双眼调节等量同步训练在屈光参差性弱视治疗中疗效观察

The effect of the binocular accommodation training in anisometropic amblyopia patients

目的探讨双眼调节等量、同步的视觉训练在屈光参差性弱视患者治疗中的作用。方法临床病例对照研究。治疗组30例55只眼，对照组35例65只眼，年龄4~12岁。两组均进行规范的屈光不正矫正检查、配镜，屈光参差患者同时进行健眼遮盖治疗，两组均采用DV100多媒体训练软件的综合方法治疗。治疗组依据视功能检查结果，同时增加双眼视功能训练，包含进行单双眼调节等量、同步训练，融合训练、脱抑制训练。结果治疗组患者弱视眼的视力增长速度和双眼视功能均优于对照组，弱视眼的视力回退率低于对照组。治疗组基本治愈率为81.81%，总有效率为92.72%，对照组基本治愈率为53.85%，总有效率为78.46%，两组间比较差异有统计学意义（Z=2.36，Z=2.30，P〈0.01）。调节等量、同步一致性，治疗组治疗前调节等量、同步一致率14.5%，0%，治疗后87.3%，85.5%。对照组治疗前调节等量、同步一致率16.9%，0%，治疗后55.4%，15.4%。两组治疗前后比较差异有统计学意义（χ2=14.43，P〈0.01）。立体视觉治疗组，有效率87.27%、恢复正常率45.45%，对照组有效率58.46%、恢复正常率18.46%，两组立体视有效率和正常率比较差异有统计学意义（χ2=12.17，χ2=10.71，P〈0.01）。视力回退，治疗组3回退率为9.1%；对照组，回退率30.76%，两组间经统计分析差异有统计学意义（χ2=8.49，P〈0. 01）。结论在屈光参差性弱视患者的治疗过程中增加双眼调节等量、同步训练后，可以明显的减少患者的治疗周期，减少视力回退，显著调高双眼视功能。

ObjectiveTo observe the effect of the binocular accommodation training in anisometropic amblyopia patients.MethodsA clinical case-control study. A total of 30 cases （55 eyes） were included in treatment group and 35 cases （65 eyes） were included in control group. ALL of these patients were aged between 4 to 12 years old. Both groups were corrected refractive error normatively. The healthy eye was covered in anisometropia patients. Both groups were trained by DV100, a kind of training software. In addition, the treatment group received extra binocular visual training including monocular or binocular equivalent and synchronous accommodation training, fusion function training and anti-suppression training.ResultsThe visual acuity of amblyopic eyes improved faster and the binocular vision was better in the treatment group. The visual regression rate of amblyopic eyes was lower in the treatment group. The cure rate was significantly improved in the treatment group （81.81%） compared with the control group （53.85%）. A similar result was found for the effective rate, which was 92.72% in the treatment group and was 78.46% in the control group （Z=2.36, Z=2.30, P 〈0.01）. The concordance rate of equivalent and synchronous accommodation was significantly improved after treatment compared with before treatment in both two groups （χ2=14.43, P 〈0.01）. The effective rate and cure rate of stereopsis were respectively 87.27% and 45.45% in the treatment group, which was significantly greater compared with the control group （χ2= 12.17, χ2=10.71, P 〈0.01）. The visual regression rate was 9.1% in the treatment group and was 30.76% in the control group. This difference was statistically significant （χ2=8.49, P 〈0.01）.ConclusionsThe binocular equivalent and synchronous accommodation training can help to reduce treatment cycle, reduce visual regression and improve binocular vision in anisometropic amblyopia.