Bilateral Adie’s Tonic Pupil and Hyperopic Shift in Idiopathic Sclerochoroidal Calcification

Sclerochoroidal calcification is a rare but recognised ophthalmic manifestation seen mostly in elderly Caucasian individuals. The lesions, often bilateral, appear as yellow-white irregular subretinal lesions usually found along the mid-peripheral fundus. Though typically asymptomatic, sclerochoroidal calcification has rarely been associated with parafoveal involvement, choroidal neovascularisation, and serous detachment of the calcifications. Visual involvement is typically minimal, and neovascularisation is often visually insignificant. We present a rare case of sclerochoroidal calcification in a 64-year-old Caucasian female who presented with painless progressive bilateral vision loss and a hyperoptic shift with subsequent development of bilateral sequential Adie’s tonic pupil. To the best of our knowledge, this is the first such report in the English language literature.     

传统弱视治疗方法联合视功能训练治疗远视性屈光参差性弱视的疗效

目的　评价传统弱视治疗方法联合视功能训练治疗远视性屈光参差性弱视的疗效。方法　收集2016年3月至2017年5月就诊于天津市眼科医院弱视训练室的50例远视性屈光参差性弱视患者,年龄（7.57±2.65）岁。所有患者均排除其他眼部疾病、危险因素和全身性疾病。在屈光矫正、遮盖健眼的基础上对弱视眼进行治疗,分析治疗前后的视力、立体视变化情况。结果　根据筛选最终纳入31例远视性屈光参差性弱视患者,其中轻度弱视10例,中度弱视15例,重度弱视6例。31例患儿治疗前及治疗后3个月、6个月视力差异有统计学意义（F=48.591,P=0.000）;中、重度弱视组治疗前后3个时间点差异均有统计学意义,轻度弱视组治疗后与治疗前视力相比,差异有统计学意义,但治疗后6个月与治疗后3个月视力相比差异无统计学意义（P=0.223）。轻度弱视组与中、重度弱视组治疗后视力进步情况差异均有统计学意义（χ²=6.005,P=0.022;χ²=5.760,P=0.026）;治疗后立体视比治疗前明显提高,与视力呈负相关（r=-0.537,P=0.002;r=-0.885,P=0.000）。结论　传统弱视治疗方法联合视功能训练不仅可以提高远视性屈光参差性弱视患者视力,而且有助于双眼视功能的恢复。     

基于EDI-OCT技术观察远视性弱视儿童脉络膜结构的变化

目的:通过增强深度成像光学相干断层扫描(EDI-OCT)技术比较远视性弱视与同龄正常儿童脉络膜结构的差异。方法:选取2021-01/12就诊于我院的远视性弱视儿童35例50眼纳入弱视组,选取同期就诊一般资料相匹配的健康儿童30例51眼纳入对照组,均进行EDI-OCT检查,测量脉络膜厚度(CT),并对图像进行处理后获取总脉络膜面积(TCA)、血管腔面积(LA)、基质面积(SA)、脉络膜血管指数(CVI)。结果:弱视组各区域TCA(下方除外)、SA(外环下方除外)、LA与CT(下方、颞侧除外)均明显大于对照组(P<0.05);除外环颞侧外,两组各区域CVI无明显差异(P>0.05);除鼻侧外,不同远视程度弱视儿童CT无明显差异(P>0.05)。结论:远视性弱视存在脉络膜结构异常,随着远视度数增加,TCA、LA、SA有增大趋势,脉络膜结构改变与远视性弱视有关。     

配戴减少周边远视离焦眼镜对近视儿童眼部参数的影响

目的：通过比较配戴减少周边远视离焦设计的框架眼镜(AMSPL)和普通球柱镜框架眼镜(SPL)对近视儿童眼部各参数的影响,确定AMSPL安全性和有效性。

方法：随机抽取2017-07/2018-02于我院眼科中心配戴AMSPL的8～14岁近视儿童50例作为AMSPL组,同样抽取年龄、近视程度及配镜时间相当的SPL配戴者资料50例作为SPL组。检查两组患者眼压、睫状肌麻痹下的屈光状态、远距水平隐斜、近距水平隐斜、AC/A等双眼协动参数。

