不同视感知觉和眼球运动控制能力的间歇性外斜视患者临床特征比较

Comparison of clinical characteristics in intermittent exotropia patients with different visual perception and oculomotor control

目的探讨不同视感知觉和眼球运动控制能力的间歇性外斜视(IXT)患者临床特征的差异。方法横断面研究。选取2021年3月至2023年5月就诊于北京同仁医院的未成年IXT患者,收集人口学特征并完成视感知觉功能和眼球运动控制力评估。根据检查结果将患者分为同时视存在和消失组、融合视存在和消失组、远立体视正常和消失组、近立体视正常和损伤组。不符合正态分布的计量资料采用M(Q_(1),Q_(3))描述,比较组间修正纽卡斯尔控制评分(RNCS)、看近斜视度、看远斜视度及病程、发病年龄的差异,并分析视感知觉与眼球运动控制能力的相关性以及病程、发病年龄分别与视感知觉、眼球运动控制能力的相关性。结果共纳入381例IXT患者,男189例,女192例,年龄7(6,9)岁。视感知觉正常患者占19.4%(74/381)。与同时视、融合视存在组以及远/近立体视正常组相比,同时视、融合视、远立体视消失组和近立体视损伤组RNCS评分[7(5,9)分比4(3,6)分,6(5,8)分比4(3,6)分,5(4,7)分比3(3,5)分,5(3,6)分比4(3,6)分]、看近斜视度[65^(Δ)(60^(Δ),80^(Δ))比40^(Δ)(30^(Δ),50^(Δ)),60^(Δ)(45^(Δ),65^(Δ))比40^(Δ)(30^(Δ),50^(Δ)),50^(Δ)(40^(Δ),60^(Δ))比35^(Δ)(30^(Δ),45^(Δ)),45^(Δ)(30^(Δ),60^(Δ))比40^(Δ)(30^(Δ),50^(Δ))]、看远斜视度[60^(Δ)(50^(Δ),75^(Δ))比35^(Δ)(25^(Δ),50^(Δ)),55^(Δ)(41^(Δ),65^(Δ))比35^(Δ)(25^(Δ),45^(Δ)),45^(Δ)(30^(Δ),60^(Δ))比35^(Δ)(25^(Δ),45^(Δ)),40^(Δ)(30^(Δ),60^(Δ))比35^(Δ)(25^(Δ),45^(Δ))]均较高(均P<0.05)。与同时视、融合视存在组以及远立体视正常组相比,同时视、融合视和远立体视消失组病程较长[3(1,5)年比2(1,3)年,2(1,4)年比1(1,3)年,2(1,4)年比1(1,3)年,均P<0.05]。与远立体视正常组相比,远立体视消失组发病年龄较小[5(3,7)岁比6(4,8)岁,P=0.005]。Pearson相关性分析结果显示,主观斜视角、随机点立体图(RDS)立体视锐度分别与RNCS、看近和看远斜视度均呈正相关(r=0.414、0.516、0.559,均P<0.001;r=0.153、0.142和0.173,均P<0.05);主观斜视角、RNCS、看近和看远斜视度均与病程呈正相关(r=0.238、0.195、0.236、0.239,均P<0.001),与发病年龄呈负相关(r=-0.184、-0.279、-0.112和-0.147,均P<0.05)。结论间歇性外斜视近20%患者视感知觉功能正常,病程越长,发病年龄越小,眼球运动控制能力损伤越严重,视感知觉功能异常也越严重。

Objective To explore the clinical characteristics of intermittent exotropia(IXT)patients with different visual perception and oculomotor control.Methods A cross-sectional study was conducted.Minor IXT patients between March 2021 and May 2023 at Beijing Tongren Hospital were enrolled.Demographic characteristics were recorded,and visual perception and oculomotor control were evaluated.The patients were divided into simultaneous vision disappearing and existing groups,fusion disappearing and existing groups,distant stereoscopic vision disappearing and normal groups,and near stereoscopic vision injury and normal groups.Statistical description was performed by using M(Q_(1),Q_(3)).Rank sum test was used to compare the Revised Newcastle Control Score(RNCS),near and far strabismus degree,duration of disease,and age of onset among different groups.The correlation between visual perception and oculomotor control and the correlation of duration of disease and age of onset with visual perception and oculomotor control were analyzed by Pearson correlation analysis.Results A total of 381 patients were enrolled,including 189 males and 192 females,with a median age of 7(6,9)years.The incidence of normal visual perception was 19.4%(74/381).Compared with simultaneous vision and fusion existing groups and distant and near stereoscopic vision normal groups,the RNCS[7(5,9)vs 4(3,6),6(5,8)vs 4(3,6),5(4,7)vs 3(3,5),and 5(3,6)vs 4(3,6)],near strabismus degree[65^(Δ)(60^(Δ),80^(Δ))vs 40^(Δ)(30^(Δ),50^(Δ)),60^(Δ)(45^(Δ),65^(Δ))vs 40^(Δ)(30^(Δ),50^(Δ)),50^(Δ)(40^(Δ),60^(Δ))vs 35^(Δ)(30^(Δ),45^(Δ)),and 45^(Δ)(30^(Δ),60^(Δ))vs 40^(Δ)(30^(Δ),50^(Δ))]and far strabismus degree[60^(Δ)(50^(Δ),75^(Δ))vs 35^(Δ)(25^(Δ),50^(Δ)),55^(Δ)(41^(Δ),65^(Δ))vs 35^(Δ)(25^(Δ),45^(Δ)),45^(Δ)(30^(Δ),60^(Δ))vs 35^(Δ)(25^(Δ),45^(Δ)),and 40^(Δ)(30^(Δ),60^(Δ))vs 35^(Δ)(25^(Δ),45^(Δ))]increased significantly in disappearing simultaneous vision,fusion,and distant stereoscopic vision groups and injury near stereoscopic vision group(all P<0.05).Compared with simultaneous vision and fusion existing groups and distant stereoscopic vision normal group,duration of disease was significant longer in disappearing simultaneous vision,fusion,and distant stereoscopic vision groups[3(1,5)years vs 2(1,3)years,2(1,4)years vs 1(1,3)years,2(1,4)years vs 1(1,3)years,all P<0.05].The age of onset in disappearing distant stereoscopic vision group was significantly lower than normal distant stereoscopic vision group[5(3,7)years vs 6(4,8)years,P=0.005].Pearson correlation analysis showed that subjective angle and random dot stereogram(RDS)stereoacuity were positive correlation with RNCS,and the near and far strabismus degree(r=0.414,0.516,and 0.559,all P<0.001;r=0.153,0.142,and 0.173,all P<0.05).Subjective angle,RNCS,and the near and far strabismus degree were positive correlation with duration of disease(r=0.238,0.195,0.236,0.239,all P<0.001)and negative correlation with age of onset(r=-0.184,-0.279,-0.112,-0.147,all P<0.05).Conclusions Nearly 20%of IXT patients have normal visual perception.With the longer duration of disease or lower age of onset,the incidence of abnormal visual perception is higher and injury of visual perception and oculomotor control is more serious.