[摘要] 现代三维图形影像显示技术可以为双眼视觉功能检查和训练提供现实模拟度更高的载体ꎻ为医 学培训提供沉浸式手术情境模拟ꎬ帮助医学生尽快掌握手术技巧ꎻ提供更生动准确的三维人体生理和病理影 像ꎬ使医生更易于判断病变的层次、形状和血管等复杂结构的解剖关系ꎬ进一步提高医学诊断的效率ꎮ 在微创 手术中ꎬ三维图形影像显示技术不仅让术者更易判断术区各组织及其与手术器械间的位置关系和距离ꎬ还能 通过叠加相同区域的术前检查影像提供手术导航ꎬ实现精准微创手术ꎮ 尽管显示模式转换带来的不适应、三 维重建图像部分信息损失以及使用者视觉疲劳等仍是需要克服的问题ꎬ三维图形影像显示技术在医学领域 仍然拥有广阔的发展空间ꎬ是推动医学进步的新能源新动力ꎮ 作者对国内外三维图形影像显示技术在医学领 域的研究和应用作一综述ꎮ [关键词] 三维显示ꎻ医学诊断ꎻ医学培训ꎻ微创手术 [中图分类号] TP391􀆰 4ꎻR-05 [文献标志码] A [文章编号] 2095 ̄3097(2019)05 ̄0314 ̄04 doi: 10􀆰 3969 / j􀆰 issn􀆰 2095 ̄3097􀆰 2019􀆰 05􀆰 015

Objective:To evaluate the efficacy of the multimedia visual perceptual learning system for improving visual acuity in pediatric patients with amblyopia and to discuss factors influencing the therapeutic effects of perceptual learning.Methods:This was a prospective randomized controlled study Amblyopic children aged from 3 to 11 years (n=112) were recruited from the ophthalmology clinic.Participants were randomly assigned to the experimental group that utilized the multimedia visual perceptual learning system or a control group utilizing the synoptophore.All subjects underwent perceptual learning and patching or refractive correction,depending upon the individual situation.After the baseline visit,follow-up visits were held after 10,20,and 30 treatments.Finally,the clinical efficacy and improvement of visual acuity in the two groups were analyzed and compared,using chi-square test,independent-samples t test,Pearson correlation test.Results:The curative effect of the experimental group was better than the control group at different training periods (Z=-4.128,-4.806,-3.063,P＜0.O0 1).The change in visual acuity in the experimental group was significantly higher at the 10th and 20th training sessions (t=3.471,3.290,P＜0.05).In the moderate and severe amblyopia groups,the curative effect of the experimental group was better than the control group (Z=-3.050,P=0.021),and was the same as in the anisometropic amblyopia group (Z=-2.864,P=0.004) and 7-11 year-old group (Z=-2.631,P=0.009).There was a moderate correlation at baseline and an improvement in visual acuity in both groups (r=0.690,0.650,P＜0.05).Conclusions:The multimedia visual perceptual learning system can achieve an optimal effect in a short period of time.The improvement in vision relates to the sex of the patient,and the degree and type of amblyopia,which are clinically significant to amblyopia therapy.

1皮亚杰简介皮亚杰(Jean Piaget,1896-1980)，亦译皮阿热，瑞士心理学家，发生认识论创始人。以其对儿童智力规律的创造性研究闻名于世，被誉为心理学史上的一位“巨人”。其提出的认知发展理论不仅是日内瓦学派的理论基础，也是欧洲机能主义的重大发展。[1]开辟了心理学研究的一个新途径，对西方现代心理学的发展和改革具有重要影响。

AIM:To evaluate the effect of digital multimedia visual training in stereoacuity rebuilding of the postoperative intermittent exotropia.METHODS:Eighty-three patients with intermittent exotropia were randomly divided into 2 groups including treatment group and control group.In the treatment group,41 patients were trained with digital multimedia system including antisuppression and fusion function training.In the control group,42 patients received no any training.The differences of binocular visual and fusion range and final deviation were compared between the two groups before and after treatment.RESULTS:When compared with control group,the stereoscopic vision had significantly rebuilded(P<0.05),the fusion function was greatly enhanced(P<0.05),treatment group got better efficacy in final deviation(P<0.05).CONCLUSION:The digital multimedia visual training can promote binocular function and increase the final orthotropia ratio.The new treatment provides a new feasible way for intermittent exotropia clinical therapy.

