间歇性外斜视手术矫正前后融合和立体视功能对照研究

Comparative study on binocular fusion and stereoacuity of patients with intermittent exotropia before and after surgery

目的对间歇性外斜视患者手术矫正前、后的双眼融合功能和立体视锐度进行对照比较。方法回顾性系列病例研究。对2008年9月至2011年8月在山东大学附属省立医院眼科中心确诊为间歇性外斜视并一次性手术正位（＋5～—10PD）的连续性病例114例，采用Titmus立体视图测定患者看近立体视锐度；采用手电筒式Worth四点灯评估患者的中心融合和周边融合功能；采用三棱镜加交替遮盖法测量患者戴镜注视6m及33em调节性视标的第一眼位斜视度。按照患者术后不同斜视度分为A组（＋1～＋5PD）、B组（0PD）、C组（-1～-5PD）、D组（-6～-10PD）四组，采用X^2检验及配对设计的符号秩和检验分别对手术前、后的双眼融合功能和立体视锐度进行比较，以P〈0．05为差异有统计学意义。结果术前与术后双眼融合功能的差异有统计学意义（P=0．000）。A、B、C、D四组之间术后双眼融合功能的差异有统计学意义（P=0．004）。术前与术后立体视锐度的差异有统计学意义（P=0．000）。A组手术前、后立体视锐度的差异无统计学意义（P=0．336），其余各组手术前、后立体视锐度的差异均有统计学意义（P=0．001）。结论间歇性外斜视患者手术矫正后的双眼融合功能和立体视锐度比手术前明显提高。

Objective To compare the binocular fusion and stereoacuity achieved in patients be-fore and after successful surgical alignment of intermittent exotropia. Methods Retrospective case se-ries study. Consecutive cases of 114 patients of intermittent exotropia with successful surgical align-ment （＋5--10PD） in the Eye Center of Provincial Hospital affiliated to Shandong University were retrospectively recruited. Titmus stereogram was used to evaluate the near stereoacuity and Worth 4 dots flashlight test was used to evaluate the central and peripheral fusion of the patients before and after successful surgical alignment of intermittent exotropia. Prism and alternative cover test was used to evaluate the deviation of the patients fixating at accommodative targets of 6m and 33cm. Based on the angles examined after surgery, 114 patients were divided into 4 groups （Group A： ＋1-＋ 5PD; Group B： 0 PD; Group C：-1--5PD; Group D： -6--10PD）. Chi-square test and nonparametric Wilcoxon signed rank test were used to compare the binocular fusion and stereoacuity of patients re- spectively before and after surgery, P 〈0.05 were considered statistically significant. Results There were significant difference statistically between binocular fusion evaluated before surgery and that af-ter surgery in patients with intermittent exotropia （P =0.000）. Binocular fusion evaluated after sur-gery was significantly different among 4 groups （P =0.004）. There was statistical significance be-tween stereoacuity examined before and after surgery （P =0.000）. Stereoacuity examined before and af-ter surgery was not significantly different in Group A （P =0.336）, others had statistical significance （P =0.001）. Conclusions There is significant improvement in binocular fusion and stereoacuity after successful surgical alignment of patients with intermittent exotropia, compared with that before surgery.