Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.
Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India; Prof. Brien Holden Eye Research Center, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India.
J AAPOS. 2021 Jun;25(3):162.e1-162.e6. doi: 10.1016/j.jaapos.2021.02.010. Epub 2021 Jun 6.
To report a consolidated management protocol for patients with spasm of near reflex (SNR), including classification of cases as mild, moderate, and severe based on treatment outcomes.
Patients with SNR treated at a single institution between August 2016 and November 2018 were included. Management of SNR included modified optical fogging, vision therapy, and pharmacological intervention (cyclopentolate eye drops and, if required, atropine eye drops). Outcome measures were visual acuity (20/25 or better) and refractive error (reduction of excessive myopia).
Of 1,306 patients examined during the study period, 66 were diagnosed with SNR, yielding a prevalence of 5% among first-time patients visiting our binocular vision and orthoptics clinic. Of the 45 patients recruited for this study (mean age, 14 ± 5 years; 24 males), all three near-triad components were involved in 11 patients (24%), only the accommodation component in 32 (71%), and only the convergence component in 2 (4%). SNR was relieved in the first post-cyclopentolate refraction visit or with the modified optical fogging technique in 29 patients (66%; mild SNR) and with one-time usage of atropine eyedrops in 10 patients (22%; moderate SNR). In 6 patients (13%), atropine was continued long-term (severe SNR). Of 15 patients with long-term follow-up (1 year), 11 (73%) had persistent relief of SNR.
In our study cohort, SNR with accommodation component was the most common and could be largely relaxed through a one-time use of cycloplegic eye drops and optical intervention. Only severe forms of SNR may require extended use of strong cycloplegics.
报告一种针对近反射痉挛（SNR）患者的综合管理方案，根据治疗结果将病例分为轻度、中度和重度。
纳入 2016 年 8 月至 2018 年 11 月在一家机构接受治疗的 SNR 患者。SNR 的管理包括改良光学雾化、视觉治疗和药物干预（环戊醇滴眼液，如果需要，还包括阿托品滴眼液）。结局测量包括视力（20/25 或更好）和屈光不正（减少高度近视）。
在研究期间检查的 1306 名患者中，有 66 名被诊断为 SNR，在首次到我们的双眼视觉和斜视诊所就诊的患者中，患病率为 5%。本研究共招募 45 名患者（平均年龄 14±5 岁；24 名男性），11 名患者（24%）涉及近三联征的所有三个组成部分，32 名患者（71%）仅涉及调节成分，2 名患者（4%）仅涉及集合成分。29 名患者（66%；轻度 SNR）在首次环戊醇验光后或改良光学雾化技术后，SNR 得到缓解，10 名患者（22%；中度 SNR）仅使用一次阿托品滴眼剂。在 6 名患者（13%）中，长期使用阿托品（重度 SNR）。在 15 名长期随访（1 年）的患者中，11 名（73%）SNR 持续缓解。
在我们的研究队列中，伴有调节成分的 SNR 最为常见，通过一次性使用睫状肌麻痹滴眼液和光学干预可以得到很大缓解。只有严重的 SNR 形式可能需要长期使用强效睫状肌麻痹剂。
