LASIK矫治高度屈光参差性弱视儿童的立体视觉研究

Study of stereopsis after LASIK for high anisometropic amblyopia in children

目的观察儿童高度屈光参差性弱视患者接受LASIK后立体视觉的恢复情况及其矫治儿童高度屈光参差性弱视的疗效。设计前瞻性非随机自身对照观察。研究对象36例36眼行LASIK手术的6～12岁高度屈光参差性弱视儿童患者。方法患者在LASIK术前、术后3、6及12个月检查视力、屈光度,采用颜氏立体视觉检查图检查立体视觉。立体视锐度≤60″为有中央立体视;80″～800″为有周边立体视;>800″为立体视盲。按最佳矫正视力分为轻、中、重度弱视三组。主要指标立体视锐度。结果 LASIK术后12个月裸眼视力、最佳矫正视力、屈光参差程度较术前均明显改善(P均<0.05)。术前、术后6个月和术后12个月立体视盲分别占55.6%(20例)、33.3%(12例)和16.7%(6例)(P均<0.05)。术后12个月轻度弱视组100%恢复了立体视,其中40.0%(8例)恢复了中央立体视;中度弱视组有10.0%(1例)恢复了中央立体视,70.0%(7例)恢复了周边立体视;而重度弱视组仅33.3%(2例)恢复了周边立体视(P均<0.05)。术后12个月,年龄<10岁者与≥10岁者分别有89.5%、76.5%恢复了立体视(P=0.351)。结论屈光参差性弱视儿童立体视建立与弱视程度、弱视治疗时间有关。对于不能耐受戴镜矫正的严重屈光参差性弱视患儿,LASIK手术是一种安全、有效的治疗手段,术后可能恢复正常或部分立体视。

Objective To observe the recovery of stereo vision of high anisometropic amblyopia children after LASIK, and to evaluate the effect of LASIK treatment of children with high anisometropic amblyopia. Design A prospective non-randomized self-controlled study. Participants 36 eyes of 36 children aged six to twelve with high anisometropic amblyopia after LASIK. Methods Preoperatively, 3, 6 and 12 months after LASIK, high anisometropic amblyopia children were examined in visual acuity, refraction, and three-dimensional visual examination used YaM-dimensional visual inspection of figure. Stereoacuity of 60 ＂ or less was for the central stereopsis, 80＂ - 800 ＂for peripheral stereopsis, 〉 800＂ for stereo blindness. By best corrected visual acuity the children were divided into mild, moderate and severe amblyopia groups. Main Outcome Measures Stereoacuity. Results Twelve months after surgery, the visual acuity, best corrected visual acuity and degree of anisometropia were significantly improved （P all〈0.05）. Stereo blindness were 55.6% （20 cases）, 33.3% （12 cases） and 16.7% （6 cases） preoperatively, 6 months and 12 months after LASIK. The difference was sta- tistically significant between the preoperative and postoperative 6 months and 12 months results （P all〈0.05）. 100% children in mild amblyopia group had restored three-dimensional vision 12 months after LASIK, among them 40.0% （8 cases） had restored the central stereopsis,10.0% children （one case） in moderate amblyopia group had restored the central stereopsis, and 70.0% （7 cases） recovered peripheral stereopsis. Only 33.3% children （2 cases） in the severe amblyopia group recovered peripheral stereopsis （P all〈0.05）. 12 months after operation, 89.5% and 76.5% of the children aged less than 10 and 10 years or more returned to stereopsis （P = 0.351）. Conclusion Construction of stereoscopic vision in anisometropic amblyopia children is related with the degree and treatment duration of amblyopia. For children with severe anisometropic amblyopia who can not tolerate wearing glasses for the correction, LASIK surgery is a safe and effective treatment. The patients may resume normal or part of three-dimensional vision.