探讨遮盖法在弱视治疗中的意义

Investigation of occlusion therapy for the treatment of amblyopia

目的:观察遮盖法治疗弱视的效果,同时分析不同遮盖时间、年龄差异、发病原因及弱视程度的疗效特点从而探讨其在弱视治疗中的临床意义。方法:回顾性研究,自2005-06/2008-06就诊于我院斜弱视门诊患儿107例143眼,男(45例69眼),女(62例74眼)。平均年龄5.3岁,其中斜视性弱视26眼,屈光参差性弱视37眼,屈光不正性弱视80眼,轻度弱视43眼,中度弱视81眼,重度弱视19眼。根据治疗方法不同随机分组为完全遮盖组、4h遮盖组、单纯配镜矫正组。随访1a中观察并记录3组患儿最佳矫正视力,视力提高行数及弱视治愈率。结果:遮盖组视力平均提高2.4行,单纯戴镜组视力平均提高1.7行,遮盖组较对照组视力提高明显(P<0.05)。视力提高达0.8以上治愈率为遮盖组(11眼,11.5%),对照组(4眼,8.5%),遮盖组治愈率明显高于对照组(P<0.05)。间断遮盖和全日遮盖两种方法对轻度和中度弱视组视力提高无统计学差异(轻度χ2=0.84,P=0.77;中度χ2=0.91,P=0.57),重度弱视组患者全日遮盖较间断遮盖视力明显提高(χ2=13.57,P<0.05)。间断遮盖4h组在3,6,12mo视力平均分别为0.41,0.56,0.67;全日遮盖组在3,6,12mo视力平均分别为0.38,0.68,0.72,其中第6mo全日遮盖组视力改善较间断遮盖组明显增高趋势但无统计学意义(χ2=2.0,P=0.60)。结论:遮盖法是弱视治疗中常用且有效的治疗方法,对于轻中度弱视可采用间断遮盖的方法,重度弱视采用全天遮盖的方法,维持患者的依从性是治疗的关键。

AIM：To observe the effect of occlusion therapy for the treatment of amblyopia,and to analyze the time of occlusion,age,causes of disease and degrees of amblyopia and explore clinical significance of occlusion therapy for the treatment of amblyopia.·METHODS：In this retrospective study,107 infants（143 eyes） who attended strabismus and amblyopia department of our hospital from July 2005 to July 2008,including 45 males（69 eyes） and 62 females（74 eyes）,were included,and the average age was 5.3.Of them,there were 26 eyes with strabismic amblyopia,37 eyes with anisometropic amblyopia,80 eyes with ametropic amblyopia,43 eyes with mild amblyopia,81 eyes with midrange amblyopia and 19 eyes with severe amblyopia.The patients were divided into complete occlusion group,4 hours occlusion group and correction group.The best corrected visual acuities,lines of vision improvement and recovery rate of amblyopia of the three groups were observed and recorded during the one year follow-up.·RESULTS：Visual acuities were improved 2.4 lines in occlusion group,1.7 lines in correction group.Visual acuities were improved significantly in occlusion group compared with that in the control group（P〈0.05）.Recovery rate of visual acuities of 0.8 or higher was 11.5%（11 eyes） in occlusion group and 8.5%（4 eyes） in the control group,and the difference was significant between the two groups（P〈0.05）.There was no significant difference between 4h occlusion group and complete occlusion group for the treatment of mild to moderate amblyopia,but the difference between 4 hours occlusion group and complete occlusion group for the treatment of severe amblyopia was significant（χ2=13.57,P〈0.05）.Average visual acuities were 0.41,0.56 and 0.67 in the 3rdmo,the 6thmonth and the 12thmonth in 4 hours occlusion group respectively,and were 0.38,0.68 and 0.72 in the 3rdmonth,the 6thmonth and the 12thmonth in complete occlusion group respectively.The visual acuity improved obviously in the 6thmonth in complete occlusion group compared with that in the 4 hours occlusion group,but the difference was not significant（χ2=2.0,P=0.60）.·CONCLUSION：Occlusion seems to be frequently used and effective for the treatment of amblyopia.Incontinuous occlusion can be used to treat mild or moderate amblyopia,and severe amblyopia can be treated by complete occlusion.The key of treatment seems to be keep the patients＇ compliance.