不同训练方式对间歇性外斜视患者术后斜视度及双眼视觉功能的疗效观察

Effect of different training methods on strabismus and binocular visual function for postoperative patients with intermittent exotropia

目的 比较不同训练方式对间歇性外斜视患者术后斜视度及双眼视觉功能的疗效.方法 前瞻性研究.收集北京同仁医院北京同仁眼科中心2017年1 月至2017 年9 月间歇性外斜视且进行斜视矫正术者312 例.其中,男性162 例,女性150 例,年龄3~36 岁,平均(11.3±7.3)岁.根据术后1 周开始不同训练的需要,采用数字表法随机将患者分为观察组(102 例)、传统训练组(105 例)及视感知训练组(105 例).检查并记录患者训练前、训练后1 个月、训练后3 个月及训练后6个月时的远近斜视度、同视机三级功能恢复率及近立体视恢复率.采用广义线性混合效应线性模型,对上述指标进行比较.结果 训练前、训练后1 、3 个月及6 个月三组平均看近斜视度分别为(0.68±2.08)△、(1.45±3.19)△、(1.74±3.69)△及(2.36±4.48)△.训练后 1 个月、3 个月及6个月与训练前比较差异有统计学意义(t=2.57,2.98,3.54;P<0.05).看远斜视度分别为(0.70±2.15)△、(1.45±3.19△、(1.78±3.72)△及(2.42±4.5 1)△.训练后1 个月、3 个月及6 个月与训练前比较差异有统计学意义(t=2.35,2.75,3.67;P<0.05).同视机Ⅰ级功能恢复率,术后均达到95%以上,三组的组间差异无统计学意义(F=0.92,P>0.05).同视机Ⅱ级功能恢复率,训练后3 个月比训练前增加16例(占9.25%),其差异有统计学意义(F=4.32,P<0.05);训练后6 个月比训练前及训练后1 个月分别增加23 例(占 13.29%)及20 例(占 11.56%),其差异有统计学意义(F=6.15,5.17;P<0.05).同视机Ⅲ级功能恢复率,视感知觉组训练后3 个月及6 个月比训练前分别增加17例(占31.48%)及21 例(占38.89%),其差异有统计学意义(F=10.80,16.34;P<0.05);传统训练组训练后3个月及6个月比训练前分别增加13例(占20.64%)及14例(占22.20%),其差异有统计学意义(F=5.36,6.22;P<0.05).近立体视恢复率,训练后3 个月比训练前增加22 例(占12.87%),其差异有统计学意义(F=6.28,P<0.05);训练后6个月比训练前、训练后1 个月及3个月分别增加46 例(占26.90%)、40 例(占23.39%)及24例(占14.03%),其差异有统计学意义(F=12.35,9.54,5.78;P<0.05).结论 间歇性外斜患者术后经过训练,其同视机Ⅰ级功能恢复率、Ⅱ级功能恢复率及近立体视恢复率均比训练前提高;视感知觉训练组及传统训练组患者的同视机Ⅲ级功能恢复率,训练后3个月及6个月均显著高于训练前.而观察组患者,不但其同视机三级功能恢复率无提高,而且随着时间的延续其远近斜视度却均表现为增大的情况.

Objective To compare the effect of different training methods on strabismus and binocular visual function for postoperative patients with intermittenl exotropia.Methods Prospeclixe randomized controlled study.312 patients with intermiltent exotropia who untlenvent strabismus surgeiy from January to September 2017 in Beijing Tongren Hospital were recruited,including 162 males and 150 females,age(3 to 36)with an average age of(11.3±7.3)years-old.According to the table of Random Numbers,patients were divided into three groups,including observation group(102),traditional binocular vision Iraining grouj)(105)and visual perception training group(105).The patients were followed up at before and 1,3 and 6 months after training.Generalized Unecir Mixed Effec t Linear Model was used to the strabismus and binocular visual finictioii before and 1,3,and 6 months after training.Results The near stmbisnius hefore*training,after tiainiiig in 1,3,and 6 months was(0.68±2.08)A,(1.45±3.19)△,(1.74±3.69)△ ami(2.36±4.48)△,respectively.Hie comparison between 1,3 and 6 months after training anti beforerain in g、vas statistically significant(F=2.57,2.98,3.54;P<0.05).The far stml)ismus before Iraining,after training;in 1,3,and 6 months were(0.70±2.15)△,(1.45±3.19)△,(1.78±3.72)△ aii(l(2.42±4.51)A,resperlivdy.The(.om[mi.is(ms between 1,3 and 6 months after training and Ijefore training were statistically significant(F=2.35,2.75,3.67;P<0.05).The recoveiy rate of grade I hinoc ular funt-tion after ojjeration was more than 95%;there were no significant differences in groups(F=0.92,P>0.05).The recover)rate of grade Ⅱ binoc-ular(unction from 16 rases accouting for 9.25%was higher at 3 months after training than at before tiaining,and their comparisons were statistically significanl(F=4.32,P<0.05).The recoveiy rates of grade Ⅱ hinocular function from 23 cases accouting lor 13.29%and 20 cases accouting for 11.56%were higher at 6 months after training than at 1 month after training,and their comjwisons were statistically significant(F=6.15,5.17;P<0.05).the recoven rates of grade H[binocular function from 17 cases accouting for 31.48%and 21 cases accouting for 38.89%were higher at 3 months and 6 months after training compared with that before training in visual perception training grouj),and tlieir comparisons were statistically signilicanl(F=10.80,16.34;P<0.05).The recoveiy rates of grade Ⅲ binocular function from 13 cases accouting for 20.64%and 14 cases accouting for 22.20%were higher at 3 and 6 months after the training compared with that before the training in traditional hinocular vision training group,and their comparisons were statistically significant(F=5.36,6.22;P<0.05).The recoveiy rates of near stereopsis from 122 cases acc-outing for 12.87%were higher at 3 months after training compared with that l)efore training,and their comparisons were statistically significant(F=6.28,P<0.05).The recoven rates of near stereopsis from 46 cases accouting for 26.90%,40 cases accouting for 23.39%and 24 cases accouting for 14.03%were higher at 6 months after the training compared with that l)efore the training,1 month and 3 months after training,and their comparisons were statistically significant(F=12.35,9.54,5.78;P<0.05).Conclusions After the training of patients with intermittent exotropia,the rec,overy,rate of grade I,grade Ⅱ binocular function and near stereoscopic1 vision of was improved compared with that before training.The recoven rate of grade Ⅲ binocular function was significantly improved in the traditional hinocular vision training group and tlie visual perception training group at 3 and 6 months after training than before training;however the recovery rate was not improved in the observation group.I5olh further and near strabisnms had increase with the time going on.