基于双眼推拉模型的视觉训练在9~16岁屈光参差性弱视儿童中的应用

Comparison of the Effectiveness of Two Visual Training Models for Anisometropic Amblyopia in Patients Aged 9─16

目的:比较基于双眼推拉模型的视觉训练和传统综合训练对9~16岁大龄屈光参差性弱视儿童的临床疗效。方法:前瞻性随机对照研究。收集2017年6月至2018年3月在南宁市爱尔眼科医院门诊确诊的9~16岁屈光参差性弱视儿童64例(64眼)。随机分为推拉模型训练组(32例)和传统综合训练组(32例),2组均在屈光矫正的基础上联合视觉训练治疗12个月。推拉模型训练组全天无需遮盖,通过双眼分视以视频刺激的方式进行训练。具体训练方案由医师根据患者初始视力、知觉眼位、抑制度、视功能缺损的严重程度以及每阶段训练后的进步情况等信息来制定。传统综合训练组是在遮盖优势眼的基础上予以精细训练、红光闪烁训练。比较2组患者治疗前后的最佳矫正视力、0阶立体视、1阶立体视、2阶立体视及屈光度数的变化。2组疗效(等级资料)、阶度立体视的比较采用秩和检验,对屈光度数的变化的分析采用独立样本 t检验。 结果:治疗12个月后,2组各失访1例。经过治疗,推拉模型训练组基本治愈7眼(23%),进步24眼(77%),无效0眼(0%);传统综合训练组基本治愈2眼(6%),进步25眼(81%),无效4眼(13%),2组疗效比较差异有统计学意义( Z=-2.490, P=0.013)。推拉模型训练组31眼logMAR视力总共提高146行,传统综合训练组总共提高89行。推拉模型训练组视力提升效率高于传统综合训练组。推拉模型训练组的0阶立体视、1阶立体视、2阶立体视改善程度均较传统综合训练组明显( Z=-4.861, P<0.001;Z=-3.706, P<0.001;Z=-5.819, P<0.001)。治疗前后2组患者的球镜度数、柱镜度数、等效球镜度数差异均无统计学意义。 结论:基于双眼推拉模型的视觉训练在改善大龄屈光参差性弱视儿童弱视眼的视力及立体视方面均优于传统综合训练。

Objective:To compare the effectiveness of visual training based on the binocular push-pull model and traditional combined training for anisometropic amblyopia in patients aged 9 to 16 years.Methods:This was a prospective randomized,controlled study.A total of 64 patients(64 eyes)aged 9 to 16 years who had been diagnosed with anisometropic amblyopia were recruited in Nanning Aier Eye Hospital from June 2017 to March 2018.Patients were randomly divided into a push-pull training group(32 eyes)and a traditional combined training group(32 eyes).The two groups underwent visual training and refractive correction for 12 months.Patients in the push-pull training group were trained with video stimulation by binocular splitting without eye covering,and the training details were designed based on visual acuity(VA),eye position during perception,degree of inhibition,severity of visual impairment and the effect of the most recent training session.Meanwhile,patients in the traditional combined training group underwent fine training and red light flashing at the same time by covering the non-amblyopic eye.The best corrected visual acuity,zero-order stereopsis,first-order stereopsis,second-order stereopsis and refractive error before and after treatment were compared between the two groups.A rank sum test compared the therapeutic effect(grading data),and order of stereopsis between the groups.An independent samples t test compared the change in visual acuity between the groups.Results:After 12 months of treatment,a patient lost in each group.The push-pull training group had basically cured 7 eyes(23%),improved 24 eyes(77%),and failed 0 eyes(0%);the traditional combined training group basically cured 2 eyes(6%),improved 25 eyes(81%),and failed 4 eyes(13%).The differences of the therapeutic effects were statistically significant(Z=-2.490,P=0.013).The logMAR visual acuity total for distance in the push-pull training group improved 146 lines,which was higher than 89 lines for traditional combined training group.Furthermore,compared with the traditional combined training group,zero-order stereopsis,the first-order stereopsis and second-order stereopsis of the push-pull training group improved significantly(Z=-4.861,P<0.001;Z=-3.706,P<0.001;Z=-5.819,P<0.001).However,there was no significant difference in spherical refraction,cylinder refraction,or spherical equivalent between the two groups before and after treatment.Conclusions:Visual training based on the binocular push-pull model is superior to the traditional combined training in improving visual acuity and stereopsis of patients with anisometropic amblyopia aged 9 to 16 years.