不同年龄段基本型间歇性外斜视青少年的斜视手术疗效观察

The efficacy of strabismus surgery in adolescents with basic intermittent exotropia at different age stages

目的探讨不同年龄段基本型间歇性外斜视青少年行斜视矫正术的疗效。方法2017年1月至2019年1月行单眼手术治疗的基本型间歇性外斜视青少年患者81例,均行单眼外直肌后徙加内直肌截除术手术治疗,根据患者年龄分为低龄组(4~8岁,38例)及大龄组(8~18岁,43例)。比较两组术前及术后3月看远和看近的斜视度、融合功能(融合范围)、近立体视锐度,及生活质量[斜视儿童生存质量量表(Child-IXTQ)]的差异,并比较两组术后3月的临床疗效。结果术后3月,两组看远、看近斜视度均较术前降低,且低龄组术后斜视度低于大龄组,治愈率高于大龄组(P<0.05);两组融合范围均较术前改善,且低龄组优于大龄组(P<0.05);儿童及家长代理Child-IXTQ评分均较术前升高,低龄组优于大龄组(P<0.05)。两组手术前后近立体视锐度比较,差异无统计学意义(P>0.05)。结论不同年龄段基本型间歇性外斜视青少年行斜视矫正术的治疗效果均较好,但年龄较小者术后正位率更高,融合功能恢复更佳,生活质量改善更明显;临床可考虑在患儿能配合术前检查情况下,尽早及时治疗间歇性外斜视,以达到功能性治愈,改善患者生活质量。

Objective To explore the efficacy of strabismus correction surgery in the treatment of adolescents with basic intermittent exotropia at different age groups.Methods A retrospective analysis was performed on clinical data of 81 adolescent patients with basic intermittent exotropia in our hospital who underwent monocular surgery from January 2017 to January 2019.The patients were treated by monocular lateral rectus recession combined with medial rectus resection.They were divided into younger age group(4-8 years old,n=38)and older age group(8-18 years old,n=43).The distance and near exotropia deviations,fusion function(fusion range),near stereoscopic visual acuity and quality of life estimated with Child Intermittent Exotropia Questionnaire(Child-IXTQ)were compared between the two groups before surgery and after 3 months of surgery.Results After 3 months of surgery,the distance and near exotropia deviations were decreased compared with those before surgery(P<0.05),and the postoperative exotropia deviation of the younger age group was lower than that of the older age group(P<0.05).The clinical efficacy of the younger age group was higher than that of the older age group(P<0.05).The fusion ranges in the two groups were improved compared with those before surgery(P<0.05),and the range in the younger age group was better than that in the older age group(P<0.05).The Child-IXTQ scores of children and parent agents were increased compared with those before surgery(P<0.05),and the scores in the younger age group were better than those in the older age group(P<0.05).There was no statistically significant difference in the near stereoscopic visual acuity before and after surgery between the two groups(P>0.05).Conclusion Strabismus correction surgery is an effective treatment for adolescent patients with basic intermittent exotropia at different age groups,but younger patients have higher postoperative normotopia rate,better fusion function recovery,and significant improvement of quality of life.Clinically,it could be considered to treat intermittent exotropia as young as possible in order to achieve a functional cure and improve the quality of life if children patients could cooperate with preoperative examination.