#1
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Äèñêóññèÿ î ñïàçìå àêêîìîäàöèè
Öèòàòà:
1. Ñîâåðøåííî íå îáîñíîâàííàÿ. Èãðû íà òåëåôîíå íèêàê íå âëèÿþò íè íà àêêîìîäàöèþ, íè íà ìèîïèþ. 2. Ó êàæäîãî ÷åëîâåêà ñóùåñòâóåò îïðåäåë¸ííîå íàïðÿæåíèå àêêîìîäàöèè, êîòîðîå îáüÿñíÿåòñÿ äåéñòâèåì âåãåòàòèâíîé íåðâíîé ñèñòåìû, ñîñòàâëÿåò ïðèìåðíî 0,5 äèîïòðèé (ó âñåõ) è ìîæåò áûòü ñíÿòî âîçäåéñòâèåì ëèòè÷åñêèõ/ìèìåòè÷åñêèõ ïðåïàðàòîâ. È âîçíèêàåò ìíèìîå âðåìåííîå "âîññòàíîâëåíèå çðåíèÿ". Íî òîëüêî ïîêà âîçäåéñòâóþò õîëèíîëèòèêè. Ïîñëå îòìåíû ïðåïàðàòà âîññòàíîâèòñÿ è äåéñòâèå ñèìï/ïàðàñèìï ñèë íà ìûøöó è âñ¸ âåðí¸òñÿ íà íà÷àëüíûé óðîâåíü. Íèêàêîãî ñïàçìà â ïðÿìîì ïîíèìàíèè ýòîãî ñëîâà òàì íåò. Åñëè ñòàëè ïîÿâëÿòüñÿ "ìèíóñû", êàê íè êðóòè - ýòî ìèîïèÿ! Òàê ÷òî âñÿêèå èðèôðèíû, öèêëîìåäû è ò.ï. - ýòî íå ëå÷åíèå, à ïóñêàíèå ïûëè â ãëàçà. |
#2
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Öèòàòà:
Ïðî âòîðîé àáçàö... îõ ïðîãðåññèâíûå äåòñêèå îêóëèñòû íà âàñ áû íàâåðíîå íàêèíóëèñü...) Ìèîïèÿ, êîòîðàÿ íà ñàìîì äåëå ãèïåðìåòðîïèÿ - êëàññèêà, ïðè êîòîðîé öèêëîïëåãèÿ êðèòè÷íà, è íàçíà÷àþòñÿ îòíþäü íå ìèíóñîâûå î÷êè. p.s. ìèìåòèêè è öèêëîïëåãèÿ? íå îäîáðÿþ. îñêîìèíà æå æ. |
#3
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#4
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Öèòàòà:
 äèàãíîç ñïàçì àêêîìîäàöèè òîæå íå âåðþÈ èì íå ïîëüçóþñü. Âåðíåå âåðþ, íî òàêîé äèàãíîç îïèñûâàåòñÿ â ëèòåðàòóðå êàê ðåäêîñòü ïðè òÿæåëûõ íåâðîëîãè÷åñêèõ ñîñòîÿíèÿõ. ×èòàë, êàæåòñÿ Ñåðåãåé Íèêîëàåâè÷, ïðèâîäèë ññûëêè íà ñèòóàöèè ñ ÐÑ è ïðî÷èõ íåõîðîøèõ øòóêàõ. Äóìàþ ñïàçì àêêîìîäàöèè - äèàãíîç ïðèçðàê, îïÿòü æå âûñòàâëÿåòñÿ êàê ÏÝÏ è Â×Ä áîëüøèíñòâó äåòåé ñî ñëàáîé ìèîïèåé â îñíîâíîì â ñòðàíàõ ÑÍÃ. Âûñòàâëåíèå äèàãíîçà ñïàçìà àêêîìîäàöèè îñíîâûâàåòñÿ íà òîì, ÷òî öèêëîïëåãè÷åñêóþ ðåôðàêöèþ íåêîòîðûå îêóëèñòû âîñïðèíèìàþò , êàê èñòèííóþ. Îäíàêî, ïîëíûé ïàðàëè÷ àêêîìîäàöèè íå åñòåñòâåííîå ñîñòîÿíèå ýòî ñîñòîÿíèå ïîëíîãî ïàðàëè÷à. Òàê íà êàêîì îñíîâàíèè åå áðàòü çà èñòèííóþ? È ïî÷åìó ìû äîëæíû, åñëè âèäèì ðàçíèöó â ðåôðàêöèè íàçûâàòü ýòî ñïàçìîì? Ýòî âñåðàâíî, ÷òî íàçûâàòü ñïàçìîì ïîëíûé ïàðàëè÷ êèøå÷íèêà èëè æåë÷íîãî ïóçûðÿ, à åñòåñòâåííûì ñîñòîÿíèåì íàçûâàòü åãî ïàðàëè÷...  îáùåì ñîãëàñåí ñ äîêòîðîì Àinakoz. Åñëè "äåòñêèå îêóëèñòû" âñå æå íàêèíóòñÿ, òî ÿ ñîãëàñåí çàðàíåå ñî âñåìè èõ ñëîâàìè è ïðèçíàþ ñåáÿ ïîëíîñòüþ ïîðàæåííûì è óõîæó â êóñòû. Ñïîðèòü íå îõîòà Íî äèàãíîçà "ñïàçìà àêêîìîäàöèè" â òîì ïîíèìàíèè â êîòîðîì îí åñòü ñåé÷àñ â íàøåé ñòðàíå- íåò. |
