儿童部分调节性内斜视术前戴镜时限对术后效果的影响

Influence of preoperative wearing time on postoperative effects in children with partially accommodative esotropia

目的探讨儿童部分调节性内斜视术前戴镜时限对术后效果的影响。方法对2015年10月至2016年10月期间来我院就诊的60例部分调节性内斜视儿童,散瞳后进行验光全矫配镜。按术前戴镜时限分为A、B两组,A组为术前戴镜0.5a且斜视度稳定的患儿30例; B组为术前戴镜1.0a且斜视度稳定的患儿30例。每组患儿分别记录术前和术后0.5a的视力、眼位、同视机及Titmus立体视检查结果并进行相关统计分析。结果术后0.5a随访时,戴镜正位54例,过矫1例,欠矫5例。术后0.5a复查时,患儿术后双眼视功能较术前明显改善(P=0. 000),其中,A组无同时视及拥有一级视功能、二级视功能、三级视功能者分别为10例、2例、4例、14例,拥有近立体视功能者14例; B组无同时视及拥有一级视功能、二级视功能、三级视功能者分别为5例、3例、4例、18例,拥有近立体视功能者18例。A、B两组术后最佳矫正视力、眼位的正位率、各级视功能保留率、拥有近立体视功能的比例相比差异均无统计学意义(均为P> 0. 05)。结论对于部分调节性内斜视的患儿术前戴镜0.5a即可以行手术矫正眼位,以期尽早改善眼位及双眼视功能。若因各种主、客观因素限制不能在戴镜0.5a时手术,则宜在戴镜1.0a时手术可取得较好的效果。

Objective To evaluate the influence of preoperative wearing time on postoperative effect in children with partially accommodative esotropia.Methods Sixty children with partially accommodative esotropia who visited our hospital from October 2015 to October 2016 were placed in full cycloplegic refraction by using 10 g·L^-1 Atropine eye gel and then wore full hyperopic correction glasses.The children were divided into A and B group according to preoperative wearing time.A group were thirty patients who wore glasses half a year before the operation and whose esotropia angle was stable.B group were thirty patients who wore glasses one year before the operation and whose esotropia angle was stable.The visual acuity,eye position and the results of synoptophore and Titmus stereoacuity test were recorded before and half a year after the surgery in each group,and the related statistical analysis were carried out.Results Half a year after the operation,fifty-four patients achieved orthotropia when wearing full hyperopic correction glasses.One patient was overcorrected.Five patients were undercorrected.The postoperative binocular visual function of the children improved obviouslyduring the reexamination half a year after the operation(P=0.000).Among A group,there were 10 patients,2 patients,4 patients,14 patients had no binocular visual function and had primary visual function,secondary visual function and tertiary visual function.There were 14 patients had near stereopsis.Among B group,there were 5 patients,3 patients,4 patients,18 patients had no binocular visual function and had primary visual function,secondary visual function and tertiary visual function.There were 18 patients had near stereopsis.There were no statistically significant difference of the best corrected visual acuity,the positivity of eye position,the retention of visual functions at all levels and the proportion of near stereopsis between A and B group(all P >0.05).Conclusion To children with partially accommodative esotropia,we should do the operation to correct the eye position when wearing full hyperopic correction glasses for half a year so as to improve the eye position and binocular vision as early as possible.If we cannot operate when they wear glasses for half a year due to various of subjective and objective factors,a good postoperative effect can be achieved if the procedure is performed when they wear glasses for one year.