儿童弱视愈后转归情况的分析

目的:探讨儿童弱视治愈后的转归情况,寻找脱镜指标及防止弱视复发、发生假性近视和形成真性近视的途径。方法:对治愈的儿童弱视368例678眼进行3～7a的观察,每1～2mo复查1次,均检查裸眼远近视力、眼位、屈光间质、眼底、注视性质、电脑验光、小瞳孔下动态检影或必要时阿托品散瞳验光等。符合以下4项指标可以脱镜:(1)双眼裸视远近视力≥1.0,≥6mo;(2)眼位正常或斜视性弱视的残余斜视度<5。者;(3)远视屈光度≤+1.00DS;(4)远视散光度≤+0.50DC。若发现裸眼远视力≤0.9时,就一定要查清原因给予恰当治疗。结果:本组368例678眼的弱视儿童治愈后,经3～7a的治疗,有205例364眼(53.7%)脱镜,其中轻度弱视244眼脱镜率为70.5%,高于中度114眼(37.4%)和重度6眼(22.2%)。屈光不正性弱视脱镜305眼,脱镜率为59.0%,屈光参差性29眼42.0%,斜视性30眼32.6%,无明显差异。单纯远视性弱视脱镜316眼,脱镜率为62.7%,高于单纯远散11眼(28.2%)和复性远散37眼(30.1%);而单纯近视性弱视和单纯近散、复性近散性弱视均没能脱镜。弱视儿童初戴眼镜属低屈光度(球镜≤3.00D,柱镜≤1.00D)脱镜289眼,脱镜率为58.7%,中度(球镜3.25～4.75D,柱镜1.25～1.50D)58眼48.7%,高于高度(球镜≥5.00D,柱镜≥1.75D)17眼(25.4%)。从就诊时的年龄上看3～8岁者脱镜率高。还发现弱视复发6例9眼,发生率为1.3%;发生假性近视7例10眼,发生率为1.5%;形成真性近视31例62眼,发生率为9.1%;残余斜视4例4眼,发生率为0.6%。还需要继续治疗观察者115例229眼,占治愈眼数的33.8%。结论:分析儿童弱视治愈后病例的追踪观察,对巩固疗效,降低复发率,提高远期疗效是有实际价值和意义的。从转归情况分析:长期定期追踪观察能早期发现弱视复发、假性近视,及时采取正确治疗措施,可防止形成真性近视和提高弱视的治疗效果。同时证明上述4项脱镜指标是可行的;脱镜后仍要坚持追踪观察,最好观察超过视力发育敏感期12岁之后。

Analysis on the recovery condition of child amblyopia

AIM:To investigate the recovery condition of child amblyopia,and to seek an effective method of preventing the amblyopia recrudescence,pseudomyopia and myopia formation by off glass indicate. METHODS:After follow-up of 3-7 years(every 1-2 months one time),totally 368 cases 678 eyes were analyzed.The vision,eye position,refraction,fundus, fixation property,computer optometry,dynamic examine by small pupil or the pupil optometry by atropine disperses were examined.The indicate of off glass following 4 targets;(1) bare vision≥1.0 in both eyes, following up time was a half year;(2) normal eye position or residual strabismus<5°;(3) hyperopia diopter≤+ 1.00DS;(4) the hyperopia astigmatism≤+ 0.50 DC.If the bare vision≤0.9,the necessary reason should be ascertain and appropriate treatment should be given. RESULTS:Totally 368 cases(678 eyes) amblyopia children underwent the regular treatment(3-7years),205 cases(678 eyes) took off the glasses(53.7%).And in mild amblyopia children(244 eyes) the off glass rate was 70.5%,which was higher than that in the moderate amblyopia children(114 eyes,37.4%) and the severe amblyopia children(6 eyes,22.2%).The off glass rate in ametropia amblyopia(678 eyes)(305 eyes,59.0%),which was similar to that in anisometropia children(29 eyes, 42.0%) and the strabismus children(30 eyes,32.6%). The pure hyperopia children(316 eyes) off glass rate was 62.7%,higher than that in pure astigmatism children(11 eyes,28.2%) and the complex astigmatism children(37 eyes,30.1%);But the pure myopia amblyopia,pure myopia astigmatism amblyopia,and the complex myopia astigmatism amblyopia did not take off the glass.The amblyopia child with the low diopter serve as mild amblyopia(289 eyes,spherical Iens≤3.00D,cylindrical lens≤1.00D) and the off glass rate was 58.7%;The moderate amblyopia(58 eyes,spherical lens 3.25-4.75D, cylindrical lens 1.25-1.50D),accounted for 48.5%,higher than that in high amblyopia(spherical lens≥5.00D, cylindrical lens≥1.75D;17 eyes,25.4%).The off glass rate was 70.5%for 3-8 years.The recurrence rate of amblyopia was in 1.3%,pseudomyopia in 1.5%,myopia in 9.1%,and the residual strbismus in 0.6%.115 cases (229 eyes,33.8%) should be observed. CONCLUSION:Analysis of the recovery in child amblyopia can consolidate curative effect,reduce the recurrence rate,enhance therapeutic effect.The long-term regular tracing and observation of the recovery in child amblyopia can discover the early amblyopia recrudescence and pseudomyopia,and prevent the formation of myopia and enhance the treatment of amblyopia by taking the correct remedial measure promptly.The above 4 items of off glass indicate are feasible;Tracing observation was necessary after 12 years old.