182例儿童弱视综合治疗临床观察

Clinical outcome of 182 cases of Amblyopia in Children after Combined Modality Therapy

目的：总结分析一组弱视儿童3年综合治疗随访结果，观察不同年龄、不同类型、不同程度弱视治疗的疗效。方法：182例（276眼）3～13岁弱视儿童，男95例（157眼），女87例（119眼）。均用1%硫酸阿托品眼膏散瞳验光，并给予恰当的屈光矫正。每6～12个月重新验光1次，同时给予相应的遮盖疗法、药物、光学压抑法及各种视觉刺激疗法等综合疗法治疗，每个月复查视力，随访18～36个月，平均24个月。结果：本组弱视儿童治疗总有效率为90.22%，治愈占57.61%，进步占32.61%，无效占9.78%。其中3～6岁组总有效率为95.92%，优于7～13岁组的总有效率76.25%（P＜0.05）；轻度弱视总有效率为98.79%，中度弱视总有效率为82.95%，均明显优于重度弱视的总有效率为56.52%（P＜0.05）；屈光不正性弱视总有效率为94.76%，屈光参差性弱视总有效率为90.62%，均优于斜视性弱视的总有效率73.58%（P＜0.05）；中心注视总有效率为99.45%，明显优于旁中心注视的总有效率72.04%（P＜0.01）。结论：早期发现，早期干预，积极恰当的治疗可以最大限度地治愈儿童弱视。

Objective To observe the clinical outcome of amblyopia in children after 3 years of treatment.To compare effectiveness of treatment among different age groups,types and severity groups of amblyopia.Methods 182 cases（276 eyes） aging from 3 years old to 13 years old,male 95 cases（157 eyes）,female 87 cases（119 eyes）.All of the patients were given 1%Atropine sulfate eye ointment for mydriatic refractometry and proper correction of refractive errors.Every 6 to 12 months,all the patients underwent a mydriatic refractometry and were given proper combination of the following management including occlusion treatment,medication,optical penalization and photic stimulation.Patients were followed up from 18 months to 36 months（ave. 24 months） with eyesight check up every month.Results The overall therapeutic efficacy in this group of patients was as high as 90.22%,cure rate 57.61%,improvement rate 32.61%and no effect 9.78%.Among which,age 3 to 6 years old group had an overall therapeutic efficacy as high as 95.92%while the 7 to 13 years age group had one only at 76.25%（P〈0.05）;mild amblyopia group had a therapeutic efficacy of 98.79%,moderate amblyopia group had a therapeutic efficacy of 82.95%,both of which were much higher than the severe group with a therapeutic efficacy only at 56.52%（P〈0.05）;group amblyopias had a therapeutic efficacy of 94.76%while group anisometropic amblyopia’s therapeutic efficacy was 90.62%,both of which were higher than that of group strabismic amblyopia at 73.58%（P〈0.05）;central fixation group’s therapeutic efficacy was 99.45% which was much better than that of eccentric fixation 72.04%（P〈0.05）. Conclusion To achieve optimal outcome,early diagnosis,early interference with aggressive combined therapy is highly recommended to cure amblyopia in children.