摘要: 目的：对儿童弱视临床治疗中1) 远视性儿童弱视愈后脫镜指标。2) 儿童弱视愈后复发概念与分期。3)儿童弱视痊愈或脫镜后近视化。4) 治疗年龄限制。5) 结束治疗等。很少有人涉及，报道也很少的这五个方面问题进行研究探讨。方法：弱视儿童就诊后，散瞳验光配戴合适的矫治眼镜、遮盖疗法、使用家庭弱视治疗仪、1个月定期复查，痊愈后，按：(1) 双眼裸眼远近视力≥1.0(国际标准视力表)半年以上者(年龄在3~5岁儿童视力的正常值下限为0.5，6岁及以上儿童视力的正常值下限为0.7)，(2) 眼位正常或斜视性弱视治愈后残余斜视度<5˚者，(3) 远视屈光度≤1.00 DS者(3岁≤+2.00 DS，4~5岁≤+1.50 DS)，(4) 远视散光度≤+0.50 DC，4项指标。决定脫镜。结果：1) 初诊年龄越小疗效越好：2.5~6岁脱镜24.17%，痊愈40.44%，基本治愈24.83%，合计89.44%，均高于其他年龄组；2) 初诊轻度弱视(0.8~0.6)脱镜20.57%，痊愈75.18%，合计95.75%，明显高于中度弱视(0.5~0.2)脱镜22.26%，痊愈32.75%，基本治愈27.16%，合计82.17%和重度弱视(0.1以下)脱镜14.17%，痊愈7.58%，基本治愈48.76%，合计71.05%。3) 初诊屈光度数低度(球镜≤3.00 D，柱镜≤1.00 D)脱镜17.52%，痊愈57.18%，基本治愈16.06%，合计90.76%，高于中度(球镜3.25~4.75 D，柱镜1.25~1.50 D)脱镜26.17%，痊愈24.00%，基本治愈30.06%，合计80.23%和高度(球镜≥5.00 D，柱镜≥1.75 D)脱镜19.28%，痊愈17.69%，基本治愈30.06%，合计72.08%；4) 初诊时单纯远视，脱镜23.34%，痊愈39.68%，基本治愈35.11%，合计87.10%，高于单纯远视散光，脱镜12.38%，痊愈37.13%，基本治愈25.25%，合计74.76%和复性远视散光脱镜10.80%，痊愈36.21%，基本治愈25.08%，合计72.09%；5) 治疗时间与疗效的关系：从表5可以看出经过3年治疗者脱镜21.77%，痊愈49.10%，基本治愈20.87%，合计91.74%；4年治疗者脱镜26.02%，痊愈47.37%，基本治愈18.95%，合计92.34%；5年治疗者脱镜29.35%，痊愈49.74%，基本治愈15.4%，合计94.73%；6年治疗者脱镜29.30%，痊愈58.06%，基本治愈9.68%，合计97.04%均3年高于以下治疗者(
P < 0.05)。结论：1) 修正后远视性儿童弱视脱镜指标应是：(1) 双眼裸眼远近视力1.0(国际标准视力表)半年以上者(年龄在3~5岁儿童视力的正常值下限为0.5，4至5岁低于0.6，6岁及以上儿童视力的正常值下限为0.7)，(2) 眼位正常或斜视性弱视治愈后残余斜视度<5˚者，(3) 远视屈光度≤1.00 DS者(3岁≤+2.00 DS，4~5岁+1.50 DS)，(4) 远视散光度+0.50 DC，4项指标。2) 弱视复发的概念，我们认为：弱视复发是指弱视经过治疗后，矫正视力提高到≥0.9(国际标准视力)或裸眼视力提高到≥1.0后，视力又出现下降，经复方托吡卡胺或阿托品散瞳验光后证明屈光度明显增加，即为弱视复发。弱视复发的分期：我们认为按治疗儿童弱视不同阶段，弱视复发应分三期，即：基本治愈后弱视复发、痊愈后弱视复发和脫镜后弱视复发。3) 儿童弱视痊愈或脫镜后近视化的问题，我们主张早期发现假性近视及时治疗，防止形成真性近视。4) 治疗年龄限制的问题我们认为：2周岁半就可以开始弱视治疗，最佳时期为2周岁~6周岁，7~12周岁属适宜年龄，但对13~18周岁的儿童弱视不要轻易放弃治疗。5) 结束治疗的问题，我们认为：远视性儿童弱视在脱镜后结束治疗是最安全，视力回退率最低。而近视性弱视，基本治愈或痊愈后就可结束治疗。
Abstract: Objective: Clinical treatment of amblyopia in children, 1) The index of disconnection after amblyopia recovery in hyperopic children. 2) The concept and stage of amblyopia recurrence in children. 3) Children & apos; samblyopia recovered or became myopic after taking off glasses. 4) Age limit of treatment. 5) End treatment. Very few people are involved, The report also very few of these five aspects of the study. Methods: after the amblyopia children went to the doctor, they wore suitable corrective glasses, covered therapy, used the family amblyopia therapeutic instrument, and reexamined regularly for 1 month, note: (1) binocular naked near and far vision ≥ 1.0 (International Standard Visual Acuity Chart) for more than half a year (the lower limit of normal vision for children aged 3~5 years is 0.5, and the lower limit of normal vision for children aged 6 years and over is 0.7), (2) residual strabismus < 5˚, (3) hyperopic dioptre ≤ 1.00 ds (3 years ≤ + 2.00 ds, 4~5 years ≤ + 1.50 ds) and (4) hyperopic astigmatism ≤ + 0.50 DC. Decided to take off the lens. Results: 1) The younger the age at first diagnosis, the better the curative effect: 2.5~6 years old, 24.17%, 40.44%, 24.83%, 89.44%, all higher than other age groups, 2) The mild amblyopia at first diagnosis (0.8~0.6), 20.57%, 24.83%, 89.44%, the recovery rate was 75.18% (95.75%), significantly higher than that of the moderate amblyopia (0.5~0.2) (22.26%) , the recovery rate was 32.75% , the basic recovery rate was 27.16%, the total recovery rate was 82.17%, the severe amblyopia (0.1 or less) was 14.17%, the recovery rate was 7.58%, the basic cure rate was 48.76% and the total cure rate was 71.05%. 