小儿内斜视矫正术后双眼单视功能的建立

Establishment of binocular single vision after surgical correction of eye position in infantile esotropia

目的：探讨小儿内斜视矫正术后双眼单视功能的建立情况及其影响因素。方法采用手电筒式Worth四点灯和Titmus立体视图测定小儿内斜视矫正术216例的中心融合、周边融合及立体视锐度。利用Logistic回归分析双眼单视功能建立的影响因素。结果术后获得周边融合者占62.5%；获得中心融合者占6.02%；获得不同程度的立体视者占50.5%。术后双眼单视功能明显升高,双眼单视功能与各变量密切相关：病程（β=1.511,P=0.04）、术前斜视度（β=1.734,P=0.03）与术后双眼单视功能的建立呈正相关；与手术年龄（β=-0.85,P=0.01）、弱视治疗时间（β=-0.24,P=0.03）以及术后斜视度（β=-1.41,P=0.02）呈负相关。结论内斜视小儿应尽早手术,治疗时间越早及斜视度越小者,术后越容易建立周边融合。先天性内斜视建立周边融合的程度较非调节性内斜视及部分调节性内斜视者更难。

Objective To investigate the establishment of binocular vision and its influencing factors after surgical correction of pediatric esotropia. Methods Two hundred and sixteen cases of children who underwent esotropia surgery were measured. The center fusion, peripheral fusion and stereopsis were recorded by using torch-style lighting and Titmus Worth four dimensional view of assessment. The influencing factors of establishment of binocular vision were analysed by logistic regression analysis. Results Patients who achieved peripheral fusion after surgery accounted for 62. 5% （135/216）, achieved centers fusion accounted for 6. 02% （13/216）, and achieved stereopsis with varying degrees accounted for 50. 5% （109/216）. Binocular vision after surgery was significantly improved, and it was closely related with the following variable：Disease duration （β=1. 51, P=0. 04） and preoperative strabismus （β=1. 734, P=0. 03） were positively correlated with establishment of postoperative binocular vision function. The establishment of postoperative binocular vision function was negatively related with operative age （β= -0. 85, P=0. 01）, amblyopia treatment time （β= -0. 24, P=0. 03）, and postoperative strabismus （β= -1. 412,P=0. 02）. Conclusion Infantile esotropia should be corrected by surgery as soon as possible. The peripheral fusion could be established more easily if the children were treated early and the strabismus was mild. The peripheral fusion was established more difficult in congenital esotropia than that in non-accommodative estropia and that in partially accommodative esotropia.