#5
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Öèòàòà:
Ìîæíî ñîñëàòüñÿ íà òîðîïëèâîñòü ìåäñåñòðû ïðè îïðåäåëåíèè îñòðîòû çðåíèÿ è ðåôðàêöèè ñóáúåêòèâíûì ìåòîäîì, íà òî, ÷òî íå íàéäåí îáùèé ÿçûê ñ äèò¸íêîì - ò.å. ñëó÷àéíîñòü. Íî, îïÿòü æå, êàê ÿ ïîíÿë, íå ó îäíîãî ìåíÿ òàêèå ÷óäåñà áûâàþò. È êàê ýòî íàçâàòü. È íóæíî ëè íàçûâàòü, ïóñêàé áåç èìåíè îñòà¸òñÿ; ãëàâíîå çíàòü îñíîâíîå, ÷òî íå öèêëîïëåãèðîâàâøè - î÷êè íå âûïèñûâàé? Åäèíàæäû õîðîøåíüêî öèêëîïëåãèðîâàííûé (ïàðó ðàç â òå÷åíèå ïðè¸ìà çàêàïàíûé) ãèïåðìåòðîï +2.0 íè çà ÷òî íå ïîñìååò ïðèäòè ÷åðåç ïàðó íåäåëü ðåôðàêöèîííî ìèîïîì? À åñëè èñõîäíî ïðèø¸ë ìèîïîì - 4.0, öèêëîïåíòîëàò äâàæäû, ÷åðåç ÷àñ ñêèàñêîïè÷åñêè è ñóáúåêòèâíûì ìåòîäîì -2,0, à ÷åðåç íåäåëüêó áåç öèêëîïëåãèè -3,0, òî êàê íàçâàòü ðàçíèöó ìåæäó -3.0 è -2.0, - ïðåäëàãàþ òîëüêî ýòî ñ÷èòàòü ïðèâû÷íûì òîíóñîì àêêîìîäàöèè è âûïèñûâàòü î÷êè, îòòàëêèâàÿñü èñõîäíî îò ìàêñèìàëüíîé öèôðó -3,0, à íå íà -4.0 (äî öèêëîïëåãèè) è -2.0 (ïîä öèêëîïëåãèåé). |
#6
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Öèòàòà:
Êðîìå òîãî, ñêàæó ÷òî ó ìèîïîâ âîîáùå "ñïàçì àêêîìîäàöèè" íåâîçìîæåí, òàê êàê ýòà ñàìàÿ àêêîìîäàöèÿ îñëàáëÿåòñÿ ñî âðåìåíåì, çà íåíàäîáíîñòüþ. (ìûøöà ïî÷òè íå ðàáîòàåò òàê êàê ãëàç è òàê "íàñòðîåí íà áëèçü", ñîîòâåòñòâåííî ïðîèñõîäÿò ïðîöåññû å¸ àòðîôèè) õîòèòå ïîäòâåðæäåíèÿ - ïðîâåðüòå ðåçåðâû àêêîìîäàöèè ó ìîëîäîãî ýììåòðîïà è, ê ïðèìåðó, ìèîïà ñðåäíåé ñòåïåíè. |
#7
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Ñêàæèòå, âû äóìàåòå ÷òî ñïàçì àêêîìîäàöèè íå ìîæåò áûòü ñòàðòîâûì òîë÷êîì ê ðàçâèòèþ ìèîïèè? Èëè ó ìèîïîâ ýòà "íàñòðîéêà íà áëèçü" ïðèñóòñòâóåò ñ ðîæäåíèÿ?
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#8
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Äóìàþ, ÷òî èìååòñÿ â âèäó, ÷òî àêêîìîäàöèÿ íå ðàáîòàåò, ò.ê.îíà íå íóæíà ïðè ìèîïèè íà ðàçíûå ðàññòîÿíèÿ ïðè ðàçíîé ðåôðàêöèè, òóò âñå ïîíÿòíî
ìíå íå ïîíÿòíî ñëîâî "àòðîôèÿ", åñòü ëè êàêèå òî äàííûå, ÷òî öèëèàðíàÿ ìûøöà ìåíÿåòñÿ ìîðôîëîãè÷åñêè? Ò.å äîëæíû áûòü ïðîáëåìû ó îïåðèðîâàííûõ ïàöèåíòîâ â îòäàëåííûå ñðîêè? |
#9
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Íó òåîðåòè÷åñêè äîëæíà àòðîôèðîâàòüñÿ. Íå çíàþ åñòü ëè ìîðôîëîãè÷åñêèå èññëåäîâàíèÿ, íî ðåçåðâû àêêîìîäàöèè ó ìèîïîâ ñíèæåíû, òî åñòü ìûøöà îñëàáëåíà, îñîáåííî ó òåõ, êòî íå ïîëüçóåòñÿ ïîñòîÿííî î÷êàìè èëè ÌÊË.
