成人外斜视术后双眼视觉重建及其影响因素

The study of re-establishment of binocular vision and the impact factors in adults after exotropia surgery

目的探讨成人外斜视术后双眼视觉重建及其影响因素。方法回顾性病例研究。收集发病年龄相对明确的术前无双眼视功能的成人外斜视患者54例，按发病年龄9岁之前或之后分为BVM（before visual maturity，〈9岁者）组及AVM（after visual maturity，≥9岁者）组，分别于术前及术后6周用同视机测远双眼视觉，用颜氏《数字化立体视图》测近立体视觉。采用x2检验分析比较2组患者术后双眼视功能的变化：采用logistic回归分析发病年龄、手术年龄、术前斜视度数、外斜视类型对术后立体视的影响。结果术后远双眼视觉重建率：Ⅰ级：AVM组77％，BVM组33％（X2=10．240，P〈0．01）；Ⅱ级：AVM组77％，BVM组33％（X2=10．240，P〈0．01）；Ⅲ级：AVM组47％，BVM组17％（x2=5．400，P〈0．05）。近立体视重建率：AVM组73％，BVM组29％（x2=10．461，P〈0．01）。Logistic多因素回归分析显示，发病年龄及手术年龄是影响术后远（OR=6．046，P〈0．05；OR=0．140，P〈0．01；）、近立体视（OR=10．825，P〈0．05；OR=0．189，P〈0．05）重建的重要因素，而术前斜视度数及外斜视类型对术后远、近立体视的重建无显著影响。结论成人外斜视术后也可获得一定程度的双眼视功能，甚至是立体视功能。发病年龄及手术年龄可影响术后立体视的获得，其中发病年龄起关键作用。为了提高术后双眼视觉的重建，成人外斜视手术宜早不宜晚。

Objective To study the restoration of binocular vision and the factors that impact adults after exotropia surgery. Methods Fifty-four adult patients with exotropia were divided into two groups, based on age of onset： before visual maturity （BVM, 〈9 years old） or after visual maturity （AVM, ≥9 years old）. Binocular vision, both distance and near, was checked before surgery and 6 weeks after surgery with a synoptophore and Yan＇s digital stereogram. Results The restoration rate of distance binocular vision was as follows： For grade I binocular vision, the rate was 77% in the AVM group, which was significantly higher than the rate for the BVM group （33%; X2=10.240, P〈0.01）. For grade Ⅱ, the rate was the same as for grade Ⅰ. For grade Ⅲ, the rate was 47% in the AVM group and was 17% in the BVM group. Differences between the two groups were statistically significant （X2= 5.400, P〈0.05）. The restoration rate of near binocular vision was 73% in the AVM group, which was significantly higher than that for the BVM group （29%; x2=10.461, P〈0.01）. Logistic analysis showed that the age of onset and the age at the time of surgery are the important factors affecting the restoration of postoperative distance （OR=6.046, P〈0.05; OR=0.140, P〈0.01） and near stereopsis （OR= 10.825, P〈0.05; OR=0.189, P〈0.05）. The type of exotropia and the degree of the preoperative strabismus had no marked influences on binocular vision. Conclusion Surgical correction of adult exotropia is helpful in the restoration of binocular visual functions and beneficial to obtaining a certain degree of stereopsis. The restoration of distance stereopsis is associated with the age of onset and the age at the time of surgery. The age of onset played a key role in obtaining stereopsis. In order to improve postoperative binocular vision, surgery should be performed as early as possible for adult exotropia patients.