间歇性外斜视儿童矫正术后远期疗效

Long-term surgical results of children with Intermittent Exotropia

目的：探讨间歇性外斜视儿童斜视矫正术后的远期临床效果及其术后动态变化.方法：回顾性系列病例研究.收集2013年2月至2014年8月于温州医科大学附属眼视光医院斜弱视专科接受手术治疗且随诊时间超过12个月的间歇性外斜视儿童,分析患儿术前、术后1周、术后1个月和末次随访时的远、近斜视角及双眼视功能参数.采用独立样本t检验比较术前和术后各时期的远、近斜视角.采用卡方检验比较手术前后远、近知觉性融合及立体视功能.结果：共纳入患儿139例,手术年龄为7.4±2.6（4～14）岁.随访时间为21.0±10.5（12～51）个月.术前视远和视近的斜视度分别为-33.9△±10.9△（-20△～-75△）和-38.2△±10.2△（-20△～-85△）.末次随访时视远和视近的斜视度分别为-6.4△±8.0△（＋16△～-35△）和-7.7△±9.6△（＋20△～-40△）,103例（74.1%）保持成功,35例（25.2%）欠矫复发,1例（0.7%）保持过矫.末次随访时双眼视功能显著改善,远、近知觉性融合功能较术前均有显著改善（χ2=26.88、26.24,均P〈0.001）,远、近立体视较术前均显著改善（χ2=64.38,P〈0.001;χ2=14.63,P=0.002）.末次随访时复发的35例患儿其远知觉性融合功能较术前显著改善（χ2=14.58,P=0.002）,远、近立体视水平均有所改善,但差异无统计学意义.结论：约3/4的间歇性外斜视儿童术后远期能维持正位,患者术后双眼视功能有显著改善.即便是术后复发患儿,其双眼视功能仍较术前有所改善.

Objective： To investigate the long-term clinical effects and postoperative changes in children with intermittent exotropia. Methods： In this retrospective case series study, 139 children with intermittent exotropia and who underwent strabismus surgery were followed for more than 12 months. Distant and near squint angles as well as binocular visual function parameters were collected preoperatively, at 1 week and 1 month postoperatively, and at the last follow-up. Independent sample t-tests were used to compare the distant and near squint angles between the pre- and postoperative periods. Chi-square tests were used to analyze distant and near sensory fusion and stereopsis. results： The mean age was 7.4 ± 2.6 years （range 4-14 years）, and the follow-up time was 21.0 ± 10.5 months （range 12-51 months）. The preoperative distant and near deviation were -33.9△ ± 10.9△（range -20△--75△） and -38.2△ ± 10.2△（range -20△--85△）, respectively. At the fnal follow-up examination, the mean postoperative distant and near squint angles were -6.4△ ± 8.0△（＋16△--35△） and -7.7△ ± 9.6△（＋ 20△--40△） respectively. Among the patients, 103 cases （74.1%） were orthophoric, 35 cases （25.2%） had recurrent exotropia, and 1 case （0.7%） showed overcorrected strabismus. Bilateral visual acuity was significantly improved at the final follow-up examination. The distant and near perceptual fusion were significantly improved （ χ2=26.88, 26.24, P 〈 0.001）, as was the distant and near stereopsis （ χ2=64.38, P 〈 0.001; χ2=14.63, P=0.002）. The 35 patients who relapsed at the last follow up had significantly improved perceptual fusion function （ χ2=14.58, P=0.002） and better distant and near stereopsis acuity, although the changes were not statistically significant. conclusions： Approximately 75% of the children with intermittent exotropia maintained long-term orthophoria after surgery, and their binocular vision was significantly improved. Even in children with postoperative recurrence, binocular visual function was better than before surgery.