视动性眼球震颤法在儿童视力检查中的应用分析

目的探讨视动性眼球震颤(OKN)法在儿童视力检查中的可行性、准确性与稳定性。方法回顾性对照研究。分别采用OKN法及标准对数视力表对256例6~13岁儿童进行视力检测及分析:①OKN法的总体可测率及不同年龄、性别的差异性;②2种方法检测结果的相关性和一致性;③OKN法检测视力的可重复性。结果不同年龄儿童的可测率为58.00%~87.50%,总体可测率为74.41%±9.16%;不同年龄、性别儿童间可测率差异无统计学意义;OKN法及标准对数视力表总体呈正相关,相关系数r值为0.871(P<0.01);OKN法与标准对数视力表检测结果总体差值为-0.11±0.14,2种方法检测结果的95%一致性界限为-0.38~0.16;OKN法2次检测结果总体差值为-0.02±0.25,2次检测结果的95%一致性界限为-0.51~0.47。结论OKN法用于儿童视力检测具有一定的可行性、准确性以及良好的稳定性。

进行性核上性麻痹患者视动性眼球震颤异常

Objectives: To measure vertical and horizontal responses to optokinetic (OK) s timulation and investigate directional abnormalities of quick phases in progress ive supranuclear palsy (PSP). Methods: Saccades and OK nystagmus were studied in six PSP patients, five with Parkinsons disease (PD), and 10 controls. The OK stimulus subtended 72°horizontally, 60°vertically, consisted of black and whit e stripes, and moved at 10-50°/s. Results: All PSP patients showed slowed volu ntary vertical saccades and nystagmus quick phases compared with PD or controls. Small, paired, horizontal saccadic intrusions (SWJ) were more frequent and larg er in PSP during fixation. Vertical saccades were transiently faster at the time of SWJ and horizontal saccades in PSP. During vertical OK nystagmus, small quic k phases were often combined with horizontal SWJ in all subjects; in PSP the vec tor was closer to horizontal. Vertical OK slow phase gain was reduced in PSP but , in most PD patients, was similar to normals. The average position of gaze shif ted in the direction of vertical OK stimulus in PSP patients with preserved slow phase responses but impaired quick phases. Conclusions: Vertical OK responses i n PSP show impaired slow phase responses, and quick phases that are slowed and c ombined with SWJ to produce an oblique vector. SWJ facilitate vertical saccades and quick phases in PSP, but it is unclear whether this is an adaptive process o r a result of the disease. A large OK stimulus is useful to induce responses tha t can be quantitatively analysed in patients with limited voluntary range of ver tical gaze.

帕金森综合征的异常眼球运动研究进展

帕金森综合征是指有类似帕金森病表现的多种疾病,其中包括帕金森病(PD)、多系统萎缩(MSA)、进行性核上性麻痹(PSP)。PD以震颤、肌强直、动作迟缓、姿势平衡障碍的运动症状和睡眠障碍、嗅觉障碍、自主神经功能障碍、认知和精神障碍等非运动症状为临床特征。MSA以自主神经功能障碍、帕金森病、小脑共济失调和锥体束征的不同组合为主要临床表现。PSP是一种非典型帕金森综合征,早期可出现步态不稳所致跌倒,可见核上性凝视麻痹或迟缓,锥体外系肌强直,伴皮层下认知和精神行为改变。不正常的眼球运动很常见,有时在运动障碍性疾病中也很突出。眼球运动检查包括床边评估和实验室记录眼球错位、不自主眼球运动,包括眼球震颤和扫视侵入、视振荡、诱发性眼球震颤、扫视、平滑跟踪和前庭眼反射。眼动检查已被证明是鉴别帕金森综合征的一个极好的工具。本文综述PD、MSA及PSP的眼动特征,旨在为三者的鉴别诊断提供依据。

双向Glenn术后一过性失明1例

患者男性,9个月。因＂发现心脏杂音8个月＂于2016年11月28日入院。入院后心脏彩超提示：复杂型先天性心脏病,单心室,完全型大动脉转位,肺动脉狭窄,卵圆孔未闭,房水平左向右分流,二、三尖瓣少量返流。心脏CT示：复杂型先天性心脏病,不定型单心室,完全型大动脉转位,肺动脉瓣下狭窄,房间隔缺损。血气分析示：pH：7.38,PaO2：51.7mmHg,PaCO2：28.4 mmHg,SaO2：83.1%。

青光眼的眼球运动改变

近年来许多研究关注青光眼患者的眼球运动变化与年龄匹配的健康志愿者相比,青光眼患者的眼球运动表现出显著的改变,包括眼球扫视运动速度下降、运动延迟、准确度下降、扫视幅度减小以及反向眼球震颤缺失等这些改变可能与青光眼患者视网膜神经纤维层特别是大细胞神经元的损害,继而影响上丘、初级视皮层等调控扫视运动和视动性眼震的神经结构有关。眼动用于青光眼诊断的相关研究已初具雏形。