对有限制因素者行牵拉试验排查;采用复视像、Hess屏、同视机分析复视性质及受累肌;根据病史采用影像学检查、血生化实验室检查;全身病进行相关科室会诊。结果:本组414例单眼发病399例,双眼发病15例。单一神经麻痹417眼,滑车神经居首位153眼,其后为外展神经135眼,动眼神经129眼;复合神经麻痹12眼。发病原因主要是血管性疾病,其次为眼科手术后斜视,其后有外伤、感染炎症、肿瘤等,此外原因不明者35例。结论:年龄相关的血管性疾病是老年人复视斜视的主要原因或高危险因素,通常治疗预后较好。眼科手术后的斜视应引起眼科医师的重视。影像学诊断和实验室检查可有助临床诊断治疗。     

Patterns of III nerve synkinesis

PURPOSE Various patterns of synkinesis have been observed following both congenital and acquired III nerve palsies. Aberrant regeneration is the most widely accepted mechanism which explains this synkinesis. Two models of aberrant regeneration have been proposed, namely central collateral axon sprouting, and misdirection of regenerating neurones at the site of nerve injury. We have studied the clinical patterns of III nerve recovery and synkinesis following III nerve palsies and relate the findings to the proposed models of synkinesis. MATERIALS AND METHODS Twelve patients with acquired and two with early onset III nerve synkinesis were reviewed. The type, rate and pattern of recovery of III nerve palsy was established from case notes. Observations and measurements of ocular motility, pupil movements, eyelid position and intraocular pressure changes were performed on each patient. Signs of contralateral synkinetic movements were also sought. RESULTS Upper lid retraction on attempted down gaze and in adduction was the most frequent synkinetic movement recorded. Observation of pupil size revealed evidence of pupillary-extraocular muscle synkinesis in all gaze positions except abduction. Similarly, intraocular pressure changes and signs of globe retraction showed widespread extraocular muscle co-contraction. Synkinetic levator innervation of extraocular muscles [i.e., LPS to MR, IR, SR] was also observed, a finding not previously reported in III nerve palsy but predicted by our model of misdirection of regenerating neurones at the site of nerve injury. There was no evidence of contralateral aberrant innervation. CONCLUSION Evidence of III nerve synkinesis in patients with III nerve palsy is widespread and the patterns of synkinesis observed were broadly similar for all patients irrespective of the aetiology. Random aberrant III nerve regeneration at the site of nerve injury best explains the patterns of synkinesis observed. Central collateral axon sprouting does not seem to play a major part in the synkinetic movements observed in acquired III nerve lesions.     

显微镜下斜视矫正术387例临床分析

目的:回顾性分析显微镜下斜视矫正术的优越性。方法:斜视患者387例,男224例,女163例,年龄3～65岁,其中共同性斜视296例,麻痹性斜视65例,A-V征19例,垂直分离性斜视7例。全部病例均在显微镜下完成斜视矫正术,对复杂性斜视手术行睫状前血管分离保留。结果:术后23例欠矫,8例过矫,斜视矫正率达92.0%,有效率达100%。无1例发生眼前节缺血;手术视野清晰,操作准确,损伤小;手术并发症极少,局部反应轻微,恢复快。结论:显微镜下斜视手术与以往常规肉眼下斜视手术相比,无论从减轻手术创伤提高手术的准确性和减少手术并发症上,都有诸多的优越性。     

调节性内斜视弱视儿童治疗前后多焦VEP与多焦ERG的研究

目的 探讨内斜视性弱视儿童多焦VEP（mfVEP）和多焦ERG（mfERG）的特征及治疗后的改变.方法 对30例4～8岁内斜视弱视儿童治疗前及治疗后行mfVEP和mfERG检测,并与同龄正常儿童比较.结果 治疗前内斜视弱视眼mfERG及mfVEP各环P1波振幅密度降低,中心区域差异显著;mfVEP峰潜时延长,且鼻颞侧存在差异.治疗后,mfERG及mfVEP P1波振幅密度上升,mfVEP峰潜时较治疗前缩短,鼻颞侧差异缩小.结论 治疗后较治疗前内斜视弱视眼多焦电生理结果改善,其可作为弱视疗效的评价指标.     

调节性内斜视弱视儿童多焦视诱发电位的研究

目的探讨内斜视弱视眼多焦视诱发电位（mfVEP）的特征性改变。方法对30例4～8岁调节性内斜视弱视儿童行mfVEP检测,并与同年龄正常儿童进行比较。结果内斜视弱视眼各环N1、P1波振幅密度值降低、峰潜时延长．在中心区存在显著性差异;鼻颞侧反应峰潜时存在差异。各组上半视网膜N1、P1波较下方振幅密度降低、峰潜时延长,存在统计学差异。结论内斜视弱视眼在中央及鼻侧区域视功能下降明显。     

高度近视性斜视的研究进展

高度近视性斜视是一种特殊类型的斜视,以固定性内斜视和下斜视多见.本文系统描述了该病的临床特征,并初步总结了针对该疾病的特征性检查,分析比较了近期国内外对高度近视性斜视的治疗方法.     

