Bradford G M, Kutschke P J, Scott W E
Department of Ophthalmology, Medical College of Georgia, Augusta.
Ophthalmology. 1992 Oct;99(10):1616-21. doi: 10.1016/s0161-6420(92)31758-0.
The purpose of this study is to analyze the visual results of full-time occlusion therapy in pediatric patients with monocular structural abnormalities and amblyopia.
The authors reviewed the charts of visually immature patients with unilateral structural abnormalities and decreased visual acuity, who presented to the University of Iowa Hospitals and Clinics over a 20-year period, and underwent amblyopia therapy. The results were categorized according to the type of structural abnormality (i.e., partial media opacity, macula lesion, or optic nerve abnormality). Associated factors, including anisometropia, strabismus, age of presentation, and pupillary responses, were analyzed.
Fifty-one percent of the 51 patients in the study achieved a visual acuity of at least 20/80, including 72% of the patients with media opacities, 42% with macular lesions, and 21% with optic nerve anomalies. Strabismus and anisometropia occurred frequently and were not prognostically significant. Relative afferent pupillary defects did not contraindicate good results. Amblyopia recurred in 31% of patients and was successfully treated with resumption of full-time occlusion. Occlusion amblyopia occurred in only one patient and was easily reversed.
The authors recommend a trial of full-time occlusion for patients with all three types of unilateral structural abnormalities. The patients with partial media opacities have a high success rate. Despite lower success rates for the other two groups, good results are possible; no better treatment option exists.
本研究旨在分析单眼结构异常和弱视的儿科患者进行全天遮盖疗法的视觉效果。
作者回顾了20年间就诊于爱荷华大学医院及诊所并接受弱视治疗的视觉未成熟、单侧结构异常且视力下降患者的病历。结果根据结构异常类型（即部分介质混浊、黄斑病变或视神经异常）进行分类。分析了相关因素，包括屈光参差、斜视、就诊年龄和瞳孔反应。
研究中的51例患者中有51%的视力至少达到20/80，其中介质混浊患者中有72%、黄斑病变患者中有42%、视神经异常患者中有21%达到该视力。斜视和屈光参差经常出现，且对预后无显著影响。相对性传入瞳孔障碍并不妨碍取得良好效果。31%的患者弱视复发，恢复全天遮盖治疗后成功治愈。仅1例患者发生遮盖性弱视，且易于逆转。
作者建议对所有三种类型的单侧结构异常患者进行全天遮盖试验。部分介质混浊的患者成功率较高。尽管其他两组的成功率较低，但仍可能取得良好效果；不存在更好的治疗选择。
