同视机法与基于计算机平台的知觉眼位检查法检测间歇性外斜视患者主观斜视角的对比观察

Comparative study of subjective squint deviation in patients with intermittent exotropia measured with synoptophore method and computer-based perceptual eye position test

目的对比分析同视机法与基于计算机平台的知觉眼位检查法检测间歇性外斜视患者的主观斜视角的差别。设计前瞻性比较性病例系列。研究对象间歇性外斜视患者355例。方法用同视机检测患者的远距离主观斜视角,用基于计算机平台的知觉眼位检查方法检测间患者的中距离主观斜视角。主要指标水平主观斜视角和垂直主观斜视角。结果同视机检查水平主观斜视角平均值为(-8.85±5.39)°,垂直眼位偏斜平均值为(2.13±1.33)°;知觉眼位检查水平主观斜视角平均值为(287.41±220.80)像素(1°=53像素),垂直眼位偏斜平均值为(25.06±33.95)像素。水平主观斜视角的检出率,知觉眼位检查(84.79%,301/355)高于同视机检查(63.10%,224/355)(χ^2=51.115,P=0.000);垂直眼位偏斜的检出率,知觉眼位检查(82.82%,294/355)高于同视机检查(6.44%,23/355)(χ^2=267.033,P=0.000)。同视机检查23例存在垂直眼位偏斜的患者,其水平主观斜视角为(-10.48±3.19)°,其垂直主观斜视角为(2.13±1.33)°,两者之间不呈线性相关(r=-0.211,P=0.335)。知觉眼位检查294例存在垂直眼位偏斜的患者,其水平主观斜视角为(291.05±220.43)像素,垂直主观斜视角为(25.06±33.95)像素,两者之间呈线性相关(r=0.406,P=0.000)。206例患者两种方法同时检测出了水平主观斜视角,同视机检查为(-8.84±5.31)°,知觉眼位检查为(296.14±222.19)像素,两者之间呈线性相关(r=-0.301,P=0.000)。22例用两种方法同时检测出垂直眼位偏斜,同视机检查为(2.09±1.34)°,知觉眼位检查为(42.95±40.88)像素,两者之间不具有线性相关关系(r=0.119,P=0.598)。结论在间歇性外斜视患者中,同视机法与知觉眼位主观斜视角检查法均能反映患者双眼分视状态下水平方向的眼位偏斜状态;知觉眼位检查法在垂直方向的眼位偏斜检出率明显高于同视机法;垂直方向的知觉眼位偏斜随着水平方向知觉眼位偏斜的增加而增大。知觉眼位检查法是一种更灵敏精确地反映间歇性外斜视患者眼位偏斜状态的检查方法。

Objective To compare the subjective squint deviation(SSD)in patients with intermittent exotropia detected with synoptophore method and computer-based perceptual eye position(PEP)test.Design Prospective comparative case series.Participants 355 patients with intermittent exotropia.Methods The long-distance SSD was detected with synoptophore method and,at the same time,middle-distance SSD was detected with the computer-based PEP test.Main Outcome Measures Horizontal SSD and vertical SSD.Results With synoptophore method,the mean SSD in the horizontal direction was(-8.85±5.39)°,and mean vertical deviation of eye position was(2.13±1.33)°.With PEP test,the mean SSD in the horizontal direction was(287.41±220.80)(1°=53 pixels)pixels,and mean vertical deviation of eye position was(25.06±33.95)pixels.The detection rate of horizontal SSD was higher with PEP test(84.79%,301/355)than with synoptophore method(63.10%,224/355)(χ^2=51.115,P=0.000).The detection rate of vertical eye position deviation was higher with PEP test(82.82%,294/355)than with synoptophore method(6.44%,23/355)(χ^2=267.033,P=0.000).The horizontal SSD was(-10.48±3.19)°and the vertical SSD was(-2.13±1.33)°in 23 patients with vertical eye position deviation detected with synoptophore method,and there was no linear correlation between them(r=-0.211,P=0.335).The horizontal SSD was(291.05±220.43)pixels,and the vertical SSD was(25.06±33.95)pixels,and there was a linear correlation between them(r=0.406,P=0.000).In 206 patients simultaneously having horizontal SSD of two methods,the SSD was(-8.84±5.31)°in synoptophore method and(296.14±222.19)pixels in PEP test,respectively.And there was a linear correlation between them(r=-0.301,P=0.000).In 22 patients simultaneously having the vertical SSD of two methods,the SSD was(2.09±1.34)°in synoptophore method,and(42.95±40.88)pixels in PEP test.And there was no linear correlation between them(r=0.119,P=0.598).Conclusion In patients with intermittent exotropia,both SSD and PEP can reflect the horizontal eyes position deviation in the state of binocular differentiate gaze,but the detection rate of PEP test in the vertical direction was much higher than that of synoptophore method.The vertical PEP increased accordingly with the enlargement of the horizontal PEP.PEP test was a more sensitive and more comprehensive test of the eye position deviation.