正常及异常双眼视觉的视动震颤（OKN）反应特性研究

为探讨不同双眼视觉状态下ＯＫＮ反应的特性,对正常人和不同类型的双眼视觉异常者的单眼鼻向及颞向ＯＫＮ反应进行了研究。实验发现：单眼视觉抑制者表现出鼻向与颞向ＯＫＮ反应不对称特性;两眼皆因视剥夺造成双眼视觉异常者主要以ＯＫＮ眼动增益降低为特点;双眼视觉正常者鼻、颞向ＯＫＮ反应是对称的。结果表明：单眼ＯＫＮ眼动反应的不对称特性及增益改变对探讨双眼视觉异常机制有重要意义,为视皮层双眼细胞异常导致单眼ＯＫＮ不对称的假设提供了支持性证据,并对弱视早期诊断及其分类有重要价值。     

Focus: Preventive Medicine: 2020 Evaluation of Portable Vision Screening Instruments

Amblyopia is the most common cause of preventable visual impairment in children and occurs as a result of unilateral or bilateral impairment in best-corrected visual acuity. Early diagnosis and proper treatment are crucial to prevent poor visual outcomes in adulthood. Advances in technology have provided more objective diagnostic tools, which can now be used by a wide range of healthcare providers. Here, we highlight tools that have gained popularity in the past two decades and compare clinically relevant parameters to guide primary care providers seeking to incorporate instrumental vision screening in pediatric patient care.     

综合治疗法对不同弱视儿童治疗效果观察

目的:探讨综合治疗法对不同程度、不同年龄、不同类型的弱视患儿的临床疗效。方法:选取2012年1月~2014年1月在我院接受治疗的弱视患儿393例(671眼),根据弱视程度分为轻度组(299眼)、中度组(293眼)和重度组(79眼),3组患者均采用遮盖、精细目力训练、仪器训练及压抑疗法进行治疗,均治疗6~12个月,比较不同程度、不同年龄、不同类型的弱视患儿治疗后临床疗效。结果:治疗后,轻度、中度和重度组患儿的治愈率分别为90.97%、72.35%和17.72%,总有效率分别为100.00%、96.93%和84.81%,组间比较差异具有统计学意义(P0.05)。3~5岁、6~8岁和9~11岁患儿的治愈率分别为77.08%、74.72%和71.03%,总有效率分别为99.48%、97.36%和93.93%,3~5岁患儿总有效率显著高于9~11岁患儿(P0.05),但三个年龄段患儿治愈率差异不显著(P0.05)。屈光不正性弱视患儿、斜视性弱视患儿、屈光参差性弱视患儿的治愈率分别为85.65%、45.75%和61.54%,总有效率分别为99.34%、90.20%和95.38%,其中,屈光不正性弱视患儿经治疗的总有效率和治愈率均显著高于其他两种类型(P0.05)。结论:综合治疗法对弱视患儿的临床疗效与弱视程度、弱视类型和年龄密切相关,结合儿童弱视类型提早治疗是提高预后的关键。     

单眼睑缝合1周建立形觉剥夺性弱视猫模型

目的比较正常组、模型组及对照组的图形视觉诱发电位(PVEP)和扫描视觉诱发电位(SVEP)视力,研究各组的视觉电生理表现,探讨单眼睑缝合1周是否可以建立形觉剥夺性弱视模型。方法分析三组PVEP的波形变化、潜时及完成一次诱发反应的时间;比较各组由SVEP得出的客观视力。结果①正常组PVEP由2个波峰组成“M型”(正向波向上),模型组及对照组出现波的分离—波形由多个波组成,而且完成一次反应的时间延长。②缝合侧的N75延迟,SVEP视力较正常组差且差别有统计学意义。③对照组未缝合侧视力恢复到正常水平而缝合侧视力仍差且与正常组有统计学差异。结论短期形觉剥夺的视觉电生理变化是弱视猫的一种表现,单眼睑缝合1周即可建立形觉剥夺性弱视猫的模型。     

不同类型弱视儿童视网膜神经纤维层与预后视力恢复的相关性

摘要 目的：探讨不同类型弱视儿童视网膜神经纤维层（RNFL）与预后视力恢复的相关性。方法：选择2017年6月至2020年6月在本院眼科就诊的80例弱视患儿作为研究对象,其中屈光参差性弱视32例（A组）、斜视性弱视28例（B组）、屈光不正性弱视20例（C组）。三组患儿都进行常规检查与光学相干断层成像（OCT）,调查随访患儿的预后视力恢复情况,并进行相关性分析。结果：三组的视盘面积、盘沿面积、校正视盘面积、校正盘沿面积、等效球镜绝对值、眼轴长度等数据对比无差异（P>0.05）。B组与C组的上方、鼻侧、下方、颞侧、全周的RNFL厚度都高于A组（P<0.05）,C组高于B组（P<0.05）。随访截止时间为2021年1月,A组、B组与C组的总有效率分别为87.5 %、85.7 %和85.0 %,对比无差异（P>0.05）。Pearson线性相关分析显示预后总有效率与上方、鼻侧、下方、颞侧、全周的RNFL厚度均存在相关性（P<0.05）。结论：不同类型弱视儿童的视网膜神经纤维层结构厚度存在差异,与患儿的预后视力恢复存在相关性。     

儿童弱视治疗依从行为的心理因素分析及提高治疗依从性的途径探讨

目的:探讨儿童弱视治疗依从行为的心理因素及提高治疗依从性在此过程中的重要性。方法:随机抽取2012年6月至2013年3月于我院眼科就诊的弱视患儿作为调查对象。对弱视儿童及其家属进行问卷调查,了解其心理情况以及治疗过程中的依从性。结果:在本次研究过程中发现儿童弱视治疗依从行为中只有在训练时戴镜状况的依从性相对较高,影响儿童弱视治疗依从行为的心理因素主要是缺乏自信及厌倦心理,差异统计学意义(均P0.05)。结论:影响儿童弱视治疗依从行为的心理因素主要是缺乏自信及厌倦心理,家长的监督及鼓励在提高治疗依从性过程中起重要作用。     

阿托品压抑疗法和遮盖疗法在治疗小儿弱视中的效果观察

目的:探讨遮盖疗法与阿托品压抑疗法治疗儿童弱视后视功能的变化差异。方法:90例单纯屈光参差弱视儿童随机分为压抑组和遮盖组各45例,两组弱视眼均佩带适矫眼镜,压抑组采用优势眼采用阿托品完全压抑法,遮盖组优势眼6h/日遮盖治疗,均连续治疗6个月,比较两组患儿视力变化情况。结果:治疗后压抑组的视力-0.044±0.137显著优于遮盖组视力-0.217±0.196(P0.05)。压抑组治疗后的P-VEP潜时、P-VEP振幅分别为105.3±4.9(ms)、14.8±3.6(uv)显著优于遮盖组(P0.05)。压抑组的立体视重建疗效分布显著的优于遮盖组(P0.05),压抑组的有效率80%显著的高于遮盖组的60%(P0.05)。压抑组的疗效分布显著的优于遮盖组(P0.05),压抑组的有效率84.44%显著的高于遮盖组的57.78%(P0.05)。结论:阿托品压抑疗法治疗弱视儿童较遮盖疗法具有更加显著的治疗效果。     

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%^1-3, the majority of cases being monocular². Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself^4,5 . Amblyopia is characterized by both monocular and binocular deficits^6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions⁸. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia^9,10 .Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device^11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control^13,14 and patient^6,9,11 populations.In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia^12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device¹⁵.