不同类型斜视手术前后远近立体视的变化

Clinical study on distance and near stereoacuity changes in patients with different types of strabismus before and after surgery

目的:探讨斜视类型对术后远、近立体视恢复的影响。方法:选取72例不同类型斜视患者,按斜视类型分为四组:组1为非调节性内斜视,组2为间歇性外斜视,组3为恒定性外斜视,组4为外斜V征伴下斜肌亢进。手术前后分别应用同视机检查远立体视。采用颜少明编绘的《立体视觉检查图》检查近立体视锐度。记录并分析术前、术后第7d,1、3、6mo的各项检查数据。结果:斜视患者72例术后远、近立体视的恢复较术前有明显改善,其差异有统计学意义(P<0.05)。间歇性外斜视组术后远、近立体视的恢复优于非调节性内斜视组、恒定性外斜视组及外斜V征伴下斜肌亢进组,其差异有统计学意义(P<0.05)。非调节性内斜视组、恒定性外斜视组和外斜V征伴下斜肌亢进组术后不同时期远、近立体视的恢复差异无统计学意义(P>0.05)。远立体视(0例)比近立体视(19例,26%)的损害更严重,术后近立体视(51例,71%)的恢复明显优于远立体视(17例,24%),术后1mo远、近立体视恢复效果明显。结论:不同斜视类型对术后远、近立体视恢复的影响存在差异,间歇性外斜视术后远、近立体视的恢复效果最佳。非调节性内斜视、恒定性外斜视和外斜V征伴下斜肌亢进对术后远、近立体视的恢复影响一致。斜视患者远立体视损害较重,术后近立体视恢复明显优于远立体视。

AIM:To discuss and evaluate how different types of strabismus impact on the recovery of distance and near stereoacuity after strabismus surgery.METHODS:We selected 72 cases of strabismus who were treated in our hospital.They were divided into four groups:Group 1 as constant non-accommodative esotropia;Group 2 as intermittent exotropia;Group 3 as constant exotropia;Group 4 as exotropia V sign with inferior oblique hyperfunction.The distance stereoacuity were examined by synoptophore and the near stereoacuity was examined by Shaoming Yan's stereogram.Above examination data was collected and recorded before surgery,7d,1,3,and 6mo after surgery.RESULTS:The 72 patients'distance and near stereoacuity were significantly improved after their surgery,compared with their previous binocular vision.The improvement showed statistical significant(P<0.05).The recovery of Group 2's distance and near stereoacuity had been proved superior to that of Group 1,Group 3,and Group 4.The changes in the distance and near stereoacuity of Group 2 were statistically significant(P<0.05).There were no statistically significant changes in the distance and near stereoacuity of Group 1,Group 3,and Group 4 after the surgeries(P>0.05).The damage of distance stereoacuity(0 cases)was more severe than the damage of near stereoacuity(19 cases,26%).After the surgeries,near stereoacuity's(51 cases,71%)recovery was significantly superior to the distance stereoacuity's recovery(17 cases,24%).At 1mo after the surgeries,the improvement of distance and near stereoacuity was most obvious.CONCLUSION:Postoperative recovery of distance and near stereoacuity varies as per strabismus type.Intermittent exotropia's patients show the best recovery of distance and near stereoacuity after the surgeries.The clinical results on the recovery of distance and near stereoacuity after surgery for constant non-accommodative esotropia,constant exotropia and exotropia V sign with inferior oblique hyperfunction are consistent.As the distance stereoacuity of the patients with strabismus has more severe damage,the recovery of near stereoacuity is superior to that of distance stereoacuity.