Stimulus deprivation amblyopia in human congenital ptosis: a study of 100 patients.
Stimulus deprivation amblyopia in human congenital ptosis: a study of 100 patients.
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DOI：
10.1076/stra.8.4.261.687
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发表时间：
2000-12-01
期刊：
影响因子：
0.9
通讯作者：
Martus, P
中科院分区：
文献类型：
--
作者：
Gusek-Schneider, G C;Martus, P
目的：目的：探讨先天性上睑下垂患者中刺激剥夺性弱视（stimulationdeprivationamblyopia，SDA）的发生率，并与其他原因引起的弱视进行比较。先天性上睑下垂128眼（单侧72眼，双侧28眼）。调查时的年龄为1岁及以上，平均11岁10个月。弱视定义为最佳矫正视力小于1.0或双眼之间的差异至少为0.2。弱视的病因有：弱视性屈光不正：散光≥ 1 dpt，屈光参差≥ 1 dpt（79%睫状肌麻痹）和斜视。在没有其他弱视原因的情况下，假定为SDA。结果：128只下垂眼中弱视的总发生率为89/128（70%）。在3.9%的病例中（5/128; 2只眼单侧上睑下垂，3只眼双侧上睑下垂），我们假设SDA。下垂眼与（单侧：n = 35，双侧：n = 34）和无遮盖光轴的情况显示：在单侧上睑下垂的情况下，弱视更常见于有遮盖光轴的下垂眼：30/35 vs. 24/37（p = 0.06）;在双侧上睑下垂的情况下，这种差异是显著的：34例中的27例对22例中的8例（p < 0.05）。在SDA的情况下，只有一只眼睛的光轴被覆盖，在患者双侧上睑下垂。屈光参差的发生率无差异：53例中有19例vs. 47例中有14例（p = 0.52）。散光更常见于单侧上睑下垂中光轴被遮盖的下垂眼：35只中的23只对37只中的16只（p = 0.06），但双侧上睑下垂中没有散光：34只中的21只对22只中的13只（p > 0.9）。斜视在光轴被遮盖的下垂眼中明显更常见：35只中有13只对37只中有4只（p < 0.05）单侧上睑下垂，34例中7例vs. 22例中1例（p = 0.13）。结论：与经典的刺激剥夺性弱视动物模型相反，这种实体在人类先天性上睑下垂中是罕见的，也许是因为补偿头部姿势的反作用。融合中断导致斜视可能是先天性上睑下垂弱视的另一间接原因。在上睑下垂的病例中，预防性弱视治疗是重要的，只要儿童不可能进行视力测试。
AIM: To investigate the frequency of stimulus deprivation amblyopia (SDA) in comparison with other reasons for amblyopia in human congenital ptosis.METHODS: The frequency and causes of amblyopia were evaluated in the 200 eyes of 100 patients. Congenital ptosis was present in 128 eyes (72 unilateral, 28 bilateral). The age at investigation was one year and older, with an average of 11 years and 10 months. Amblyopia was defined as best corrected visual acuity less than 1.0 or a difference between the two eyes of at least 0.2. The following causes of amblyopia were identified: amblyopiogenic refractive errors: astigmatism > or = 1 dpt, anisometropia > or = 1 dpt (79% cycloplegia) and strabismus. In cases with no other reasons for amblyopia, SDA was assumed. Statistical analysis was performed using the chi-square and the sign tests.RESULTS: The overall incidence of amblyopia in ptotic eyes was 89/128 (70%). In 3.9% of the cases (5/128; 2 eyes with unilateral and 3 eyes with bilateral ptosis) we assumed SDA. A comparison of ptotic eyes with (unilateral: n = 35, bilateral: n = 34) and without covered optical axis revealed the following: in the case of unilateral ptosis, amblyopia was found more often in ptotic eyes with covered optical axis: 30 out of 35 vs. 24 out of 37 (p = 0.06); in the case of bilateral ptosis this difference was significant: 27 out of 34 vs. 8 out of 22 (p < 0.05). In the case of SDA, the optical axis was covered in only a single eye, in a patient with bilateral ptosis. There was no difference in the incidence of anisometropia: 19 out of 53 vs. 14 out of 47 (p = 0.52). Astigmatism was found more frequently in ptotic eyes with covered optical axis in unilateral ptosis: 23 out of 35 vs. 16 out of 37 (p = 0.06) but not in bilateral ptosis: 21 out of 34 vs. 13 out of 22 (p > 0.9). Strabismus was found significantly more frequently in ptotic eyes with covered optical axis: 13 out of 35 vs. 4 out of 37 (p < 0.05) in unilateral ptosis and 7 out of 34 vs. 1 out of 22 (p = 0.13) in bilateral ptosis.CONCLUSION: In contrast to the classical animal models of stimulus deprivation amblyopia, this entity is rare in human congenital ptosis, perhaps because of the counter effect of compensating head posture. Disruption of fusion resulting in strabismus might be an additional indirect cause of amblyopia in congenital ptosis. Prophylactic amblyopia treatment in ptosis cases is important as long as no testing of visual acuity is possible in a child.