儿童弱视治疗中遮盖疗法的合理应用

Rational application of the occlusion in the treatment of childrens’ amblyopia

目的探讨遮盖疗法治疗儿童弱视的适应证。设计前瞻性队列研究。研究对象从儿童视光专家门诊中选择年龄在3～10岁,双眼最佳矫正视力相差大于一行(国际标准视力表)的90例弱视儿童(147眼)。方法将弱视儿童分为4组:具有3级视功能的56例(112眼),均为屈光不正性弱视,通过简单随机方法分为A、B两组,每组各28例;无同视功能的34例(35眼),其中屈光参差性弱视27例(27眼),屈光不正性弱视7例(8眼),通过简单随机方法分为C、D两组,每组各17例。A组、C组采用常规弱视治疗加遮盖疗法;B组、D组采用常规弱视治疗,不予遮盖。分别于治疗后2、4、6个月随访观察最佳矫正视力恢复情况。主要指标弱视眼治疗前后的最佳矫正视力(国际标准视力表)。结果治疗后4组儿童的最佳矫正视力均有提高。具有3级视功能的A、B两组间比较,治疗后2、4、6个月差异均无统计学意义(P均>0.05);无同视功能的C、D两组间比较,给予遮盖疗法的C组各时间段最佳矫正视力较不予遮盖疗法的D组提高明显(P均<0.01)。结论对于具有3级视功能的弱视儿童,治疗时不必采用遮盖疗法,而无同视功能的弱视儿童,则需要对优势眼采用适当的遮盖疗法。

Objective To investigate indications of occlusion in the treatment of children＇s amblyopia. Design Prospective cohort study. Participants 147 eyes of 90 children with amblyopia. Methods The study involved 90 children aged 3 to 10 years. The leteral difference of best corrected visual acuity （BCVA） was more than 1 line （measured by the international standard visual acuity chart）. Among them, 56 children （112 eyes） with ametropic amblyopia and normal stereopsis were randomly divided into 2 groups, Group A and Group B, 28 children in each group. 34 children（35 eyes） with abnormal binocular vision were randomly divided into 2 groups, Group C and Group D, 17 children in each group. Children in Group A and Group C were given routine therapy and the occlusion therapy. Children in Group B and Group D were given routine therapy only. All patients were followed up at 2 months, 4 months and 6 months after therapy. Main Outcome Measures The BCVA change after the treatment. Results The BCVA of all children was improved. There was no significant difference statistically between the improvement of Group A and Group B （P〉0.05）. But the improvement of BCVA in Group C was significantly better than that in Group D. Conclusion The occlusion therapy is beneficial to the children with amplyopia and abnormal binocular vision, but not the indication for the amplyopic children with normal binocular vision.