各类斜视发病率在正常人群中大约为1%,飞行员中发病率更低,占飞行员住院疾病谱及停飞疾病谱极小比例,其治疗也具有特殊性。现将我科收治的病例总结报告如下。一、对象与方法1.对象:2004—2010年收治的海军航空兵飞行员斜视患者共10例,均为男性,年龄25～50岁。包括歼击机飞行员5名,运输机飞行员4名,直升机飞行员1名。其中间歇性外斜3例,斜视度均<30~△;外隐斜超标5例;上斜肌麻痹

AIM:To evaluate digital multimedia visual training as treatment for amblyopia in children.METHODS:Seventy-six juvenile patients(117 eyes) with amblyopia were chosen and treated with digital multimedia visual training and classic combined therapy.Each amblyopia type were used in this study for two groups,experinmental and control.The therapeutic effect and treatment time of two groups were compared and the binocular function was observed.RESULTS:When compared with control group,the treatment time was significantly shorter(P<0.05),and it would took much longer for the correct visual acuity increasing 1 LogMAR line in control group,while experimental group got better efficacy in binocular vision(P<0.05).CONCLUSION:The multimedia visual training can promote binocular function and shorten the treatment cycle of vision dysfunction.The new treatment can achieve the best treatment effectiveness in a short time and provide a new feasible way for amblyopia clinical therapy.

0 引言 急性共同性内斜视(acute concomitant esotmpia,ACE)是一种特殊类型的斜视,在临床中并不少见,但由先天性小脑扁桃体下疝综合征(Chiari畸形)所致,国内尚未报道,现遇见一例,报告如下.

Objective To develop a new instrument for measuring the degree of compensatory head posture. Methods According to the mechanism and 3D characteristic of the compensatory head posture,a square body with aprotractor on its left,right and anterior face respectively and acompass with graduation(0°-360°)on its superior sur- face,every protractor with a miniature bearing needle installed in its center with a measure range of 0°-90°is de- signed and manufactured with organic glass through the computer carve technology,The instrument canmeasure the precise degree of the compensatory head posture in horizontal,vertical and rotary direction at one time when it is fixed on the head,by the action of gravity and the compass needle directional invariance.Conclusions The com- pensatory head posture measuring instrument is extremely useful for the diagnosis,operation design and evaluation of therapeutic effect and is worthy of clinical application.

Objective To determine effects of induced anisometropia on stereopsis to assess the potentially detrimental effects of uncorrected anisometropia on stereoacuity in sailers.Methods Twenty-five healthy adult volunteers,who were 22-34 years old(mean:27 years old)and free of ocular diseases,participated in the study.The different lenses ranging from 1-3 D were planced in front of right eyes of subjects,which leaded to 4 different types of anisometropia(simple hypometropia,simple hypermetropia.Stereoacuity was measured by YAN Shao-ming Digital Stereoscopic Test Charts.Results The levels of stereoacuity decreased in all subjects as the degree of anisometropia increased.One diopter of spherical anisometropia had subjects'stereoaeuity reduced to 50″-54″ and that of cylindrical anisometropia had subjects'stereoacuity reduced to 50″-52″.Regardless of type,three diopters of anisometropia had all suhjeets'stereoacuity reduced significantly.Conclusions Low levels of anisometropia can have potentially significant adverse effect on highgrade binocular vision function in adults.Foveal suppression,which is directly related to the degree of anisometmpia,may be responsible for the reduction of stereopsis.

1 临床资料 患儿,男,1岁半,因双眼视力不佳、偏斜1年于2005年7月18日初诊.患儿足月顺产,无产后吸氧史.出生6个月时父母发现其视力不佳,双眼经常同时向右侧偏斜.