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#10
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Íî, ýòî ãëàäêàÿ ìóñêóëàòóðà. Ãëàäêàÿ, âðîäå íèêîãäà íå àòðîôèðóåòñÿ Åñòü ëè ïðîáëåìû ó ëþäåé, êîòîðûé íå êîððåãèðîâàëèñü èëè íå êîððåãèðîâàëèñü ïîëíîñòüþ, à ïîòîì â 25 ëåò ñäåëàëè ëàçåðíóþ îïåðàöèþ?
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#11
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Äèñêóññèÿ î ñïàçìå àêêîìîäàöèè
Íó íàñ÷¸ò ëàçåðíîé íå çíàþ, äà âîò íåäàâíèé ïðèìåð: ïàöèåíòêå ïîäîáðàë ëèíçû (27 ëåò), äî ýòîãî íîñèëà òîëüêî î÷êè íà -3.5 ïðè ìèîïèè â 5.5. Ëèíçû -5, âäàëü 1.0, êîìôîðòíî, ÷èòàòü íå ìîæåò.
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#12
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#13
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À âîò òàêàÿ èíôîðìàöèÿ. Êèòàéñêèå íîâîðîæä¸ííûå, â ñðåäíåì +0.58 Ä íà âõîäå (äî öèêëîïëåãèè) è +3.55 íà âûõîäå (ïîä öèêëîïëåãèåé). 3.0 äèîïòðèè ÷åãî?, ò.å. êàê íàçâàòü. Ñïàçì àêêîìîäàöèè?  ñòàòüå íàçâàíî òîíè÷åñêîé àêêîìîäàöèåé.
À ïî÷åìó è çà÷åì? Invest Ophthalmol Vis Sci. 2011 Apr 14;52(5):2456-61. Print 2011 Apr. Cycloplegic and noncycloplegic refractions of Chinese neonatal infants. Chen J, Xie A, Hou L, Su Y, Lu F, Thorn F. Source School of Optometry and Ophthalmology, Wenzhou Medical College, Wenzhou, China. Abstract PURPOSE: To examine Chinese neonatal infants with both cycloplegic and noncycloplegic retinoscopy and to compare the distribution of refractive errors for the two techniques. METHODS: Cycloplegic retinoscopy was performed by two experienced pediatric ophthalmologists on 81 neonatal infants randomly selected from a group of 185 neonates who had undergone noncycloplegic retinoscopy. All infants were between 1 day and 6 days of age and were born without incident at full term. RESULTS: The mean cycloplegic spherical equivalent (CSE) was highly hyperopic (+3.55 diopters [D] ± 2.39 D). The mean noncycloplegic spherical equivalent (nCSE) was +0.58 D ± 2.32 D. The high reliability of the refractive measurements was demonstrated by high correlations between examiners (CSE: OD, r = 0.96; OS, r = 0.97; nCSE: OD, r = 0.94; OS, r = 0.93 OS) and between eyes (CSE: examiner 1, r = 0.94; examiner 2, r = 0.95; nCSE: examiner 1, r = 0.95; examiner 2, r = 0.97). The correlation between CSE and nCSE was much lower (examiner 1: OD, r = 0.76; OS, r = 0.73; examiner 2: OD, r = 0.72; OS, r = 0.70). Prevalence of astigmatism was very low (1.6% ≥ 1.0 D). CONCLUSIONS: The level of hyperopia was very high in these infants, and the offsetting tonic accommodation demonstrated by the difference between CSE and nCSE was much higher than in any previous report. Low amounts of infantile hyperopia and high astigmatism are associated with future myopia in the West. The Chinese neonates in this study had high amounts of hyperopia and little astigmatism, yet they are at high risk to become myopic. |
#14
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Íó âñ¸ ïðàâèëüíî. Ýòî è åñòü òîíóñ âåãåòàòèâíîé í.ñ. Ïðî ÷òî ÿ è ãîâîðþ. Íèêàêîãî ñïàçìà òàì íåò.
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#15
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îõ, óæ ýòà ëþáèìàÿ ìíîé ðåôðàêöèÿ.....
Ñïîðèòü íå áóäó, íî ãèïåðìåòðîïîâ+2-+3, óõîäÿùèõ â ìèíóñ - ïîëíî. Ïîçàêàïûâàþò - âèçóñ äî 1,0 áåç êîððåêöèè. À êàê èíòåðïðåòèðîâàòü òîãäà "çàïàñ àêêîìîäàöèè" ? |