笔尖训练与双眼视觉训练治疗间歇性外斜视术后欠矫的疗效对比

Comparative Study of Pencil Push-Up Training versus Binocular Vision Training for a Slight Postoperative Undercorrection of Intermittent Exotropia

目的:比较笔尖训练法和双眼视觉训练法治疗间歇性外斜视患者术后轻度欠矫的疗效。方法:前瞻性队列研究。纳入在南京医科大学附属儿童医院眼科接受间歇性外斜视手术治疗并于2015年6月至2016年6月发生术后轻度欠矫(-8^△^-15^△)的患者54例。将患者分为笔尖训练组和双眼视觉训练组。笔尖训练为将笔尖由远移近到鼻根至出现复视后再退回,患者反复训练,20个周期为1组,连续做3组,共约15min,每天2次,每周训练5d,持续6个月;双眼视觉训练组患者进行每周1次,每次60min的医院内训练,以及每周5次,每次15min的家庭训练,持续6个月。所有患者均于训练前,训练1个月、3个月和6个月时接受看远斜视度、看近斜视度和看远立体视检查。数据采用独立样本t检验、重复测量两因素方差分析、卡方检验进行分析。结果:54例患者中,26例进行笔尖训练,28例进行双眼视觉训练。训练前笔尖训练组和双眼视觉训练组的看远、看近斜视度差异无统计学意义;训练3个月时,笔尖训练组看远、看近斜视度均大于双眼视觉训练组,差异有统计学意义(t=3.44,P<0.001;t=2.55,P=0.01)。双眼视觉训练组训练1个月和3个月时看远斜视度差值、看近斜视度差值均大于笔尖训练组,差异有统计学意义(t=-3.17,P=0.003;t=2.32,P=0.02)。训练1个月、3个月时,2组看远立体视差异无统计学意义;训练6个月时,双眼视觉训练组看远立体视优于笔尖训练组,差异有统计学意义(t=9.33,P<0.001),训练6个月时,双眼视觉训练组正常立体视获得率高于笔尖训练组,差异有统计学意义(χ^2=5.02,P=0.03)。结论:笔尖训练和双眼视觉训练均能降低间歇性外斜视术后欠矫患者斜视度,效果一致,但双眼视觉训练对欠矫患儿立体视功能的恢复优于笔尖训练。

Objective:To compare the efficacy of vision training and pencil push-ups as treatments for patients with small-angle exodeviation after surgery for intermittent exotropia.Methods:A controlled clinical trial was performed.Patients who presented with small-angle exodeviation(15^△>exotropia>8^△)after surgery for intermittent exotropia were recruited in Children's Hospital of Nanjing Medical Uviverstiy from June 2015 to June 2016.Fifty-four patients were divided into a vision training group(28)and a pencil push-up group(26).Patients in the pencil push-up group were instructed to hold a pencil at arm's length directly between their eyes.They were asked to continue moving the pencil slowly toward their nose until it could no longer be seen as a single image and then try to get the pencil point back into a single image.Patients were instructed to do 3 sets of 20 pencil push-ups per day at home,5 days per week for 6 months.This treatment required an average of 15 minutes per day.Patients in the vision training group received therapy administered by a trained therapist during a weekly 60-minute office visit,with additional procedures to be performed at home for 15 minutes a day,5 times per week for 6 months.Tests were performed before training and compared to results at 1,3 and 6 months after training,including exodeviation at distance and near,and stereoacuity at distance.An independent samples t test,two-way repeated measures ANOVA,a paired t test and chi-square test were used for statistical analysis.Results:At 1 month and 6 months after training,the magnitude of the exodeviation between the pencil push-up group and the vision training group at distance and near was not significantly different.However,there was a significant difference between groups at 3 months after training,demonstrating a higher magnitude of exodeviation in the pencil push-up group than in the vision training group(t=3.44,P<0.001;t=2.55,P=0.01).The difference in the magnitude of exodeviation at distance and near between 1 month and 3 months after training was significant(t=-3.17,P=0.003;t=2.32,P=0.02).At 1 month and 3 months after training,the magnitude of stereoacuity at distance between the pencil push-up group and vision training group was not significantly different,However,there was a significant difference between the two groups at 6 months,demonstrating a better stereoacuity in the vision training group than in the pencil push-up group(t=9.33,P<0.001).At 6 months after training,the normal stereoscopic acquisition rate of the vision training group was higher than that of the pencil push-up group(χ^2=5.02,P=0.03).Conclusions:Both vision training and pencil push-up training can effectively decrease the magnitude of small-angle exodeviation after surgery for intermittent exotropia.However,vision training has a better effect on stereoacuity.