脱抑制及视功能训练治疗屈光参差性弱视的临床疗效

Clinical efficacy of disinhibition and visual function training in children patients with anisometropic amblyopia

目的:探讨脱抑制及视功能训练治疗屈光参差性弱视患儿的临床疗效。方法:前瞻性病例对照研究。83例屈光参差性弱视患儿纳入本研究,所有患儿均为单眼弱视,随机分为训练组(44例44眼)和对照组(39例39眼)。所有患儿常规配镜,定量遮盖,均采用家庭+诊室训练相结合的方法。对照组训练内容为:弱视训练仪(光刷、红闪、光栅等)及电脑软件精细+刺激训练。训练组除完成对照组训练项目以外,当患儿弱视眼矫正视力已经提高到0. 6以上后进行单眼调节功能训练、脱抑制训练、双眼调节功能训练及双眼集合、融像功能训练。随访6mo后,对两组的视力疗效及远近立体视功能检查结果进行比较及统计学分析。结果:训练组与对照组相比,两个组间视力改善的总有效率差异无统计学意义,但是两个组间整体的视力疗效比较差异有统计学意义(P<0. 05),加入脱抑制及视功能训练后训练组远、近立体视功能改善的人数明显优于对照组,差异有统计学意义(P<0. 05)。结论:弱视治疗中加入脱抑制训练及双眼视功能训练后,能够增强弱视眼的竞争力,消除抑制,不但能提高视力,还能建立良好的视功能。

AIM： To evaluate the clinical efficacy of treatment viadisinhibition and visual function training in childrenpatients with anisometropic amblyopia. METHODS： Eighty - three children patients withanisometropic amblyopia were enrolled in the prospectivecase control study. All patients were monocularamblyopia, which were randomly classified into 2 groupsas a training group （44 cases） and a control group （39cases）. All patients had routine glasses and quantitativecoverage, and were treated by the combination of bothfamily and clinic training. Patients in both control andtraining groups were treated by amblyopia traininginstrument （light brush, red flash, grating, etc. ） and finestimulation training via computer software. Additionally,patients in the training group, whose corrected visionimproved more than 0. 6, were also exposed to othertreatments including monocular adjustment functiontraining, disinhibition training, binocular adjustmentfunction training, binocular integration and fusionfunction training. Visual acuity and outcomes werestatistically analyzed after 6mo.RESULTS： No significant difference in the total effectiverate of vision improvement between the two groups.However, the overall visual acuity difference between thetwo groups was statistically significant （ P 〈 0. 05 ）. Afterdisinhibition and visual function training, the number ofpatients with improvement in both far and near stereopsisin the training group was significantly greater than that in the control group （P〈0. 05）. CONCLUSION： Combinational treatment withdisinhibition and binocular visual function trainingenhances the competitiveness of amblyopic eyes andeliminate inhibition, which is accompanied by improvedvisual acuity and ameliorated visual function in childrenpatients with anisometropic amblyopia.