不同类型斜视患者术后双眼视觉重建的临床分析
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Analysis of binocular visual restoration in different types of strabismus
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    摘要:

    目的:探讨先天性上斜肌麻痹性斜视、共同性外斜视和共同性内斜视患者手术前后双眼视功能的恢复情况及临床早期变化规律。

    方法:选择年龄介于3~20岁斜视矫正术后的斜视患者106例作为研究对象,按斜视类型分为三组,三组平均发病年龄分别为:7.7±1.2,8.5±1.4,8.1±1.3岁; 病程分别为 6.75±1.20,3.42±2.42和 3.80±2.10a; 斜视度分别为 31.50±5.50,50.50±12.56和 52.25±13.80。采用三棱镜加交替遮盖法检查手术前后远近斜视度,《颜少明立体视觉检查图》检查近立体视觉,同视机检查远立体视觉及融合功能,分析3种类型斜视术后眼融合功能恢复率及立体视功能恢复率情况,术后随访8wk。

    结果:三组术前平均发病年龄差异无统计学意义(P>0.05),先天性麻痹性斜视组与共同性斜视组病程、斜视度数差异有统计学意义(P<0.05),共同性外斜视组与共同性内斜视组病程及斜视度数差异无统计学意义(P>0.05)。术后2,4,6,8wk随访先天性上斜肌麻痹性斜视组融合功能恢复率分别为12.5%,37.5%,62.5%,68.8%,立体视功能恢复率分别为0,18.8%,50.0%,56.3%; 共同性外斜视组融合功能恢复率分别为14.1%,40.8%,64.8%,69.0%,立体视功能恢复率分别为1.4%,31.0%,54.9%,59.2%; 共同性内斜视组融合功能恢复率分别为26.3%,47.4%,73.7%,78.9%,立体视功能恢复率分别为5.3%,47.4%,63.2%,68.4%; 术后2,4,6,8wk共同性外斜视组与共同性内斜视组术后眼正位率、立体视功能与融合功能恢复率差异均无统计学意义(P>0.05)。

    结论:先天性上斜肌麻痹性斜视患者斜视病程相对较长,术后近期立体视功能及融合功能恢复缓慢,且恢复率较低,于术后4wk开始明显提高,而共同性外斜视患者与共同性内斜视患者术后立体视功能及融合功能最早可于术后2wk恢复,且远期恢复率明显提高。

    Abstract:

    AIM:To investigate binocular visual function changes and the rules of clinical changes in early stage of patients with congenital paralytic strabismus, concomitant exotropia and concomitant esotropia before and after strabismus surgery.

    METHODS:Totally 106 cases of 3-20 years old strabismus patients were categorized into three groups, the average onset age of the three groups were respectively 7.7±1.2, 8.5±1.4,8.1±1.3, and the surgery age were 6.75±1.20 years, 3.42±2.42 years and 3.80±2.10 years, the grade of the strabismus were 31.50±5.50, 50.50±12.56 and 52.25±13.8. Cover test with prism was used to measure the deviation of strabismus, synoptophore was used to qualify three-degree visual function. The postoperative follow-up time was 4 weeks, 6 weeks, and 8 weeks after surgery.

    RESULTS:The difference was statistically significant in the average surgery age and grade of the strabismus between congenital paralytic strabismus group and concomitant strabismus groups(P <0.05), and not statistically significant in the average onset age(P>0.05). The convergence recovery rate of the congenital paralytic strabismus patients were respectively 12.5%, 37.5%, 62.5%, 68.8%, and the stereopsis recovery rate were respectively 0.0%, 18.8%, 50.0%, 56.3% after 2, 4, 6 and 8 weeks; the convergence recovery rate of the concomitant exotropia patients were respectively 14.1%, 40.8%, 64.8%, 69.0%, and the stereopsis recovery rate were respectively 1.4%, 31.0%, 54.9%, 59.2%; the convergence recovery rate of the concomitant esotropia patients were respectively 26.3%, 47.4%, 73.7%, 78.9%, and the stereopsis recovery rate were respectively 5.3%, 47.4%, 63.2%, 68.4%. There were no significant differences in orthophoria rate, convergence recovery rate and stereopsis recovery rate between the group of the concomitant exotropia and concomitant esotropia after 2, 4, 6 and 8 weeks(P>0.05; P>0.05).

    CONCLUSION: The restoration in convergence and stereopsis of congenital paralytic strabismus patients are lower in the early stage, the convergence recovery rate and the stereopsis recovery rate rise significantly. The binocular visual function of the concomitant exotropia patients and concomitant esotropia patients recover early after 2 weeks, and improve obviously in the later period.

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时肖,孔庆兰,张莹,等.不同类型斜视患者术后双眼视觉重建的临床分析.国际眼科杂志, 2013,13(1):193-195.

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  • 收稿日期:2012-10-26
  • 最后修改日期:2012-12-12
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