【摘要】 目的 觀察綜合療法治療大齡兒童弱視的療效。 方法 回顧分析2008年1月-2010年10月在我院初診并經綜合治療的8～13歲弱視兒童62例85只眼的臨床資料。治療前最佳矯正視力0.1~0.7，平均0.46±0.17。觀察患者經弱視綜合治療后視力、空間對比敏感度及立體視提升效果。 結果 治療后視力正常22例31只眼（36.5%），進步29例39只眼（45.9%），無效11例15只眼（17.6%）；總有效率82.4%，與治療前相比，差異有統計學意義（Plt;0.001）。空間對比敏感度基本正常11例16只眼（18.8%），進步43例58只眼（68.2%），無效8例11只眼（12.9%）。弱視眼在1.5、3、6三個低空間頻率的對比敏感度值與治療前相比提升有統計學意義（Plt;0.001）；在12和18兩個高空間頻率，對比敏感度值與治療前相比提升無統計學意義（Pgt;0.05）。立體視銳度正常12例（19.4%），進步26例（41.9%），無效24例（38.7%），立體視銳度與治療前相比提升具有統計學意義（Plt;0.001）。 結論 綜合療法治療大齡兒童弱視能取得令人較為滿意的療效，患兒視力顯著提升，低到中等頻率空間對比敏感度及立體視銳度也有較大提升。【Abstract】 Objective To explore the therapeutic effect of comprehensive therapy on elder children with amblyopia. Methods The clinical data of 62 patients (85 eyes) with amblyopia who underwent the comprehensive therapy between January 2008 and October 2010 were retrospectively analyzed. The best-corrected visual acuity was 0.1-0.7 (mean 0.46±0.17) before the treatment. The visual acuity, spatial contrast sensitivity and stereoacuity of the patients after the treatment were observed. Results After the comprehensive therapy, the visual acuity was normal in 22 patients (31 eyes, 36.5%), improved in 29 patients (39 eyes, 45.9%), invalid in 11 patients (15 eyes, 17.6%). The total effective rate was 82.4% which was differed significantly from that before the treatment (Plt;0.001). The spatial contrast sensitivity was almost normal in 11 patients (16 eyes, 18.8%), improved in 43 patients (58 eyes, 68.2%), and invalid in 8 patients (11 eyes, 12.9%). The examination of spatial contrast sensitivity showed that the improvement was only statistically significant when frequency equates 1.5, 3, or 6 (Plt;0.001) compared with those before the treatment; while no statistically significant improvement was observed in higher frequencies of 12, 18 (Pgt;0.05). The stereoacuity was normal in 12 patients (19.4%), improved in 26 (41.9%), and invalid in 24 (38.7%); the difference in stereoacuity before and after the treatment was significant (Plt;0.001). Conclusion The therapeutic effect of comprehensive therapy is good: the visual acuity of the patients improves obviously, and the low to middle spatial contrast sensitivity and stereoacuity improve apparently.
ObjectiveTo investigate whether the corneal shape recovered after discontinuation of long-term orthokeratology and whether orthokeratology increased the corneal astigmatism and ocular astigmatism.MethodsFrom December 2016 to April 2018, a retrospective study was conducted on 33 myopic patients who had undergone two times standard orthokeratology in the outpatient department of West China Hospital of Sichuan University, and had stopped wearing the first orthokeratology lens for one month before fitting the second orthokeratology lens. A total of 32 myopia frame glasses wearers were selected by simple random sampling as control. The changes of corneal flat meridian curvature (flat K), corneal steep meridian curvature (steep K), corneal astigmatism and ocular astigmatism before and after discontinuation of orthokeratology were analyzed.ResultsAmong the patients with baseline myopia diopter of ?0.25～?2.75 D, the average annual change of corneal flat K was (?0.03±0.21) D in the frame glasses group and (?0.24±0.14) D in the orthokeratology group, the difference was statistically significant (t=5.555, P<0.001). Among the patients with baseline myopia diopter of ?0.25～?2.75 D, the average annual change of corneal steep K was (0.20±0.42) D in the frame glasses group and (0.15±0.20) D in the orthokeratology group, the difference was not statistically significant (t=0.785, P=0.435). Among the patients with baseline myopia diopter of ?3.00～?5.75 D, the average annual change of corneal steep K was (0.29±0.39) D in the frame glasses group and (?0.01±0.20) D in the orthokeratology group, the difference was statistically significant (t=2.758, P=0.014). The average changes of corneal astigmatism were analyzed according to the difference of eyes, gender, age and baseline corneal astigmatism, the difference was not statistically significant (P>0.05), respectively. For patients with baseline astigmatism absolute value less than or equal to 0.50 D, the astigmatism annual change of the frame glasses group was 0.00 (0.50) D, and that of orthokeratology group was ?0.33 (0.48) D, the difference was statistically significant (Z=?2.301, P=0.021).ConclusionsThe flat K of the cornea becomes flatter and the steep K does not change after one month’s discontinuation of long-term orthokeratology. There was no difference in the increase of corneal astigmatism compared with those wearing frame glasses. When the baseline ocular astigmatism is less than or equal to 0.50 D, the increase of astigmatism may occur after discontinuation of orthokeratology.
