功能训练对间歇性外斜视调整缝线术后双眼视功能及复发的影响

Influence of function training on binocular visual function and recurrence of intermittent exotropia after surgery with adjustable suture

目的分析功能训练对间歇性外斜视调整缝线术后双眼视功能及复发的影响。方法分析2015年2月—2019年2月郑州市第二人民医院斜视小儿眼科1病区收住的360例间歇性外斜视患者,所有患者全麻行显微镜下调整缝线斜视矫正术。分为对照组和观察组,对照组124例,术后未做视功能训练;观察组236例,术后第2 d检查同视机、立体视和眼位,行个体化视功能训练。分析2组患者术后双眼视功能、眼位及复发情况。结果(1)双眼视功能:术后2组患者双眼视功能比较有统计学意义(Z7 d=2.123,P=0.034;Z1个月=6.640,Z3个月=9.241,Z6个月=7.909,均P=0.000);(2)近立体视:术后7 d,2组患者近立体视比较无统计学意义(P>0.05),术后1、3及6个月,2组比较有统计学意义(x^21个月=20.231,x^23个月=64.033,x^26个月=121.464,均P=0.000);治疗组重建三级视功能和黄斑立体视的患者比例显著高于对照组。(3)眼位:术后7 d,2组患者比较无统计学意义(P>0.05),术后1、3、6个月有统计学意义(x^21个月=4.660,P=0.031;x^23个月=5.957,P=0.015;x^26个月=8.930,P=0.003),治疗组远期效果优于对照组。(4)复发率:至术后6个月,治疗组无复发,对照组复发5例,2组比较有统计学意义(x^2=7.698,P=0.006)。结论术后视功能恢复情况是影响间歇性外斜视患者复发率的重要原因,采用调整缝线斜视矫正术、术后尽早行视功能训练可降低复发率。

OBJECTIVE To analyze the influence of functional training on binocular visual function and recurrence rate of intermittent exotropia after the surgery with adjustable suture.METHODS The clinical data of 360 patients with intermittent exotropia were analyzed,who admitted to the pediatric ophthalmology ward 1 of Zhengzhou Second Hospital from February 2015 to February 2019.Under general anesthesia,all patients underwent strabismus correction with adjustable suture under microscope.124 cases were not trained in visual function postoperatively as control group.236 cases were examined for synoptophore,near stereopsis and eye position on the 2nd day after surgery,and individualized visual function training was performed as treatment group.Binocular visual function,ocular position and recurrence rate of the two groups were observed postoperatively.RESULTS(1)Binocular visual function:there was statistical significant difference in binocular visual function between the two groups after operation(Z7 d=2.123,P=0.034;Z1 mon=6.640,Z3 mon=9.241,Z6 mon=7.909;all P=0.000);(2)Near stereopsis:There was no significant difference in near stereopsis between the two groups on the 7th days after operation(P>0.05),but there was significant difference between the two groups at 1,3 and 6 months postoperatively(c21 mon=20.231,c23 mon=64.033,c26 mon=121.464;all P=0.000),the proportion of patients in the treatment group who reconstructed the binocular visual function and macular stereoscopic vision was significantly higher than that in the control group.(3)Eye position:there was no significant difference between the two groups on the 7th day after operation(P>0.05),but there was statistical significance at 1,3 and 6 months after surgery(c21 mon=4.660,P=0.031;c23 mon=5.957,P=0.015;c26 mon=8.930,P=0.003),the long-term correction effect of the treatment group was better than that of the control group.(4)Recurrence rate:up to 6 months after operation,there was no recurrence in the treatment group and 5 cases in the control group.There was statistical significance between the two groups(c2=7.698,P=0.006).CONCLUSIONS The recovery of postoperative visual function is an important reason for the recurrence rate of intermittent exotropia.Adjusting suture strabismus correction and early postoperative visual function training can reduce the recurrence rate.