调节et -高AC/A比内斜视:以眼镜为例

E. Raab
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引用次数: 4

摘要

背景和目的对于患者的光学矫正距离是否在8棱镜屈光度的完全对准范围内,是否需要治疗近距离持续过度收敛,如果需要治疗,应该是什么,一直存在争议。患者和方法对于距离偏差减少到8或更少棱镜屈光度的患者,我的首选是在第一次处方中进行完全的睫状体麻痹矫正加上双焦点矫正,以防止最初几乎所有的调节,然后再拉回来。结果对几篇报道的回顾表明,对于这是否会导致适应性减弱和早老眼,仍然缺乏共识。最近的研究发现,尽管缓解了调节需求,但近距离趋同张力的延长会导致内侧直肌的解剖和生理改变,从而威胁到令人满意的距离对齐。低调节性内斜视类似于高AC/A型内斜视。结论单纯观察或手术均不能自发改善近侧过收敛。我将手术保留在近距离过度收敛的情况下,对于距离和近距离差距非常大的不寻常的情况,以及没有迹象表明这种情况会消失的青少年或成年人。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Accommodative ET-High AC/A Ratio Esotropia: The Case for Glasses
Background and Purpose There is a continuing debate as to whether the patient optically correctable at distance to within 8 prism diopters of perfect alignment requires treatment for persisting overconvergence at near, and if treatment is indicated, what it should be. Patients and Methods For the patient whose misalignment at distance is reduced to 8 or fewer prism diopters, my preference is for the full cycloplegic correction plus a bifocal in the first prescription, to discourage virtually all accommodation initially, with pull back later. Results Review of several reports indicates a continued lack of consensus on whether this causes disuse weakening of accommodation and premature presbyopia. Recent studies found that prolonged convergence tone at near can result in anatomic and physiologic alterations in the medial rectus muscles that threaten a satisfactory distance alignment as well, despite relief of the accommodative demand. Hypoaccommodative esotropia resembles the high AC/A variety. Conclusion Spontaneously improving over-convergence at near is not likely to occur in the hypoaccommodating patient either with observation alone or with surgery. I reserve surgery for the over-convergence at near for the unusual case of an extremely high distance-near disparity, and for the teenager or adult not showing likelihood that the condition will resolve.
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