Objective To investigate the influence of undercorrected orthokeratology on myopia control, and the correlation between target and central corneal epithelial damage. Methods A retrospective study was conducted on 22 undercorrected orthokeratology lens wearers (37 eyes) from January 2016 to February 2017, and 25 full corrected wearers (47 eyes) during the concurrent period were randomly selected as the control group. The changes of axial length before and after orthokeratology lens wearing and the within-6-month central corneal epithelial damage after orthokeratology lens wearing were analyzed. Results The average annual increase of axial length was (0.13±0.15) mm in the undercorrected group, and (0.14±0.16) mm in the full corrected group, the difference was not statistically significant (P>0.05). Multiple linear regression analysis showed that there was no correlation between the axial growth and the undercorrection of the target (P>0.05), but a negative correlation between the axial growth and the age (P<0.01). After using orthokeratology, the average annual growth of the axial length in children aged 7-10 years was (0.25±0.16) mm, and (0.10±0.14) mm in children aged 11-15 years, the difference was statistically significant (P<0.01). The incidence of central corneal epithelial punctate staining in the (–4.25)-(–5.00) D target group was 27.08%, and that in the (–3.00)-(–4.00) D target group was 16.67%, the difference was not statistically significant (P>0.05). Conclusions The effect of orthokeratology on myopia growth is not affected by the undercorrected target, not related to the undercorrection of target, but negatively correlated with the age. Undercorrected orthokeratology can still be used for myopia control in high myopia patients. No correlation is found between the target and central corneal staining.
Optometry involves knowledge from multiple fields such as biology, physics, chemistry, psychophysics, and medicine. Traditional undergraduate education in optometry mainly focuses on knowledge transmission and lacks interaction, resulting in low student interest and unsatisfactory teaching outcomes. In order to improve this situation, the teaching team of Department of Optometry and Visual Science, West China School of Medicine, Sichuan University proposed a method of integrating real visual experiences into teaching. By combining multimedia tools and existing methods, real visual phenomena and personal visual experiences are integrated into the curriculum. This new teaching method stimulates students’ interest in learning, increases classroom interaction, promotes knowledge understanding and application through vivid visual phenomena and students’ own visual experiences. This article will introduce the above teaching method.
Early onset and high incidence of myopia has caused great concern of the Party and the Government. On August 30th 2018, eight ministries and commissions, such as the Ministry of Education, jointly issued the Comprehensive Prevention and Control Implementation Scheme of Child and Adolescent Myopia, which put forward the actions and specific measures to various aspects, and particularly mentioned that the medical and health institutions should work together with families, schools, etc, to reduce the incidence of myopia. Medical institutions should do a good job in the following items: setting up visual archives for adolescents, so as to prevent and control myopia with pertinence and individualization; standardizing the process of diagnosis and treatment, doing a good job in refractive examination and correction of adolescents, and resolutely combating the commercial "treatment and correction" of myopia; strengthening myopia-related health education, and eliminating erroneous understanding to myopia prevention and control. Optometrists should play an important role in the prevention and control of myopia, speed up the cultivation of optometry talents, and call on the state to establish a professional title system and professional access standards for optometry talents as soon as possible.
