6 其他治疗方法
近年来出现很多光学仪器协助治疗弱视的方法,如各类增视仪、视功能治疗仪、视刺激疗法、光刷疗法等,但尚缺乏科学合理的实验设计,对其疗效难以作客观评价。目前国内有较多采用2或3种方法进行综合治疗弱视的临床研究,效果比单一疗法好。王勇[25]对379例3~14岁患儿进行1年的对照研究发现,进行综合治疗的治疗组基本痊愈率为71.6%,而单一弱视治疗的对照组为55.1%,两者间比有统计学意义。综合治疗法在短时间内顺序进行视觉刺激,显示了明显的治疗优势。但对诊治规律仍需不断的探索和深入的研究。
7 影响弱视治疗效果的因素
影响弱视治疗效果的因素很多,与治疗开始的年龄、治疗持续时间、弱视类型、程度和治疗方法、屈光矫正的准确度、患者对治疗的依从性等密切相关。对弱视治疗结束后的对象进行前瞻性研究(追踪并监测其视力发现,大约有四分之一已经成功治愈的弱视患儿,在治疗后1年内出现视力下降[26]。而且视力下降容易出现在治疗结束时的前13周。因此治疗后需要进行长期随访巩固,对治疗后远期的复发危险因素,应进行更多的随机临床实验研究,从而采取相应积极的方法避免这种视力回退的发生是十分重要的。
近些年,国内、外学者对弱视的病因、发病机制及视功能改变进行了大量的基础和临床研究,弱视的治疗方法亦有了不少进展,但还没有根本性突破。对弱视发病机制进行深入而艰苦的研究,探索更为有效治疗弱视药物和方法的工作尚任重而道远。
【参考文献】
[1]中华医学会眼科学会全国儿童斜视弱视防治学组. 弱视的定义、分类及疗效评价标准[J]. 中国斜视与小儿眼科杂志, 1996, 4(3: 97.
[2]SIMONS K. Amblyopia characterization, treatment and prophylaxis[J]. Surv Ophthalmol, 2005, 50(2: 123-166.
[3]The Pediatric Eye Disease Investigator Group. A randomized trial of patching regimens for treatment of moderate amblyopia in children[J]. Arch Ophthalmol, 2003, 121(5: 603-611.
[4]HOLMES J M, KRAKER R T, BECK R W, et al. A rando_mized trial of prescribed patching regimens for treatment of severe amblyopia in children[J]. Ophthalmology, 2003, 110(11: 2075-2087.
[5]The Pediatric Eye Disease Investigator Group. A prospective, pilot study of treatment of amblyopia in children 10 to 18 years old[J]. Am J Ophthalmol, 2004, 137(3: 581-583.
[6]Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children[J]. Arch Ophthalmol, 2002, 120(3: 268-278.
[7]REPKA M X, WAL1ACE D K, BECK R W, et al. Two_year follow_up of a 6_month randomized trial of atropine vs. pat_ching for treatment of moderate amblyopia in children[J]. Arch Ophthalmol, 2005, 123(2: 149-157.
[8]ARIKAN G, YAMAN A, BERK A T. Efficacy of occlusion treatment in amblyopia and clinical risk factors affecting the results of treatment[J]. Strabismus, 2005, 13(2: 63-69.
[9]STEWART C E, MOSELEY M J, FIELDER A R, et al. MOTAS Cooperative. Refractive adaptation in amblyopia: quantification of effect and implications for practice[J]. Br J Ophthalmol, 2004, 88: 1552-1556.
[10]AUTRATA R, REHUREK J. Laser_assisted sub_epithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children[J]. J Cataract Refract Surg, 2004, 30(1: 74-84.
[11]PAYSSE E A, COATS D K, HUSSEIN M A, et al. Long_term outcomes of photorefractive keratectomy for anisometropic amblyopia in children[J]. Ophthalmology, 2006, 113(2: 169-176.
[12]汪辉, 阴正勤, 陈莉, 等. LASIK矫治儿童高度近视伴复性散光性屈光参差[J]. 中国斜视与小儿眼科杂志, 2003, 11(3: 97-100.
[13]MEMBRENO J H, BROWN M M, BROWN G C, et al. A cost_utility analysis of therapy for amblyopia[J]. Ophthalmo_logy, 2002, 109: 2265-227l.
[14]GOTTLOB I, STANGLER Z E. Effect of levodopa on contrast sensitivity and scotomas in human amblyopia[J]. Invest Ophthalmol Vis Sci, 1990, 31: 776-780.
[15]LEGUIRE L E, WALSON P D, ROGERS G L, et al. Longitudinal study of levodopa/carbidopa for childhood amblyopia[J]. J Pediatr Ophthalmol Strabismus, 1993, 30(6: 354-360.
[16]GOTTLOB I, WIZOV S S, REINECKE R D. Visual acuities and scotomas after three weeks L_dopa administration in adult amblyopia[J]. Graefes Arch Clin Exp Ophthalmo1, 1995, 233: 407-413.
[17]CAMPOS E C, SCHIAVI C, BENEDETTI P. Effect of citicoline on visual acuity in amblyopia: preliminary results[J]. Graefes Arch Clin Exp Ophthalmol, 1995, 233: 307-312.
[18]CAMPOS E C. Fresina M. Medical treatment of amblyopia: present state and perspectives[J]. Strabismus, 2006, 14(2: 71-73.
[19]韩源, 吴彤霞, 孙慧华, 等. 胞二磷胆碱治疗大龄弱视疗效评估[J]. 中国斜视与小儿眼科杂志, 1999, 7(2: 53-58.
[20]李迎舒, 马红霞. 益气聪明汤加减合耳穴贴压治疗儿童弱视86例总结[J]. 湖南中医杂志, 2006, 22(4:29-30.
[21]张凤梅, 亢旭红, 张瑞彤, 等. 增视明目丸对儿童弱视疗效观察[J]. 中国中医眼科杂志, 1997, 7(2: 77-80.
[22]周晓莉, 宋大鹏. 中西医结合治疗儿童弱视56例[J]. 安徽预防医学杂志, 2006, 12(1: 59-60.
[23]黄国林. 弱视灵治疗儿童弱视疗效分析[J]. 浙江中医杂志, 1997, 32(8: 351.
[24]赖露丽, 宋大鹏. 中西医结合治疗儿童弱视56例[J]. 湖北民族学院学报: 医学版, 2005, 22(2: 66.
[25]王勇. 综合视觉刺激增视治疗弱视的临床探讨[J]. 中国斜视与小儿眼科杂志, 2006, 14: 123-126.
[26]HOLMES J M, BECK R W, KRAKER R T, et al. Pediatric Eye Disease Investigator Group. Risk of amblyopia recurrence after cessation of treatment[J]. JAAPOS, 2004, 8: 420-428. 上一页 [1] [2] [3] |