结果：AMSPL组儿童配戴初期舒适程度略低于SPL组,主要为周边视物模糊,但1mo后两者无差异; AMSPL组屈光不正度数年平均增长-0.62±0.50D,SPL组年平均增长-0.77±0.48D(P=0.072); 对于8～10岁近视儿童AMSPL组屈光不正度数年平均增长(-0.71±0.41D)低于SPL组(-1.05±0.39D),差异具有统计学意义(t=2.164,P=0.041); AMSPL组和SPL组远距水平隐斜、近距水平隐斜、AC/A等双眼协动参数无差异(P>0.05)。

结论：配戴AMSPL能在一定程度上延缓近视发展,尤其对于低龄近视儿童(8～10岁)效果较明显。配戴AMSPL与SPL相比眼部参数无明显变化,这表明近视儿童配戴AMSPL与SPL同样安全。     

Clinical evaluation of cessation of hyperopia in 123 children with accommodative esotropia treated with glasses for best corrected vision

Purpose: This study aimed to determine age at successful cessation of hyperopic glasses, the influence of hyperopia on the esotropic angle and age at discontinuation of glasses in accommodative esotropia (AE) patients. Methods: We performed a retrospective study in 123 AE patients who achieved complete emmetropization and maintained orthophoria without hyperopic glasses between March 1999 and February 2005. All patients had been prescribed the weakest possible glasses to provide best corrected vision and maintain fusion in hyperopia. Results: Pure AE was found in 64 patients and partial AE in 59. At the initial visit, 56.1% of patients had refractive errors of 3.00?5.00 D (mean cycloplegic spherical equivalent [SE]). The angle of esotropia without correction was 30.90 ± 14.80 prism dioptres (PD) (mean ± standard deviation) in pure AE, and 42.70 ± 15.19 PD in partial AE (p = 0.000). The non‐accommodative component in partial AE was 24.07 ± 14.90 PD. The mean age at cessation of glasses use was 13.50 ± 3.81 years. Stereopsis was noted in 70.2% of patients at the initial visit and 96.4% at the last visit. Pearson’s correlation coefficients (r) were 0.480 between the degree of hyperopia and amount of optically corrected esotropia (p = 0.000), and 0.434 between the degree of hyperopia and age at successful cessation of corrective glasses use (p = 0.000). Conclusions: The mean age at resolution of hyperopia with good stereopsis was 13.5 years. The degree of hyperopia seemed to correlate with the angle of esotropia and the age of successful cessation of corrective glasses.     

Clinical Results of Keratophakia and Keratomileusis

Thirteen keratophakia patients were followed for 13 to 35 months. Eighteen cases of hyperopic keratomileusis or hyperopic keratomileusis using preserved corneal tissue were followed for 2 to 30 months. All 13 patients who underwent keratophakia achieved 20/50 or better acuity. All seven patients having hyperopic keratomileusis achieved 20/60 or better acuity. Eight of the 11 patiens who had hyperopic keratomileusis using donor corneal tissue achieved 20/60 or better acuity. The preservation of lenticules after lathing did not adversely affect the correlation between predicted and observed dioptric corrections. There was a statistically significant correlation between predicted and observed dioptric correction measured at the corneal surface when the lenticule was lathed from fresh tissue (hyperopic keratomileusis) or from relatively fresh tissue (keratophakia). However, we found that there was poor correlation between the predicted and observed corrections when the lenticule was lathed from donor tissue that had been cryopreserved for long periods of time (hyperopic keratomileusis with preserved corneal tissue).     

