128例双眼复视的临床分析

目的探讨不同年龄组双眼复视的病因特点,以利于提高临床的诊治效果。方法采用三棱镜、同视机、Hess屏及红玻片等方法对128例患者进行眼位、眼球运动和复视像检查,辅以血生化和影像学检查。结果青少年复视51例,其中眼肌运动障碍性复视30例,非眼肌运动障碍性复视21例。中老年复视77例,其中眼肌运动障碍性复视71例,非眼肌运动障碍性复视6例。结论青少年复视与中老年复视主要病因不同,青少年复视的主要病因为炎症、急性共同性斜视、外伤、肿瘤及重症肌无力等;中老年复视的主要病因是血管性疾病、外伤、脑肿瘤、炎症及全身病等,主要为眼肌运动障碍性复视。     

Functional scoring of the field of binocular single vision in patients with diplopia

A simple method for scoring the field of binocular single vision (BSV) is presented. The field is plotted on the Goldmann Perimeter using the III-4e target. The method gives greater weight to functionally important areas, especially the primary and reading positions. Several cases illustrate the application of the proposed scoring system by correlating patients' subjective disabilities with their diplopia scores. The method is more precise than any previous scheme and provides a quantitative measure that makes the examination of patients with diplopia more accessible to legal evaluation and numerical analysis.     

压贴三棱镜在不同类型双眼复视患者中的应用

目的：探讨压贴三棱镜在不同类型双眼复视患者中的干预效果。

方法：回顾性病例研究。收集2018-06/2020-11在广东省江门市中心医院眼科接受压贴三棱镜干预的20例双眼复视患者,其中8例为急性共同性内斜视,5例为甲状腺相关性眼病,7例为因颅神经麻痹所致的斜视。分别于干预前后测斜视度和近立体视功能,调查干预前后患者视疲劳症状和独立驾驶能力。

结果：经过压贴三棱镜干预后,全部患者的斜视度明显减少,与干预前比较变化有差异(P<0.05)。在急性共同性内斜视和颅神经麻痹的斜视中,近立体视功能得到恢复的患者明显增多,与干预前比较变化有差异(P<0.05)。在甲状腺相关性眼病患者中,干预前后近立体视功能变化无差异(P>0.05)。经过压贴三棱镜干预后,15例视疲劳症状明显缓解,13例独立驾驶能力恢复,与干预前比较变化有差异(均P<0.05)。

结论：压贴三棱镜有效减少复视患者的斜视度,改善近立体视功能,提高生活质量。     

中老年人复视38例病因分析

目的：分析中老年人麻痹性斜视导致复视的发病原因。方法：中老年双眼复视患者38例年龄45～76岁进行常规眼科专科检查、复视像分析及血压、血生化、CT、MRI检查,明确引起眼外肌麻痹的病因。结果：在38例中腔隙性脑梗塞18例（47．4％）,脑出血2例（5．3％）,颅内肿瘤1例（2．6％）,脑外伤1例（2．6％）,病毒感染3例（7．9％）,糖尿病5例（13．2％）,高血压1例（2．6％）,Graves病2例（5.3％）,眼眶骨折1例（2．6％）,鼻咽部肿瘤2例（5．3％）,副鼻窦肿瘤1例（2．6％）,纵膈肿瘤1例（2．6％）。结论：中老年人眼外肌麻痹所致复视多能查出病因。     

眼肌运动障碍性双眼复视患者视觉相关生活质量分析

目的：评估眼肌运动障碍性双眼复视患者的视觉相关生活质量。方法：回顾性系列病例研究。采用25项美国国家眼科研究所视觉功能问卷调查( NEI-VFQ-25)中文版对2013-10/2016-03就诊于湖州师范学院附属第一医院眼科的112例眼肌运动障碍性双眼复视患者的视觉相关生活质量进行评定。结果：眼肌运动障碍性双眼复视患者的视觉相关的生活质量,包括一般健康状态、总体视觉情况、近距离工作、远距离工作、社交功能、精神健康状态、社会角色限制、独立性、驾驶和周边视野等方面评分均较正常人明显降低,差异均有统计学意义(P<0.05),但在眼痛及色觉方面差异均无统计学意义(P>0.05)。结论：眼肌运动障碍性双眼复视严重影响患者的视觉相关生活质量。在临床治疗中,应当重视双眼复视患者的视觉相关生活质量评价。     

急性共同性内斜视双眼复视患者压贴三棱镜矫正前后视觉相关生活质量及双眼视功能分析

目的：评估急性共同性内斜视(acute-onset comitant esotropia,ACE)双眼复视患者行压贴三棱镜矫正前后视觉相关生活质量及双眼视功能。

方法：回顾性病例研究。收集2014-03/2017-03于湖州市中心医院因双眼复视就诊并诊断为ACE的患者16例,采用25项美国国家眼科研究所视觉功能问卷调查(25-item National Eye Institute Visual Function Questionnaire,NEI-VFQ-25)中文版评估三棱镜矫正前后患者的视觉相关生活质量。同时记录ACE双眼复视患者三棱镜矫正前及矫正后1mo的Worth 4点灯检查、立体视检查等临床资料。数据采用配对样本t检验、卡方检验及Fisher确切概率法进行分析。

