Somer Deniz, Karabulut Esra, Cinar Fatma Gul, Altiparmak Ugur Emrah, Ünlü Nurten
a Department of Ophthalmology , SB Ankara Education and Research Hospital , Ankara , Turkey.
J Binocul Vis Ocul Motil. 2018 Apr-Jun;68(2):54-58. doi: 10.1080/2576117X.2018.1468685.
To investigate the role that dynamic retinoscopy can play in reducing the occurrence of infantile accommodative esotropia and facilitating emmetropization in infants with high hyperopia.
211 orthotropic infants under 1 year of age (3.5 to 12 months) identified as having ≥5 diopters of hyperopia in their more hyperopic eye on a routine eye exam. On enrollment, infants underwent an assessment of accommodation using dynamic retinoscopy as well as a cycloplegic refraction. Infants who showed normal accommodation were followed without spectacles. If dynamic retinoscopy showed subnormal accommodation, partial hyperopic correction that allowed for full binocular accommodative responses at near were prescribed. Main outcome measures were the occurrence of esotropia, changes in refractive error, and visual acuity.
Of the 211 infants enrolled, 146 showed normal accommodation and were followed without glasses (Group 1). None of these patients developed strabismus. Sixty-five patients showed subnormal accommodation and received partial hyperopic correction (Group 2). Thirty-four of the 65 (52%) in Group 2 did not develop strabismus (Group 2A) and 31 of the 65 (48%) developed strabismus (Group 2B). All 3 groups showed a reduction of hyperopia of 0.37D ± 0.25/year, 0.50D ± 0.28/year, and 0.60D ± 0.20/year in groups 1, 2A, and 2B, respectively. None of the differences between groups were statistically significant.
Normal accommodation on dynamic retinoscopy in orthotropic hyperopic infants is a predictor of continued good alignment and such infants can be followed without spectacles. Partial spectacle correction based on dynamic retinoscopy may have a beneficial effect on reducing the development of strabismus without impeding emmetropization. Early binocular accommodative behavior seems to be predictive of infants at risk of developing strabismus.
探讨动态检影法在降低婴儿调节性内斜视发生率及促进高度远视婴儿正视化过程中所起的作用。
211名1岁以下（3.5至12个月）的正视婴儿，在常规眼科检查中被确定为一只眼远视度数≥5屈光度。入组时，婴儿接受了动态检影法的调节评估以及睫状肌麻痹验光。调节正常的婴儿不戴眼镜进行随访。如果动态检影显示调节异常，则开具部分远视矫正处方，以允许在近距离时产生完全的双眼调节反应。主要观察指标为内斜视的发生率、屈光不正的变化及视力。
在入组的211名婴儿中，146名调节正常，不戴眼镜进行随访（第1组）。这些患者均未发生斜视。65名患者调节异常，接受了部分远视矫正（第2组）。第2组65名患者中有34名（52%）未发生斜视（第2A组），31名（48%）发生了斜视（第2B组）。所有3组的远视度数分别以每年0.37D±0.25、0.50D±0.28和0.60D±0.20的速度降低。组间差异均无统计学意义。
正视远视婴儿动态检影调节正常是持续保持良好眼位的预测指标，此类婴儿可不戴眼镜进行随访。基于动态检影的部分眼镜矫正可能对减少斜视的发生有有益作用，同时不妨碍正视化。早期双眼调节行为似乎可预测有发生斜视风险的婴儿。
