不同年龄组的间歇性外斜视术后双眼视觉恢复

Binocular vision restoration in different age group patients with intermittent exotropia

目的:探讨间歇性外斜视患者手术前后双眼视功能的临床早期变化规律,对选择合理的手术时机和双眼视功能预后做出合理的判断提供帮助。方法:选择在斜视矫正术后获得眼正位90例间歇性外斜视患者作为研究对象,双眼裸眼视力或矫正视力均≥0.9,无明显屈光参差者。按接受手术年龄分为三组:A(3～5岁),B(6～8岁),C(≥9岁)3组,每组30例。三组平均发病年龄分别为3.20±1.20,3.80±1.50和4.08±1.78岁;病程分别为2.15±1.45,3.42±2.42和6.80±5.10a;斜视度分别为30.50±5.50,47.50±12.56和63.25±13.80。采用三棱镜加遮盖法检查6m及33cm的远近斜视度,以三棱镜度记录;颜少明《立体视觉检查图》检查近立体视;同视机检查远立体视。术后2,4,6wk随访。结果:三组术前平均发病年龄的差异无显著性意义(P>0.05),病程、斜视度数的差异有显著性意义(P<0.01)。术后观察6wk,双眼视觉功能与术前比较,差异均有显著意义(P<0.01)。结论:间歇性外斜视患者的发病年龄、手术年龄、病程与术后双眼视觉的恢复、重建及功能治愈有密切关系,发病年龄越早,病程越长,对双眼视觉损害就越大,术后恢复越差,双眼视觉的恢复和重建及功能治愈所需时间长。视觉发育成熟后(≥9岁)行斜视手术,术后双眼视觉恢复慢,所需时间长。

AIM： To probe the clinical rules of binocular vision in patients with intermittent exotropia before and after the strabismus surgery in initial stage, to determine the optimal time of surgery ,and to explore the factors which can influence postoperative sensation. METHODS： Ninety intermittent exotropia patients were involved in the study with best distance corrected acuity ≥0.9 and no obvious anisometropia. Ninety cases were evenly divided into 3 groups： age 3-5, age 6-8, and age over 9. We make a comparison based on the three groups＇ data. The patients were performed operations by prismcovering approach, and examined the distance and near degrees of exotropia. Stereogram and synoptophore were tested and analyzed before and after surgery. The postoperative follow-up time was 2 weeks,4 weeks, and 6 weeks after surgery. RESULTS： The difference was statistically significant in the average surgery age and exodeviation （P〈 0.01 ）,and not statistically significant in the average onset age （ P 〉 0. 05）. The 3 near stereoacuity groups all had significant differences after 6 weeks post-surgery observation compared with the preceding surgery. CONCLUSION： From the perspective of recovery and rebuilding of the binocular vision and the functional cure, it has close relation with the patient＇s age of onset, the surgery age and the course of the disease. The younger the patient＇s age of onset and the longer the course of the disease is,the more harm to the binocular vision. What＇s more, the time for the recovery and rebuilding of the binocular vision and functional cure is also longer. The time for binocular vision recovery is longer, if we perform the strabismus surgery after vision becomes mature （after 9 years old） .