3) The initial diopter of low diopter (spherical lens ≤ 3.00 d, cylindrical lens ≤ 1.00 d) was 17.52%, the cure rate was 57.18%, the basic cure rate was 16.06%, the total rate was 90.76%, higher than moderate (3.25~4.75 D for spherical lens, 1.25~1.50 D for cylindrical lens), 26.17%, 24.00%, 30.06%, 80.23% and 19.28% for height (5.00 d for spherical lens, 1.75 D for cylindrical lens), the cure rate was 17.69%, the basic cure rate was 30.06%, the total cure rate was 72.08%, 4) At the first diagnosis, the simple hyperopia was 23.34%, the basic cure rate was 39.68%, the basic cure rate was 35.11%, the total cure rate was 87.10%, which was higher than the simple hyperopia astigmatism, the removal of mirror was 12.38%, the total cure rate was 37.13%, the cure rate was 25.25%, 74.76% in total, and 10.80%, 36.21%, 25.08%, 72.09% in total 5) The relationship between treatment time and curative effect: From Table 5, it can be seen that after 3 years treatment, 21.77% of the patients were out of mirror, 49.10% were cured, 20.87% were basically cured, 91.74% in total, 26.02% of the patients were out of mirror, 47.37% were cured, the cure rate was 18.95% (92.34%) , 29.35% (29.35%), 49.74% (49.74%), 15.4% (94.73%), 29.30% (29.30%), 58.06% (58.06%), 9.68% (94.73%), respectively, the total rate of 97.04% was higher than that of the following three years (p < 0.05). Conclusion: 1) The corrected index of amblyopia in hyperopic children should be: (1) binocular naked near-far Vision 1.0 (International Standard Visual Acuity chart) more than half a year (the lower limit of normal vision for children aged 3~5 years is 0.5, for children aged 4~5 years less than 0.6, and for children aged 6 years and over is 0.7), (2) if the eye position is normal or the residual strabismus degree is less than 5˚, after the strabismus amblyopia is cured, (3) hyperopia dioptre ≤1.00 ds (3 years ≤ + 2.00 ds, 4~5 years + 1.50 ds), (4) hyperopic Astigmatism + 0.50 DC, 4 indexes. 2) The concept of recurrent amblyopia, We Believe: Amblyopia recurrence is after treatment amblyopia, Corrected vision was improved to ≥ 0.9 (International Standard Vision) Or the naked eye vision improved to ≥ 1.0, His eyesight is failing again, after mydriasis optometry with compound tropicamide or atropine, it was proved that the diopter was obviously increased, that is, the recurrence of amblyopia. Stages of amblyopia recurrence: we believe that according to the different stages of treatment of amblyopia in children, Amblyopia recurrence should be divided into three stages, namely: After basic cure, amblyopia recurred, Amblyopia recurred after recovery and after lens removal. 3) The problem of myopia after amblyopia recovery or lens removal in children, we advocate early detection and prompt treatment of pseudomyopia, Prevent the formation of true myopia. 4) Treatment of the problem of age limitation we believe that: Amblyopia treatment can be started at the age of 21/2, the best age is 2~6, 7~12 is the right age, but 13~18-year-old children amblyopia do not easily give up treatment. 5) The problem of ending treatment, we Believe: The treatment of hyperopic amblyopia in children is the safest after taking off lens. The rate of vision regression was lowest. And myopic amblyopia, basic cure or after cure can end treatment.