结果：(1)患者行压贴三棱镜矫正后1mo的视觉相关生活质量,包括一般健康状态、总体视觉情况、精神健康状态、社会角色限制、社交功能、近距离工作、远距离工作、独立性和驾驶等方面评分较矫正前均明显提高,差异均有统计学意义(P<0.05),但在周边视野、色彩视觉和眼痛方面差异均无统计学意义(P>0.05)。(2)患者行压贴三棱镜矫正前后的远距离融合功能和近立体视功能差异均有统计学意义(P<0.05)。

结论：压贴三棱镜能够改善ACE双眼复视患者的视觉相关生活质量及双眼视功能。     

Shared characteristics of stereopsis and the purely binocular process

Wolfe and Held (1981) Vision Res. 21, 1755-1759 demonstrated the existence in the human visual system of a purely binocular process. A purely binocular process is defined as a process that responds only to binocular stimulation and not to stimulation of either eye alone. In this paper, some of the characteristics of the purely binocular process are investigated. We find: (1) the process is less sensitive to high spatial frequencies than is the visual system as a whole. (2) It is insensitive to stimuli near the detection threshold for the visual system as a whole. (3) It makes a greater contribution to the appearance of vertically oriented stimuli than to the appearance of horizontally oriented stimuli. (4) The function of the purely binocular process can be disrupted by blurring the image in one eye (artificial anisometropia). Each of these properties of the purely binocular process is similar to the known characteristics of stereopsis. This suggests that the purely binocular process is a necessary stage in stereopsis.     

Intrastromal corneal tattooing as treatment in a case of intractable strabismic diplopia (double binocular vision)

We present the case of a 29 man complaining of intractable diplopia during the last 5 years. He had undergone several surgical procedures for the treatment of his infantile strabismus since age 6 years. After surgery, the patient had been treated on 4 occasions with Botox. He also performed antisuppression exercises to encourage binocular vision. On our examination, the patient showed a 20/20 visual acuity in both eyes and a strabismic dysfunction with slight alphabet pattern, which induced a disturbing constant diplopia. Several treatment options were considered as occlusion therapy or cosmetic contact lenses, but they were not used because they were not acceptable esthetically or not tolerated. Finally, an optical penalization was induced by means of a black corneal tattooing placed at the centre of the cornea. The patient was followed for a period of 18 months, showing a complete elimination of diploia with esthetical acceptance and no inflammatory signs.     

Causes and management of bacterial keratitis in the elderly

The author evaluated 142 patients aged 65 years or older with microbial keratitis. There were relatively high rates of Pseudomonas aeruginosa infection unassociated with contact lens wear and of Streptococcus pneumoniae infection. The rates of quasicommensal and enteric infections were not proportionately elevated. Corneal disease, use of topical corticosteroids and use of contact lenses were the main predisposing factors. Patients with diabetes mellitus, dementia or chronic alcoholism appeared to be at higher risk. Trauma was rarely a factor. Complications requiring surgery were common. Corneal perforation developed in 20% of the patients, and endophthalmitis developed in 6%. The elderly often do not tolerate intensive topical antibiotic treatment well. Supplementary subconjunctival antibiotic injections under local anesthesia may be necessary. Corneal tissue glue, tarsorrhaphy and conjunctival flaps are probably underused in this age group.     

Causes and outcomes for patients presenting with diplopia to an eye casualty department

PURPOSE: To evaluate the causes and outcomes for patients presenting with diplopia to an eye casualty department. METHODS: Patients presenting with diplopia as a principal symptom, who were referred to the Orthoptic Department from Moorfields Eye Casualty over a 12-month period, were retrospectively investigated. RESULTS: One hundred and seventy-one patients were identified with complete records in 165 cases. There were 99 men and 66 women with an age range of 5-88 years. Monocular diplopia accounted for 19 cases (11.5%), whereas 146 patients (88.5%) had binocular diplopia. Cranial nerve palsies were the most common cause of binocular diplopia accounting for 98 (67%) of cases. Isolated sixth nerve palsy was the largest diagnostic group (n=45). Microvascular disease (hypertension or diabetes mellitus, or both) was present in 59% of patients with cranial nerve palsies, and of this group, 87% resolved spontaneously by 5 months rising to 95% by 12 months. CONCLUSION: Patients with clinically isolated single cranial nerve palsies associated with diabetes or hypertension are likely to recover spontaneously within 5 months and initially require observation only. However, patients with unexplained binocular diplopia and those who progress or fail to recover should be investigated to establish the underlying aetiology and managed as appropriate.     

Comparative analysis of the optical characteristics of binocular indirect ophthalmoscopes

Recommendations for the design of binocular indirect ophthalmoscopes are made based on a comparative analysis of the optics of various indirects currently available. Significant differences were found to exist in the areas of brightness, stereopsis, small pupil capability, and PD ranges among the brands under study.     

少年双眼视网膜脱离的临床特点及手术治疗

目的 少年双眼视网膜脱离是视网膜脱离的特殊类型,对视功能及生存质量的影响十分严重。本文对少年双眼视网膜脱离患者的临床特点和手术效果进行观察及评价。方法 本院分析了1998/2002收治的9例少年双眼视网膜脱离患儿的(年龄≤15岁)发病年龄、性别、裂孔类 型、位置、形态和手术方法及效果等。结果 巩膜环扎加压术一次手术视网膜复位率为94.1%(16/17)。少年双眼视网膜脱离对视功能影响严重。结论 少年双眼视网膜脱离是一类严重危害视功能的疾病。视网膜裂孔以圆孔为主伴有周边视网膜格子样变性,多位于颞下象限,并且有一定的对称性。巩膜环扎加压手术为首选手术方式,成功率较高。