斜视手术2100例回顾分析

目的:探讨斜视的诊断和手术治疗技巧。方法:回顾分析2100例斜视的临床特点及手术治疗,包括性别、年龄、临床特征、就诊季节、弱视治疗、手术时机、手术方式的选择和手术并发症等。结果:2100例斜视纳入研究(其中男1105例,女995例);各年龄段分别为:<10岁,684例(32.57%);11～20岁,895例(42.62%);21～40岁,432例(20.57%);>40岁,89例(4.24%);其中共同性内斜视882例(42.00%)、共同性外斜视845例(40.23%),非共同性内斜视172例(8.19%),非共同性外斜视130例(6.19%),先天性眼球震颤45例(2.14%),A-V征26例(1.24%)。共同性斜视早期采取水平直肌加强和减弱术,使患者建立同时视觉和治疗弱视;眼球震颤患者头位<30°的采用Parks法矫正,头位>30°者手术量增加40%～60%;A-V征斜视应针对病因,合理正确选择斜肌或直肌肌腱移位术式;急性眼外肌麻痹的病因诊断非常重要,Jensen联结术是有效的手术方式。结论:斜视和弱视并存的手术时机非常重要。复杂性斜视手术的成功率取决于术前的正确诊断、手术方案的制定、手术量的设计和术中的经验判断。     

Perioperative dexmedetomidine reduces emergence agitation without increasing the oculocardiac reflex in children: A systematic review and meta-analysis

Background:Intravenous dexmedetomidine (DEX) has been used to prevent emergence agitation (EA) in children. The aim of this meta-analysis was to evaluate whether DEX decreases EA incidence without augmenting oculocardiac reflex (OCR) in pediatric patients undergoing strabismus surgery.Methods:We searched PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library to collect the randomized controlled trials (RCTs) investigating the effects of intraoperative DEX in children undergoing strabismus surgery from inception to October 2019. Postoperative Pediatric Agitation and Emergence Delirium (PAED) score, postoperative EA, extubation or laryngeal mask airway (LMA) removal time, postanesthetic care unit (PACU) stay time, OCR, and postoperative vomiting (POV) were evaluated.Results:11 RCTs including 801 patients were included in this study. Compared with control group, intravenous DEX significantly reduced postoperative PAED score (WMD, 3.05; 95% CI: -3.82 to -2.27, P = .017) and incidences of postoperative EA 69% (RR, 0.31; 95% CI: 0.17 to 0.55, P < .00) and POV (RR, 0.28; 95% CI: 0.13 to 0.61, P = .001). Furthermore, the use of DEX significantly delayed extubation or LMA removal time (WMD, 2.11; 95% CI: 0.25 to 3.97, P < .001). No significant difference was found in the incidence of ORC and PACU stay time.Conclusion:Intravenous DEX reduced the incidences of EA without increasing OCR in pediatric patients undergoing strabismus surgery. Meanwhile, DEX infusion decreased the incidence of POV in children.     

麻痹性水平斜视的手术治疗

目的：采用Jensen直肌联结术联合麻痹肌的拮抗肌后徙术和超大量麻痹肌缩短联合超大量麻痹肌的对抗肌后徙术两种手术方法治疗麻痹性水平斜视,观察两种手术方法的治疗效果及临床意义。
　　方法：回顾性分析我院自2005-01/2014-08收治完全性或近完全性水平直肌麻痹斜视患者15例17眼,分别采用Jensen直肌联结术联合麻痹肌的拮抗肌后徙术治疗A组7例7眼,超大量麻痹肌缩短联合超大量麻痹肌的对抗肌后徙术治疗B组8例10眼,术后随访平均21±8.71 mo观察手术疗效。
　　结果：术后观察患者15例17眼均获得满意效果,14例16眼患者术后随访获得较为理想的远期效果。1例1眼患者术后6 mo随访斜视度30?。远/近斜视度数明显降低( t=28.71,P<0.001;t=36.21,P<0.001),双眼固视视野范围扩大(t=17.96,P<0.001)、麻痹肌运动程度提高等视觉功能均有不同程度改善(t=9.20,P<0.001)。
　　结论：采取Jensen直肌联结术联合麻痹肌的拮抗肌后徙术和超大量麻痹肌缩短联合超大量麻痹肌的对抗肌后徙术治疗完全性或近完全性麻痹性水平斜视,手术方法安全可靠,患者能获得眼位正位、麻痹肌运动改善、双眼固视视野扩大的长期稳定效果。     

Evaluation of the Chinese Adult Strabismus-20 （CAS-20） questionnaire using Rasch analysis

ObjectiveTo further refine the Chinese Adult Strabismus-20 （CAS-20） health-related quality of life（HRQOL） questionnaire using Rasch analysis. MethodsIn this cross-sectional study, the CAS-20 questionnaire was independently completed by 246 adult strabismus patients. Based on the score for each item, Rasch analysis was performed on the original CAS-20 using the following aspects： dimensionality, response order, local dependence, infit and outfit analysis, differential item function, subject targeting and confirmatory dimensionality. ResultsThe original CAS-20 was divided into 4 subscales, which were labeled ″self-perception″, ″interaction″, ″reading function″, and ″general function″. Response ordering was appropriate for all of the 4 subscales. As a result of infit and outfit analysis, 3 items were removed, one each from ″self-perception″, ″reading function″, and ″general function″. No significant differential item function was found for sex or age. Compared with the ability of the patients and item difficulty, the 3 subscales matched well except for ″reading function″. ConclusionThe original CAS-20 was reduced to 17 items, and divided into 4 subscales, which were ″self-perception″, ″interaction″, ″reading function″, and ″general function″. Subject response choices saved 5 test options. The refined CAS-20 may prove to be more responsive to HRQOL changes in adult strabismus patients.