医学课件：调节和聚散功能异常的诊断和处理.pdf

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1、调节和聚散功能异常临床分析与处理温州医科大学眼视光学院姜俭2015/7/9eyehospitalofWMU1患者资料患者张ＸＸ，男，24岁，温州市区人主述：佩戴OK镜后视物模糊2天佩戴OK镜前的屈光度OD-2.50=1.2OS-3.00=1.2OK镜处方OD42.50/-2.50/+0.75/10.60OS42.50/-3.00/+0.75/10.60角膜塑形术前角膜地形图角膜塑形后角膜地形图检查结果VscOD1.0OS1.0@DSub-refOD+0.50=1.0OS+0.50=1.0裂隙灯显微镜下角膜上皮无明显脱落

2、角膜无明显水肿聚散功能检查phoriaBIBOWorth4dot6Morthox/7/48/16/9fusion40cm2exo10/22/1113/24/11fusion40cm+1.00D5exo——————调节功能检查NRA/PRA=+2.00/-1.75AMP(minus-lens)OD+6.50DOS+6.50DAccfacility:slowlyinminuslensFCC=+0.75诊断和诊断依据屈光不正（角膜塑形术前主觉验光结果）OD-2.50=1.2OS-3.00=1.2调节不足调节幅度低于公式计算法PRA

3、相对较低调节灵活度负片困难可能的原因患者本身近视，调节能力相对正视者低OK镜验配为了达到较好的裸眼视力，会过矫患者本身调节能力较同龄人弱患者为了缓解疲劳和预防近视增加，平时有用睫状肌麻痹剂（追问病史，得知平时有用信流丁和托吡卡胺等眼药水）提醒验配OK镜过程中，有必要检查调节和聚散等功能如果患者为了预防近视增加而长期佩戴OK镜者，建议正矫，不能过矫。（短期为了寻求提高裸眼视力除外）注意睫状肌麻痹临床使用过程中，对调节功能的影响调节和聚散功能异常的临床分析非老视性调节障碍聚散系统障碍2015/7/9eyehospitalofWMU1

4、3非老视性调节障碍调节功能的测量调节异常诊断调节灵活度调节不足调节幅度调节灵活度不良调节滞后调节疲劳相对调节调节过度2015/7/9eyehospitalofWMU14GeneralDiagnosticCategoriesAccommodativeDysfunctions(Duke-Elder)AccommodativeInsufficiencyIll-SustainedAccommodationAccommodativeInfacilityParalysisofAccommodationSpasmofAccommo

5、dationVsAccomExcessFromAOA“CareofpatientwithAccommodativeandVergenceDysfunctionGeneralDiagnosticCategoriesAccommodativeDysfunctionsAccommodativeInsufficiencyIll-SustainedAccommodationParalysisofAccommodationUnequalaccommodationAccommodativeInfacilitySpasmofAccommodation

6、VsAccomExcessFromclinicalmanagementofbinocularvision2ndeditionAccommodativeAnomalies"NOTENOUGH”“UNSURE”"TOOMUCH"InsufficiencyInfacilityExcessLowAmplitudeMEM&FCCNormaltolowMEM&FCCLowHighLagNRA/PRAreducedLowNRAFacility:Poor–Facility:poor-/+OD,OS,OUFacility:poor+OD,OS,OUOD,OS,OUA

7、mplitudeofAccommodationMinuslenstoblurProcedurePhoropterbased,easytodoafterPRANorm:2Dlessthanpush-upPush-upProcedureFreespaceorphoropterNorm:18.5–0.3(age)Minimum:15–0.25(age)AccommodativeFacilityTestingMonocularVergenceis“openlooped”BinocularImpactofvergenceCPOE3

8、rdedpgs193-196BinocularAccommodativeFacilityTestingPatientwea