视觉训练对症状性集合不足儿童疗效的持久性观察

Long-term effectiveness of vision therapy for symptomatic convergence insufficiency in children

目的探讨症状性集合不足儿童经医院内规范视觉训练（OBVT）治愈后的持久性疗效，并分析其影响因素。方法前瞻性研究。选择在门诊被诊断为症状性集合不足，且接受12周OBVT后成功治愈者40例，平均（12．4±3．4）岁。在训练前，训练结束后1周、3个月、6个月均测量双眼视功能，并进行视疲劳症状问卷评分。采用重复测量方差分析比较训练结束后1周、3个月、6个月患者的视疲劳症状问卷评分（CISS）、集合近点（NPC）、近距正融像性聚散范围值（PFV）；训练结束后6个月复发者与未复发者的训练前参数比较采用独立样本t检验或Mann．Whitney检验；训练结束后6个月CISS与训练前参数关系进行Pearson相关分析。结果训练结束后3个月，85％（34／40）患者无体征及症状；训练结束后6个月．68％（26／38）患者无体征及症状。训练结束后1周、3个月、6个月CISS评分、NPC、PFV差异均无统计学意义；训练结束后6个月复发者与未复发者之间训练前NPC、CISS及调节幅度（AA）差异有统计学意义（Z=-3．212，P〈0．01；Z=-2．461，P〈O．05；t=2．264，P〈0．05），PFV均值差异无统计学意义：训练结束后6个月CISS评分与训练前NPC及CISS分值呈正相关（r=0．420、0．473，P〈0．01），与训练前AA呈负相关（r=-0．361，P〈0．05）。结论大部分症状性集合不足儿童经视觉训练治愈后疗效可持续6个月；训练效果的持久性可能与训练前NPC远移程度，CISS分值大小及AA大小有关。

Objective To study the long-term effectiveness of vision therapy for children who were cured after treatment for convergence insufficiency （CI） by assessing the symptoms and signs. Methods Forty patients aged 7 to 18 years who were asymptomatic after a 12-week therapy program for CI in optometric center of Tianjin Eye Hospital were recruited in this prospective study. These patients were followed up at 1 week, 3 months, and 6 months after completion of the 12-week office-based visual therapy and were examined for clinical symptom scores （CISS） and visual function parameters that near point of convergence （NPC）, near positive fusional vergence （PFV） and accommodative amplitude （AA）. The results were analyzed with repeated ANOVA, pearson correlation analysis and independent-samples t-tests. Results The percentage who remained asymptomatic with no clinical signs after 3 months and 6 months was 85%（34/40） and 68%（26/38）, respectively. There were no significant changes in the CISS, NPC or near PFV during the half-year follow-up period （F= 2.852,1.995, 3.006, P〉0.05）. But there were significant differences in the NPC, CISS and AA before 12-week therapy program between the patients who had symptoms or clinical signs and those who were normal （Z=-3.212, P〈0.01; Z=-2.461. P〈0.05; t=2.264, P〈0.05）. NPC, CISS and AA before 12-week therapy program showed a significant correlation to CISS at 6 months after treatment （r=0.420, P〈0.01; r=0.473, P〈0.01; r=-0.361, P〈0.05）. Conclusion Most children who were cured after a 12-week office- based vision therapy program for CI maintained their improvements in symptoms and signs for at least half a year after discontinuing treatment. This may be related to the near NPC and CISS as well as the AA.