三棱镜联合感知觉学习训练治疗间歇性外斜视的临床研究

Clinical application value of prism combined with perceptual learning?training in the treatment of intermittent exotropia

目的探讨间歇性外斜视发病机制及三棱镜联合感知觉学习训练治疗间歇性外斜视的临床价值。方法选取衡水市第二人民医院眼科2014年6月至2015年12月收治的110例单纯间歇性外斜视患者纳入观察组,另以同期积极配合检查的110例视力正常儿童纳入对照组。2组均行同视机检查、同视机随机点检查、Frisby立体视检测卡检测。比较2组同视机重合点、离散性融合、集合性融合、融合范围绝对值、Frisby近立体视、同视机远立体视。对观察组采取三棱镜联合感知觉学习训练治疗,比较治疗前后三棱镜远距离水平与近距离水平的离散性融合、集合性融合、融合范围、散开集合比。结果2组同视机离散性融合差异无统计学意义(P>0.05);观察组重合点较对照组外移、同视机集合性融合与融合范围绝对值较对照组缩小,Frisby近立体视较对照组减小,同视机远立体视检出率低于对照组,差异有统计学意义(P<0.05)。观察组治疗后三棱镜远距离下融合范围较治疗前变化差异无统计学意义(P>0.05),离散性融合较治疗前减小、集合性融合较治疗前增大、散开集合比减小,差异有统计学意义(P<0.05);近距离下的离散性融合较治疗前变化差异无统计学意义(P>0.05),集合性融合、融合范围较治疗前增大、散开集合比减小,差异有统计学意义(P<0.05)。结论远距离下离散性融合亢进、集合性融合缩小与近距离下集合性融合缩小、重合点向外漂移是间歇性外斜视的主要发病机制。三棱镜联合感知觉学习训练治疗间歇性外斜视可有效改善患儿远距离下离散性融合亢进、集合性融合缩小及近距离下集合性融合缩小,促进患者视功能改善,效果理想。

Objective To explore the pathogenesis of intermittent exotropia and the clinical application value of prism combined with perceptual learning training.Methods A total of 110 patients with intermittent exotropia who were admitted and treated in our hospital from June 2014 to December 2015 were enroll as observation group,and 110 healthy children with normal vision were enrolled as control group.The subjects in both groups were examined by synoptophore,random-spot synoptophore and Frisby stereoscopic inspection card.The coincidence points,dispersion fusion,collective fusion,absolute value of fusion range,Frisby near stereopsis and far stereo vision were observed and compared between the two groups.The patients in observation group were treated with prism combined with perceptual learning training.And the dispersion fusion,collective fusion,fusion range and diffuse collection ratio before and after treatment were compared.Results There was no statistically significant difference in dispersion fusion of synoptophore between the two groups(P>0.05).The outward shift of the coincidence point,collective fusion and the absolute value of fusion range in observation group were smaller than those in control group.Frisby near stereopsis was decreased compared with that in control group and the detection rate of far stereo vision in observation group was lower than that in control group(P<0.05).After treatment,there was no statistically significant difference in the fusion range of prism from a distance(P>0.05).The dispersion fusion and diffuse collection ratio were decreased while collective fusion was increased(P<0.05).Moreover,there was no statistically significant difference in dispersion fusion(P>0.05).The collective fusion and fusion range were increased while dispersion fusion was decreased,and significant differences were found(P<0.05).Conclusion The main pathogenesis of intermittent exotropia is the hyperactivity of dispersion fusion and the shrinkage of collective fusion from a distance as well as the the shrinkage of collective fusion and the outward shift of the coincidence point at a short distance.Prism combined with perceptual learning training can effectively improve the hyper fusion of dispersion fusion,the shrinkage of collective fusion from a distance and the shrinkage of collective fusion at a short distance so as to improve the visual function of the patients.