特发性黄斑裂孔双眼视功能的临床检测

Binocular function in eyes with idiopathic macular holes

目的 :分析特发性黄斑裂孔患者的双眼视功能状况 ,探讨其相关影响因素。方法 :对本组 4 0例 (4 5只眼 )患者分别进行视力检测、屈光矫正、眼前节及眼底检查 ;并且采用Amsler表检查患者的中心 10°视野有无视物变形 ,用颜少明《立体视觉检查图》检查患眼的抑制性暗点 ;采用同视机三级画片检查患者的双眼同时视功能、融合功能和远距离立体视功能。 2 1例 (2 5只眼 )行SLO微视野检查。 9例进行经睫状收稿日期 :2 0 0 3 -11-0 5 ;修回日期 :2 0 0 4-0 2 -11作者简介 :夏群 ( 195 6-) ,女 ,浙江人 ,主任医师 ,研究方向 :屈光眼肌弱视。E -mail:tang @public .fhnet.canet体平坦部玻璃体切割并裂孔填充手术。检查结果用SPSS 1.0统计软件进行t检验、χ2 检验和相关分析。结果 :患眼矫正视力为 0 .2～ 1.0 (平均 0 .4 1) ,对侧健康眼的矫正视力为0 .3～ 1.5 (平均 0 .82 ) ,患眼的平均矫正视力下降与健眼比较 ,差异有显著性 (P <0 .0 0 1)。Amsler表检测显示 82 .2 %的患眼有视物变形和 (或 )中心暗点 ,《立体视觉检查图》和SLO的微视野检查显示分别有 71.0 5 %和 72 .0 %的患眼抑制性暗点呈阳性 ,裂孔分期愈高暗点阳性率愈高 (P <0 .0 1)。采用同视机检查 4 0例患者中 ,10例 (2 5 .0 % )双眼同时视功能丢失 。

Objective:To evaluate binocular function in eyes with idiopathic macular hole.Methods:40 cases(45 eyes) with a macular hole were identified by optical coherence tomography(OCT). The mean age of the patients was 64.4 years. According to the classification of gass,2 cases were in stage Ⅰ,13 cases were in stage Ⅱ,13 cases in stage Ⅲ and 10 cases were in stage Ⅳ. 21 cases(25 eyes) underwent microperimetry(MP) examination using a scanning laser ophthalmoscope(SLO). 9 cases underwent a standard three-port vitrectomy,induction of a posterior hyaloid detachment,fluid-air exchange and intraocular gas tamponade[16% hexafluoroethane(C 2F 6) gas mixture]. All cases were given complete ocular examinations. Binocular function tests on fusion convergence and distant and near stereoscopic vision using a synoptophore were included in the exam.Results:The corrected visual acuity of 45 eyes ranged from 0.2 to 1.0(mean visual acuity 0.41). The corrected visual acuity in the affected eyes was significantly lower than that of the fellow eyes. 37 eyes(80.4%) had metamorphosis and/or central scotoma by Amsler Grid. Inhabitation scotoma on the stereoacuity chart and microperimetry were found in 33 eyes(71.7%) and 18 eyes(72%),respectively. 20 eyes(50%) did not have fusion convergence and 22 eyes(55%) had distance stereoscope vision >800″. Binocular function was related to the stage and diameter of the macular hole(P<0.05). Of the 9 eyes that underwent vitrectomy and intraocular gas tamponade,the macular holes healed in 8 eyes and 1 eye improved from stage Ⅳ to stage Ⅱ. Visual acuity improved in 4 eyes(1～2 lines),remained the same in 3 eyes,and worsened in 1 eye. Binocular function improved in 2 patients.Conclusion:Macular holes damage binocular function. Binocular function loss is related to the stage of the macular hole,the central inhibiting scotoma and the amount of time since onset. Patients with macular hole should be operated upon as early as possible,resulting in better binocular function and better recovery in stereoacuity.[