Objective To evaluate the reliability and concordance between the standardized logMAR visual acuity chart and C logarithm visual acuity chart.Methods Test and retest measurements using two versions of each chart design were obtained on the right eye of 48 high school students.Using the methods of Bland-Altman the agreement and test-retest reliability(95% confidence limits for agreement,TRV) were compared.Results For the standardized logMAR visual acuity chart,test-retest reliability was high(83.3% and 98% of retests within 0.1 LogMAR and 0.2 LogMAR of initial tests,respectively) and comparable to that of C logarithm visual acuity chart testing(87.5% and 100% of retests within 0.1 LogMAR and 0.2 LogMAR of initial tests,respectively).Based on estimates of 95% confidence intervals,a change in visual acuity of 0.15 LogMAR from baseline level is unlikely to be related to measurement variability using either of the two visual acuity testing protocol.Conclusion The standardized logMAR visual acuity chart has high test-retest reliability and good concordance with the C logarithm visual acuity chart,and can be used in choosing pilots,students and other personnel for special work.

患者男性,47岁.因复视6个月,于2003年10月7日来我院就诊.患者于6个月前车祸时额部猛烈撞击汽车前挡风玻璃致伤,伤后昏迷2个月,持续性脑脊液鼻漏2.5个月.

目的:观察准分子激光手术矫正屈光参差后,成年人的立体视觉的重建情况.方法:前瞻性非随机临床观察20例屈光参差患者.术前检查远、近立体视为零;屈光参差4.00～7.75D.准分子激光角膜屈光手术消除屈光参差后,定期随访检查立体视恢复情况.结果:术后随访6mo,90%患者术后屈光参差小于1.00D.75%患者远视力达术前最佳矫正视力.55%患者恢复立体视.结论:准分子激光治疗屈光参差后,部分成年患者能重新建立双眼视觉及立体视功能.

病例患儿男,5岁10个月.自出生后7个月时家长发现患儿双眼视力障碍、不能追随物体移动,畏光,经常用手指压眼球(图1),于2003年11月来我院就诊.患儿系第二胎,足月顺产,无外伤、手术史.意识清楚,发育和智力正常.父母非近亲结婚,家族无遗传病史及同样病史.

1临床资料 患者,男,47岁,因车祸6个月后复视,于2003年10月来我院就诊.患者于6个月前因车祸时额部猛烈撞击汽车前挡风玻璃致伤,伤后昏迷2个月,持续性脑脊液鼻漏2.5个月.

目的:研究白内障超声乳化人工晶体植入术后患者的立体视觉功能情况.方法:采用激光全息立体视觉检查图对80例白内障超声乳化并人工晶体植入术后患者进行了立体视觉锐度的测定.结果:在80例患者中,有近立体视觉者67例(83.7%),无近立体视觉者13例(16.3%).有远立体视觉者71例(88.8%),无远立体视觉者9例(11.2%).结论:立体视觉功能是评价白内障摘除并人工晶体植入术手术疗效的一项重要指标.

一、临床资料 患者男性,37岁,海军航空兵安-26运输机飞行员.5年前患者无明显诱因发生双眼视物时重影一上一下,各个方向皆有,尤以向下方注视时重影更大,精神集中时重影可消失.否认外伤史,无发热病史,无家族遗传史.曾住院使用激素、抗生素、血管扩张剂、高压氧、视功能矫正训练等各种治疗,均未见效.近一年来症状加重.

Objective:To study cyclofusion function in normal subjects.Methods:62 cases were binocularly tested for cyclofusion range and recovery point using a random dot stereogram synoptophore(RDSS).Results:①The average range of ex cyclofusion was(11.79±3.40)°～(8.23±1.91)° and in cyclofusion was(9.38±3.40)°～(6.48±2.72)° from RDSS 800″～60″.②The ex cylclofusion recovery point was(5.77±1.89)°～(3.67±1.17)°. The in cylclofusion recovery point was(3.69±1.21)°～(2.35±1.40)°.Conclusion:①The higher the stereoacuity,the broader the cyclofusion range.②Cyclofusion function may be determined by using RDSS in the clinic.

激光全息随机点立体视觉检查仪是在颜氏随机点立体视觉检查图[1]的基础上,由解放军军事医学科学院和海军总医院根据双眼视差原理设计,应用现代激光全息技术在国内率先研制而成的.为了测试和检验全息立体视力表是否可以直接行裸眼立体视敏度检测,其实用性和客观性如何,并进一步规范立体视敏度检测标准,我们应用激光全息立体视觉检查图对367名双眼视力在1.0以上的本科飞行学员进行了测试分析.