基本型间歇性外斜视手术成功率的相关因素分析

Relevant factors of successful surgery in the basic type of intermittent exotropia

目的探索基本型间歇性外斜视达到功能治愈的相关因素。方法采用前瞻性系列病例观察研究设计。纳入2015年8月至2016年3月在天津市眼科医院行斜视矫正术治疗的基本型间歇性外斜视患者132例,进行术前Newcastle评分、远近Worth 4点灯,术前、术后1 d和术后6个月眼位,术前和术后6个月视功能分析仪(FVA)远立体视、Frisby Davis Distance(FD2)远立体视和Titmus立体视觉检查图近立体视检查,分析术后6个月眼位成功和立体视重建的影响因素和最佳手术时机的截断点。结果132例患者术后6个月眼位正位者84例,手术成功率为63.6%;欠矫者44例,欠矫率为33.3%;过矫者4例,过矫率为3.0%。术后6个月眼位相关因素的Logistic回归分析结果显示,术后第1天视远斜视角和术前33 cm Worth 4点灯与术后6个月眼位有关(系数b=-0.093,P=0.037;系数b=0.725,P=0.017),术前33 cm Worth 4点灯和术后6个月眼位受试者工作特征(ROC)曲线分析结果显示,ROC曲线下面积为0.645,说明术前33 cm Worth 4点灯结果对术后6个月眼位分析诊断价值较低;术后第1天眼位在0^+10 PD的72例患者术后6个月眼位均获得成功。术后眼位矫正成功和失败患者FVA远立体视分布比较,差异有统计学意义(χ2=4.036,P=0.045);Logistic回归分析结果显示,发病年龄和术前6 m FD2远立体视与术后FVA远立体视均相关(系数b=-0.213,P=0.023;系数b=0.021,P=0.036)。ROC曲线分析结果显示,发病年龄、术前6 m FD2测量的远立体视曲线下面积分别为0.257和0.752,前者无诊断价值,后者诊断价值中等,最佳截断点是22.5″。结论术后第1天眼位影响术后眼位成功率;术后第1天的理想眼位是0^+10 PD;术后远立体视可明显改善,6 m FD2远立体视下降至22.5″之前行手术治疗可提高术后功能治愈率。

Objective To explore the relevant factors of functionally healing the basic type of intermittent exotropia.Methods A prospective observation study was designed.One hundred and thirty-two cases with basic type of intermittent exotropia in Tianjin Eye Hospital from August 2015 to March 2016.Pre-and post-operation examinations to each patient,including the tests of ocular alignment,Worth four-dot test at 2 m and 33 cm,Titmus,functional visual analyzer(FVA),Frisby Davis distance(FD2)were used to explore the influencing factors of postoperative eye position and stereoscopic reconstruction,and to find the cutoff point of surgery.This study followed the Declaration of Helsinki.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital(No.YKLL-2015-8-21).Written informed consent was obtained from each patient or guardian prior to entering study cohort.Results At 6 months postoperatively,there were 84 cases of orthopedic position,4 cases of overcorrection and 44 cases of undercorrection.The success rate was 63.6%.The deviation at day 1 and peripheral fusion function were statistically significant to postoperative eye position(b=-0.093,P=0.037;b=0.725,P=0.017).The area under the receiver operating characteristic(ROC)curve was 0.645,which showed that the result of Worth four-dot test at 33 cm had lower diagnostic value.Seventy-two cases with eye position between 0 and+10 PD at 1 day postoperatively were all successful in eye position at 6 months postoperatively.The postoperative eye position was the influencing factor for postoperative distance stereo with FVA(χ2=4.036,P=0.045).The age of onset and the preoperative distance stereoacuity with FD2 were the influencing factors of postoperative distance stereo reconstruction(b=-0.213,P=0.023;b=0.021,P=0.036).The area under the ROC curve of the age of onset and the preoperative distance stereoacuity with FD2 was 0.257 and 0.752,respectively.The former had no diagnostic value,and the latter had a medium diagnostic value.The best cutoff point was 22.5″with FD2 at 6 m.Conclusions Success rate of postoperative eye position is affected by the postoperative deviation at day 1.The optimal deviation at post-operation day 1 is 0-10 PD.Postoperative distance stereopsis is improved well and the surgery should be done before the distance stereoacuity is decreased to 22.5″with FD2 at 6 m.