减少旁中心远视离焦镜片治疗儿童近视的疗效观察

目的　观察减少旁中心远视离焦镜片治疗儿童近视的临床效果。方法　随机数字表法选取２０１４年７月至１２月于我科门诊就诊的儿童近视患者１６０例,分为试验组和对照组,每组各８０例１６０眼。试验组配戴减少旁中心远视离焦镜片,对照组配戴普通单焦镜片。按照等效球镜的度数大小分为三组:低度近视组（－１．００～－３．００Ｄ）、中度近视组（－３．２５～－６．００Ｄ）、高度近视组（＞－６．００Ｄ）。两组患者戴镜６个月后复查,１ａ后对两组屈光度、眼轴长度等近视进展指标进行比较,根据等效球镜及眼轴进展情况,分析两组的治疗效果。结果　轻度近视组:试验组增加度数为（－０．５６±０．３０）Ｄ,显著小于对照组（－０．９１±０．３７）Ｄ,差异有统计学意义（ｔ＝５．９２,Ｐ＜０．０１）;试验组眼轴增加（０．１３±０．１１）ｍｍ,显著少于对照组（０．２８±０．１４）ｍｍ,差异也有统计学意义（ｔ＝６．６７,Ｐ＜０．０１）。中度近视组:试验组增加度数（－０．５５±０．３０）Ｄ,显著小于对照组（－０．９０±０．４１）Ｄ,差异有统计学意义（ｔ＝６．０３,Ｐ＜０．０１）;试验组眼轴增加（０．１４±０．１４）ｍｍ,显著少于对照组（０．２５±０．１５）ｍｍ,差异有统计学意义（ｔ＝４．９６,Ｐ＜０．０１）。高度近视组:试验组增加度数（－０．３６±０．１６）Ｄ,显著小于对照组（－０．８８±０．３４）Ｄ,差异有统计学意义（ｔ＝５．１５,Ｐ＜０．０１）;试验组眼轴增加（０．０６±０．０４）ｍｍ,显著少于对照组（０．２６±０．１４）ｍｍ,差异有统计学意义（ｔ＝５．０２,Ｐ＜０．０１）。结论　降低周边远视性光学离焦可以延缓近视进展,减缓眼轴增长。近视性屈光不正儿童可以通过配戴减少旁中心远视离焦的美德××镜片来减缓近视的发展。     

远视性弱视儿童黄斑区视网膜厚度分析

目的通过测量远视性弱视眼的黄斑区视网膜厚度、眼轴长度、屈光度以及最佳矫正视力（BCVA）,并与正常对照眼进行比较,探讨弱视发病的视网膜形态学改变以及可能的外周机制。方法回顾性病例对照研究。选择2013年1月至2015年6月在河北医科大学第一医院眼科门诊就诊的远视性弱视儿童48例（91眼）作为弱视眼组,其中单纯远视性弱视13眼,远视散光性弱视28眼,复性远视散光性弱视50眼。选择同期在眼科门诊健康查体,裸眼视力是该年龄正常值或以上的儿童48例（96眼）作为正常对照组。采用频域OCT检测2组儿童黄斑区视网膜厚度,按照ETDRS分区记录（A1-A9,共9个分区）;并利用IOLMaster测量所有儿童的眼轴长度。采用独立样本t检验对2组儿童黄斑区视网膜厚度进行比较,采用Pearson相关分析对不同区域黄斑区视网膜厚度与眼轴长度、BCVA、屈光度的相关性进行分析。结果在各区中远视性弱视眼组与正常对照组A1区均为最薄,分别为（262±19）µm、（250±20）µm,2组间差异有统计学意义（t=2.93,P<0.05）;2组内环区平均厚度（A2-A5）最厚,分别为（301±21）µm、（305±22）µm,差异无统计学意义（t=0.36,P>0.05）;2组外环区（A6-A9）的平均厚度分别为（272±25）µm、（269±17）µm,差异无统计学意义（t=0.21,P>0.05）。弱视眼组内环下方的黄斑区视网膜厚度与BCVA呈正相关（r=0.29,P＜0.05）;外环鼻侧的黄斑区视网膜厚度与等效球镜度呈正相关（r=0.40,P＜0.01）,与眼轴长度存在负相关（r=-0.40,P＜0.01）。结论远视性弱视儿童黄斑部分区域视网膜厚度发生变化,该变化可能与弱视的发生机制有关;且黄斑区视网膜厚度与矫正视力、屈光度、眼轴长度有关。