间歇性外斜视手术前后双眼视觉的临床研究

Clinical study on binocular vision in intermittent exotropia before and after surgery

目的探讨间歇性外斜视患者手术前后双眼视觉的变化规律，为选择合理的手术时机提供依据。方法171例间歇性外斜视患者按照手术年龄分为两组，〈9岁者为组1，≥9岁者为组2。检查手术前后的远、近双眼视觉并进行分析比较。结果手术后正常近双眼视觉的重建率：组1为40．0％，组2为63．8％（P=0．002）；而同样是4岁前发病，术后组1的重建率为53．1％、组2为23．8％（P=0．032）。手术后同视机远双眼视觉的重建率组1Ⅰ级98．2％、组2Ⅰ级81．9％（P=0．027），组1Ⅱ级96．4％、组2Ⅱ级84．5％（P=0．024）组1Ⅲ级81．8％、组2Ⅲ级73．3％（P=0．844）；经Logistic相关性检验，表明手术预后与术前的近双眼视觉及发病年龄有相关性（P〈0．01）。结论手术治疗对两组远、近双眼视觉的重建均非常有效。发病年龄对术后双眼视觉的形成和恢复有一定的影响，因此对发病年龄早于4岁的患儿，应及早手术。对4岁后L越过视觉发育敏感期发病的间歇性外斜视患者，也应尽量在9岁以内手术，以提高正常远双眼视觉的重建。（中华眼科杂志，2007，43：968-971）

Objective To give a suggestion of the timing of surgery, the change of binocular vision before and after strabismus surgery was studied in intermittent exotropia. Methods One hundred and seventy-one patients, with intermittent exotropia, were divided into 2 groups, based on the age of surgery, Groupl ： younger than 9 years of age. Group2 ： 9 and older. Binocular vision of both distance and near was checked before and after surgery. Results The rebuilding rate of near binocular vision after surgery was： 40.0% for Groupl, 63. 8% for Group 2 （P =0.002） ,with same onset age （ 〈4 years） , the regain rate of Groupl was 53. 1%, Group 2 was23.8% （ P =0. 032）. The distance postoperative binocular vision, using Synoptophore, were： grade Ⅰ ： Groupl 98.2% , Group2 81.9% （ P =0. 027） ,grade Ⅱ ： Groupl 96.4% , Group2 84.5 % （ P = 0. 024） , grade Ⅲ： Groupl 81.8% , Group2 73.3% （ P = 0. 844 ）. With logistic test, the recovery of binocular vision postoperatively is correlated with preoperative near binocular vision as well as the age of onset （ P 〈 0.01 for both ）. Conclusions The surgery will substantially help to rebuild the binocular vision of both distance and near . The age of onset has significant impact on both the forming and the rebuilding of binocular vision. Operation should not be delayed if onset is younger than 4 years old. Even if the age of onset is older than 4, which is past the critical period of vision development, operative correction no later than 9 is still highly suggested, which may help to rebuild a normal distance binocular vision. （Chin J Ophthalmol , 2007,43：968-971 ）