儿童间歇性外斜视术后早期双眼视功能恢复及影响因素

Early Post-Operative Rehabilitation of Binocular Function and Its Influencing Factors in Children with Intermittent Exotropia

目的:探讨间歇性外斜视儿童眼位成功矫正后早期的双眼视功能恢复情况及其影响因素。方法:前瞻性临床研究。收集2019年7月至2020年7月期间于温州医科大学附属眼视光医院的间歇性外斜视术后1个月眼位矫正成功的患者177例,年龄7~14(9.97±2.16)岁。采用配对t检验、Pearson相关性检验和多元线性回归分析评估术后1个月的眼位和双眼视功能参数,及其与术前临床特征之间的相关性。结果:患者术后1个月斜视角均符合正位标准,与术前斜视角有显著差异(远距:-2.80^(△)±3.96^(△)vs.-33.67^(△)±9.17^(△),t=-41.83,P<0.001;近距:-4.05^(△)±4.68^(△)vs.-38.50^(△)±9.09^(△),t=-44.27,P<0.001)。远距(2.59±0.38 vs.2.80±0.25,t=7.30,P<0.001)和近距(2.19±0.36 vs.2.36±0.44,t=5.68,P<0.001)立体视较术前获得明显改善,分别有16.4%和22.0%患者获得远距和近距正常的立体视功能。术后远距知觉性融像功能较术前获得明显改善(χ^(2)=8.08,P=0.004),而近距结果与术前比较无差异明显统计学意义。术后1个月时的远距和近距立体视功能与术前年龄、屈光参差度、远距和近距立体视功能呈显著正相关(远距:r=0.15,P=0.043;r=0.19,P=0.012;r=0.28,P<0.001;r=0.22,P=0.004;近距:r=0.23,P=0.002;r=0.34,P<0.001;r=0.15,P=0.043;r=0.49,P<0.001)。结论:间歇性外斜视儿童眼位成功矫正后,术后早期立体视和知觉性融像功能较术前明显改善。术后立体视功能状态与手术年龄、屈光参差量、术前立体视功能有一定的相关性。

Objective:To investigate the early rehabilitation of binocular function and its influencing factors in children with intermittent exotropia(IXT)after successful correction of exo-deviation.Methods:This is a prospective clinical study.One hundred and seventy-seven IXT patients(age,7-14 years)with one-month postoperative successful correction exo-deviation were enrolled from July 2019 to July 2020 in Eye Hospital,Wenzhou Medical University.We used paired t test,Pearson correlation test and multiple linear regression test to evaluate the eye position and binocular function parameters at 1 month after operation and analyze the correlation between the binocular function parameters and their preoperative clinical characteristics.Results:All of the patients met the criteria of successful exodeviation correction,which was significantly different from that before operation(distant fixation:-2.80^(Δ)±3.96^(Δ)vs.-33.67^(Δ)±9.17^(Δ),t=-41.83,P<0.001;near fixation:-4.05^(Δ)±4.68^(Δ)vs.-38.50^(Δ)±9.09^(Δ),t=-44.27,P<0.001).The differences in distance and near stereopsis before and after surgery were statistically significant(2.59±0.38 vs.2.80±0.25,t=7.30,P<0.001;2.19±0.36 vs.2.36±0.44,t=5.68,P<0.001,respectively).Only 16.4%and 22.0%of the patients obtained normal distance and near stereopsis.The sensory fusion was siginficantly improved at distance(χ^(2)=8.08,P=0.004),while not at near.There was positive correlation between stereopsis and preoperative characteristic parameters,such as the operation age,anisometropia and preoperative distance and near stereopsis(distance stereopsis:r=0.15,P=0.043;r=0.19,P=0.012;r=0.28,P<0.001;r=0.22,P=0.004 respectively;near stereopsis:r=0.23,P=0.002;r=0.34,P<0.001;r=0.15,P=0.043;r=0.49,P<0.001,respectively).Conclusions:The binocular function,such as stereopsis and sensory fusion were obtained significantly rehabilitation at one-month postoperative.Early postoperative stereopsis was correlated with age,anisometropia and preoperative stereopsis.