Objective To investigate the efficacy of individualized surgical treatment on congenital superior oblique paralysis. Methods A total of 131 patients (180 eyes) undergoing surgery for congenital superior oblique palsy between October 2015 and January 2018 in West China Hospital of Sichuan University were reviewed. The clinical features, surgical methods and efficacy were analyzed. Results Among the 131 cases, 49 cases were bilateral congenital superior oblique palsy, and 82 cases were unilateral congenital superior oblique palsy; 94 cases were combined with horizontal strabismus; 17 cases (26 eyes) underwent inferior oblique recession, 53 cases (93 eyes) underwent superior oblique tuck, 4 cases underwent superior oblique tuck combined with contralateral superior rectus resection, 37 cases underwent superior oblique tuck combined with contralateral inferior rectus recession, 6 cases underwent inferior oblique recession combined with contralateral superior rectus resection, and 14 cases underwent inferior oblique transposition combined with contralateral superior rectus resection; 18 cases underwent horizontal strabismus correction at one stage, and 76 cases underwent horizontal strabismus correction at the second stage. After Surgery, there were 116 cases cured (88.55%), 15 cases improved (11.45%), and 0 case invalid. Conclusions The diagnosis of congenital superior oblique paralysis should be accurate. Individualized surgery should be designed according to the size and maximum orientation of the squint and the limitation or hyperactivity of the muscles in each diagnostic eye position.
Purpose To investigate the association between the macular volume and thickness, as assessed by optical coherence tomography (OCT), with refraction state and axial length (AL) in children. Methods A total of 100 normal children whose right eyes were randomly selected were divided into five groups due to their refraction, comprising hyperopia, emmetropia, low myopia, moderate myopia, high myopia. The AL of the eyes was measured by IOL mas ter measuring machine. Then the macular volume and thickness were measured by OCT. Results Children with high myopia have smaller macular volume and thinner parafoveal retinal thickness (especially out-ring macular). The minimum thickness and average thickness of the fovea were not significantly different among the five groups. The macular volume ,total average macular thickness and quadrant-specific macular thickness(except the nasal inner quadrants) were positively associated with refraction and negatively associated with AL, while t here were no correlation between minimum foveal thickness, the average foveal th ickness and refraction or AL. Conclusions In Chinese children, increasing axial length was associated with reduced macular volume and thickness (except the foveal region and the nasal inner quadrant). (Chin J Ocul Fundus Dis,2008,24:114-117)
目的:探討先天性上斜肌麻痹的臨床特征以及手術治療方法。方法:對四川大學華西醫院收治的先天性上斜肌麻痹126例患者的臨床特征、手術方式和療效進行回顧分析。結果:我們對126例患者進行了2月至5年的隨訪,其中治愈50(40.0%)例,改善60(47.6%)例,失敗12(9.38%)例。結論:先天性上斜肌麻痹的手術治療要按減弱直接拮抗劑或配偶肌,加強麻痹肌或間接拮抗肌的原則進行。手術的目的是消除垂直偏斜和代償頭位,避免成年后顏面、頸部和脊柱的畸形,建立雙眼單視和恢復正常的眼球功能。
目的:分析探討單眼散光弱視患兒對比敏感度(CS)視功能的受損特點。方法:對正常兒童組36例、單眼散光弱視組34例、單眼非散光弱視組33例,共103例,用靜態F.A.C.T圖表和計算機Gabor斑CS檢查程序分別檢查患兒對側眼、弱視眼及90°和180°兩主子午線方向上的對比敏感度。結果:①單眼散光弱視組和單眼非散光弱視組的對側眼、弱視眼的CS值在所有空間頻率均較正常組的CS降低(Plt;0.05),表現為中、高空間頻率區CS的明顯受損(Plt;0.01)。②單眼散光弱視組的弱視眼在90°和180°兩主子午線方向上的對比敏感度有顯著差異(Plt;0.01)。結論:弱視兒童的對側眼不正常。用計算機Gabor斑檢查可以了解弱視散光兒童不同子午線上的CS存在的差異,明確定位弱子午線,并可以針對子午線性弱視,進一步開展知覺學習的治療。