不同类型间歇性外斜视儿童调节集合功能研究

Study on the function of regulating aggregation in children with different types of intermittent exotropia

目的:通过观察集合不足型、基本型、分开过强型间歇性外斜视(IXT)儿童的调节幅度(AMP)、调节灵活度(AF)、集合近点(NPC)、调节性集合/调节(AC/A)及正相对集合(PRC)测量值,并与非斜视儿童对比,研究其调节与集合功能差异。方法:临床回顾性研究。收集2018-12/2020-06我院就诊的6~12岁IXT儿童40例,根据6m及33cm斜视度测量差值,将患者分为三组:集合不足型12例、基本型18例、分开过强型10例。同期就诊非斜视儿童20名作为对照组。采用改良移近法及±2D翻转法分别测量双眼AMP及AF,移近法测量NPC,梯度法测量AC/A值,底朝外(BO)的棱镜测量远PRC及近PRC。比较各组患者间调节及集合参数测量值的差别。结果:IXT儿童集合不足组、基本组、分开过强组与对照组双眼AMP、AF、NPC、AC/A、近PRC、远PRC比较有差异(P<0.05)。进一步两两比较,IXT各组AMP均低于对照组,集合不足组AMP低于其他IXT两组;集合不足组AF低于基本组和对照组;集合不足组NPC大于其他三组;集合不足组和基本组AC/A低于其他两组;IXT各组近PRC均低于对照组,集合不足组近PRC低于其他IXT两组;IXT各组远PRC均低于对照组(均P<0.05)。结论:IXT儿童不同类型之间存在调节及集合差异,集合不足型低于其他类型。IXT儿童双眼调节集合功能低于非斜视儿童。

AIM:To investigate the binocular accommodative amplitude(AMP)and accommodative facility(AF),near point of convergence(NPC),accommodative convergence/accomodation ratio(AC/A),positive relative convergence(PRC)of intermittent exotropia(IXT)children,according to the convergence insufficiency type,basic type,divergence excess type,and to compare with the normal children,investigating the differences of regulation and collection function.METHODS:Totally 40 IXT children were divided into three groups according to the different types of the IXT patients,the convergence insufficiency group(12 children),the basic group(18 children)and the divergence excess group(10 children).And the 20 non-exotropia children were set up as the control group.AMP was measured with improved push-up test,and AF was measured with turning over convex and concave lens test.NPC was measured with push-up test.AC/A ratio were measured with the lens gradient method.PRC was measured with BO prism.The binocular accommodative and convergence function of four groups were compared.RESULTS:The difference of AMP,AF,NPC,AC/A ratio and PRC among four groups was significant difference(P<0.05),and we did the further pair wise comparisons.AMP of the IXT group was less than the control group,and AMP of the convergence insufficiency group was the least;AF of the convergence insufficiency group was less than the basic group and the control group;NPC of the convergence insufficiency group was the largest;AC/A ratio of the convergence insufficiency group and the basic group was lower than the other two groups;PRC of the IXT group was less than the control group when fixating at near target of 33cm,and the mean of the convergence insufficiency group was the least;PRC of the IXT group was less than the control group when fixating at far target of 6mo(P<0.05).CONCLUSION:There are differences in the ocular function of accommodation and convergence in different types of IXT children,and the function of the convergence insufficiency IXT is the worst.The binocular accommodative and convergence function of IXT children is worse than non-exotropia children.