部分和全天遮盖治疗儿童单眼弱视首剂效应的疗效分析

First-dose response of part-time versus full-time occlusion therapy for the treatment of amblyopia in children

目的:探讨单眼弱视患者每日部分或全天遮盖优势眼后首次复诊的疗效,评估不同遮盖量所产生的最大效能。方法:回顾性临床研究。连续收集我院2020-01/2021-12本院门诊治愈的单眼弱视患者135例。根据遮盖时间分为2h/d遮盖组、6h/d遮盖组和全天遮盖组,配合弱视眼精细目力训练,记录首剂效应(基线视力-首次复查视力)、治愈视力、首次复诊时立体视觉以及弱视眼治愈时间。并分析影响单眼弱视患者首剂效应的因素。结果:所有患者基线视力为0.4(0.22, 0.52),首次复诊视力为0.22(0.15, 0.3),首剂效应为0.1(0.08, 0.18),弱视达治愈时视力为0(-0.08, 0.05)。2h/d遮盖组患者首剂效应为0.08(0.07, 0.12),6h/d遮盖组为0.18(0.08, 0.3),全天遮盖组为0.10(0.08, 0.18),6h/d遮盖组首剂效应最显著(P<0.05);不同影响因素分析显示3~6岁组、7~12岁组、女性组、斜视性弱视组、轻中度弱视组的6h/d遮盖首剂效应值最高(P<0.05);同时,6h/d遮盖首剂效应与弱视眼治愈时间呈正相关(r=0.334,P=0.038)。首次复诊时,6h/d遮盖组Titmus立体视敏度提高者21例(53.8%),高于2h/d和全天遮盖组[16例(41.0%),13例(22.8%),P<0.017]。结论:6h/d遮盖治疗单眼弱视患者首剂效应最显著,立体视觉恢复最好。

AIM: To investigate the efficacy of the first follow-up visit after daily partial or full-day occlusion of the dominant eye in patients with unilateral amblyopia and assess the maximum efficacy produced by different amounts of occlusion.METHODS: A retrospective clinical study was conducted on 135 cases of unilateral amblyopia cured in our hospital’s outpatient clinic from January 2020 to December 2021. They were divided into 2 h/d occlusion group, 6 h/d occlusion group and all-day occlusion group according to the duration of occlusion, with fine sight training of amblyopic eyes. The effect of the first dose(baseline visual acuity-first review visual acuity), cured visual acuity, stereo vision at the first review and cure time of amblyopic eyes were recorded. The factors affecting the first dose effect in patients with unilateral amblyopia were also analyzed.RESULTS: All patients had a baseline visual acuity of 0.4(0.22, 0.52), a first follow-up visual acuity of 0.22(0.15, 0.3), a first-dose effect of 0.1(0.08, 0.18), and a visual acuity of 0(-0.08, 0.05) when amblyopia cured. The first-dose effects were 0.08(0.07, 0.12) for patients in the 2 h/d occlusion group, 0.18(0.08, 0.3) for the 6 h/d occlusion group, and 0.10(0.08, 0.18) for the all-day occlusion group. The most significant first-dose effect was the 6 h/d occlusion group(P<0.05);Analysis of different influencing factors showed that the highest values of the first-dose effect of 6 h/d occlusion were in the 3-6 years group, 7-12 years group, female group, strabismic amblyopia group and mild to moderate group(P<0.05);Furthermore, the first dose effect of the 6 h/d occlusion was positively correlated with cure time of amblyopic eyes(r=0.334, P=0.038). At the first follow-up, 21 cases(53.8%) had improved Titmus stereo visual acuity in the 6 h/d occlusion group, which was higher than that in the 2 h/d and all-day occlusion groups [16 cases(41.0%), 13 cases(22.8%), P<0.017].CONCLUSIONS: For monocular amblyopia, the first-dose effect of 6 h/d occlusion treatment was the most significant, and the recovery of stereopsis was the best.