Quzhou Hospital of Zhejiang Medical and Health Group, Quzhou, China.
Medicine (Baltimore). 2024 May 31;103(22):e38109. doi: 10.1097/MD.0000000000038109.
The inner segments and outer segments (IS/OS) of the retinal photoreceptors are the areas that receive light signals and are the most initial sites for generating visual impulses, and the integrity of the IS/OS has a direct impact on visual sensitivity.
We performed OCT on a 6-year-old child with vision loss and found that the cause of his vision loss was a retinal IS/OS fracture, and the child underwent some treatments to improve microcirculation and nourish the retina at a higher-level hospital, but his vision never improved. Our examination of this child revealed that this child not only had decreased visual acuity, but also hypermetropia, but his near stereopsis was normal. The symptoms were similar to those of amblyopia, so we tried to use visual training as a treatment.
First, 6 sessions of fine visual stimulation were given, followed by 3 sessions of accommodation training, and we followed the 4 stages of accommodation training: perception of accommodation, amplitude of accommodation, sensitivity of accommodation, and autonomic accommodation. After 9 consecutive visual training sessions, the child's visual acuity was stabilized at 0.6, and then we added eye movement training, and after the child's visual acuity was improved to 0.7, we suppressed the visual acuity of the left eye to 0.6, so as to make the visual acuity of both eyes similar, which would promote the establishment of binocular stereo vision, and then we carried out 9 more visual training sessions, and the patient's visual acuity was stabilized at 0.8 gradually. OCT review showed that the child's retinal IS/OS fracture was basically closed.
In conclusion, our study found that visual training can restore visual acuity in children with monocular IS/OS fracture and also promote repair of IS/OS fracture, which increases our understanding and knowledge of the treatment of retinal IS/OS fracture, and this case may provide some lessons for the treatment of retinal IS/OS fracture in children. We hope to have more samples of retinal IS/OS fracture in the future to evaluate the efficacy of visual training for retinal IS/OS fracture.
视网膜光感受器的内节和外节（IS/OS）是接收光信号的区域，也是产生视觉冲动的最初部位，IS/OS 的完整性直接影响视觉灵敏度。
我们对一名视力丧失的 6 岁儿童进行了 OCT 检查，发现他视力丧失的原因是视网膜 IS/OS 断裂，该儿童在一家更高水平的医院接受了一些改善微循环和滋养视网膜的治疗，但他的视力从未改善。我们对这名儿童的检查发现，他不仅视力下降，而且还有远视，但他的近立体视正常。这些症状类似于弱视，因此我们尝试使用视觉训练作为治疗方法。
首先，进行了 6 次精细视觉刺激，然后进行了 3 次调节训练，我们遵循调节训练的 4 个阶段：调节感知、调节幅度、调节灵敏度和自主调节。经过 9 次连续的视觉训练后，儿童的视力稳定在 0.6，然后我们加入了眼球运动训练，在儿童的视力提高到 0.7 后，我们将左眼的视力抑制到 0.6，以使双眼视力相似，这将促进双眼立体视觉的建立，然后我们又进行了 9 次视觉训练，患者的视力逐渐稳定在 0.8。OCT 复查显示，儿童的视网膜 IS/OS 断裂基本闭合。
总之，我们的研究发现，视觉训练可以恢复单眼 IS/OS 断裂儿童的视力，并促进 IS/OS 断裂的修复，这增加了我们对视网膜 IS/OS 断裂治疗的理解和认识，这个病例可能为儿童视网膜 IS/OS 断裂的治疗提供了一些经验。我们希望将来有更多的视网膜 IS/OS 断裂样本，以评估视觉训练对视网膜 IS/OS 断裂的疗效。
