常规戴镜和遮盖治疗对单、双眼弱视儿童屈光状态的影响

Refractive changes in children with monocular or binocular amblyopia after treatment of spectacle and patching

目的探讨单眼及双眼弱视患儿通过常规戴镜和遮盖治疗,弱视达基本治愈后屈光状态的变化规律,以探讨弱视眼的正视化特征。方法回顾性连续观察远视性屈光不正性弱视治愈病例1~10a共56例（112眼）患者,初诊年龄（5.71±1.67）岁,观察终点年龄（8.77±2.28）岁,平均观察（3.07±1.79）a。选择等效球镜≥＋3.00D的弱视患儿。单眼弱视组弱视眼（38眼）给予所谓健眼遮盖、戴镜联合精细目力训练治疗;双眼弱视组（36眼）给予戴镜及精细目力训练治疗,所谓健眼组38眼未做任何处理。随访观察各组病例屈光度（球镜、柱镜）变化及初诊年龄、治愈年龄、治疗周期分布特点等。结果单眼弱视组：基本治愈年龄（8.34±2.15）岁,球镜度数平均每年减少（0.46±0.42）DS,柱镜度数减少（0.016±0.143）DC;所谓健眼组每年球镜度数减少（0.28±0.62）DS,柱镜度数减少（0.003±0.067）DC。双眼弱视组：基本治愈年龄（9.67±2.34）岁,球镜度数平均每年减少（0.40±0.32）DS,柱镜度数减少（-0.056±0.237）DC。3组球镜度数及柱镜度数平均每年变化值组间比较,差异均无统计学意义（P〉0.05）;所谓健眼组等效球镜数平均每年减少度数与其他2组比较,差异均有统计学意义（均为P〈0.05）。单眼弱视组的球镜度数与疗程呈负相关（r=0.428,P〈0.01）。结论常规戴镜和遮盖治疗可减慢单眼弱视所谓健眼的正视化进程,但对弱视眼无显著影响;常规戴镜治疗对双眼弱视眼正视化进程也无明显影响。

Objective To investigate the process of stigmatism in children with monocular or binocular amblyopia after treatment of spectacle combined with patching as amblyopia basically cured.Methods A retrospective case series study was taken.The records of 56 patients（112 eyes）who were diagnosed as amblyopia with hyperopic refractive error and cured for 1 year to 10 years were reviewed,and 56 subjects who were between the average age of（5.71±1.67）years at the time of diagnosis and（8.77±2.28）years at the end of observation,with follow-up of（3.07±1.79）years,were included in the study.Children,whose spherical equivalent were ≥＋3.00 D,were selected.In children with monocular amblyopia（38 eyes）,the amblyopic eyes were treated with spectacle,the fellow eyes were patched and combined with near visual training.In children with binocular amblyopia（36 eyes）,both eyes were treated with spectacle combined with near visual training.The health eyes（38 eyes）were without treatment.The changes of spherical and cylindrical powers,age of the first diagnosis,cured age and distribution of treating period were recorded at follow-up.Results In monocular amblyopic group,the cured age of amblyopic eyes was（8.34±2.15）years,an average annual reduction of spherical power was（0.46±0.42）DS and cylindrical power was（0.016±0.143）DC;An average annual reduction of spherical power in fellow eyes was（0.28±0.62）DS and cylindrical power was（0.003±0.067）DC.In binocular amblyopic group,the cured age was（9.67±2.34）years,an average annual reduction of spherical power was（0.40±0.32）DS,reduction of cylindrical power was（-0.056±0.237）DC.There were no significant statistical differences in spherical and cylindrical changes among all groups（all P0.05）,but the significantly statistical differences were found in the annual changes of spherical equivalent for the fellow eyes compared with other two groups（both P0.05）.There was negative correlation between spherical power and course of treatment in monocular amblyopic group（r=0.428,P0.01）.Conclusions The treatment with spectacle combined with patching may decrease the process of stigmatism in fellow eyes but not in amblyopic eyes.There is no remarkable effect of patching on amblyopic eyes with monocular or binocular amblyopia.