不同程度远视性屈光参差性弱视儿童视力康复后调节功能恢复情况的研究

Investigation on the recovery of accommodative function in children with different de⁃grees of hyperopia anisometropia amblyopia after visual rehabilitation

目的观察不同程度远视性屈光参差性弱视儿童矫正视力康复后,调节功能的恢复情况。方法纳入远视性屈光参差性弱视治愈儿童64例为实验组,并根据患儿初诊时弱视眼矫正视力分组,分为轻度弱视组(A组)25例,中度弱视组(B组)22例,重度弱视组(C组)17例,同时收集正视儿童24例为对照组,分别测量不同组别(包括不同年龄段)弱视眼治愈后的调节幅度、调节滞后量,与正视儿童非主导眼比较,并对结果进行统计分析。结果(1)调节幅度:A组弱视治愈眼调节幅度(11.73±1.64)D,与正视儿童非主导眼比较,差异无统计学意义(P>0.05);B组、C组弱视治愈眼调节幅度分别为(10.27±1.41)D和(9.90±1.50)D,均低于正视儿童非主导眼,差异均有统计学意义(t_(B)=4.724,t_(C)=4.865,均P=0.000);不同年龄组间比较,低龄组与中龄组弱视治愈眼调节幅度差异均无统计学意义(P>0.05);而高龄组弱视治愈眼调节幅度均低于低、中龄组,差异有统计学意义(t_(低龄)=4.079,P=0.000;t_(中龄)=3.073,P=0.004)。(2)调节滞后量:A组弱视治愈眼调节滞后量(0.59±0.32)D,与正视儿童非主导眼差异无统计学意义(P>0.05);B组、C组弱视治愈眼调节滞后量分别为(0.86±0.38)D和(1.00±0.31)D,均高于正视儿童非主导眼,差异均有统计学意义(t_(B)=2.422,P=0.020;t_(C)=4.214,P=0.000)。不同年龄组间比较,低龄组与中龄组弱视治愈眼调节滞后量差异均无统计学意义(P>0.05);高龄组弱视治愈眼调节滞后量均高于低、中龄组,差异有统计学意义(t_(低龄)=-3.181,P=0.003;t_(中龄)=-2.546,P=0.016)。(3)相关性分析:调节幅度与屈光度(r=-0.760,P=0.000)、屈光参差量(r=-0.815,P=0.000)呈负相关;调节滞后量与屈光度(r=0.593,P=0.000)、屈光参差量(r=0.703,P=0.000)呈正相关,均有统计学意义。而调节幅度、调节滞后量与治愈时间无相关性。结论不同程度远视性屈光参差性弱视儿童矫正视力康复后,弱视治愈眼调节功能的恢复程度不一致,其轻度弱视儿童调节功能基本恢复,中、重度弱视儿童调节功能仍存在缺陷。

OBJECTIVE To investigate the recovery of accommodative function after visual rehabilitation in children with different degrees of hyperopia anisometropia amblyopia.METHODS A total of 64 children with hyperopia anisometropia amblyopia were included as the experimental group,and were divided into mild amblyopia group(Group A)of 25 cases,moderate amblyopia group(Group B)of 22 cases,and severe amblyopia group(Group C)of 17 cases according to the best corrected visual acuity of the amblyopia eyes of the children at the time of first visit to the hospital.At the same time,24 cases of emmetropic children were collected as the control group,and the accommodative amplitude and the accommodative lag of the amblyopic eyes in different groups(including different age groups)after cure were measured,compared with the non-dominant eyes of emmetropic children,and the results were statistically analyzed.RESULTS(1)Accommodative amplitude:The accommodative amplitude of the cured amblyopia eyes in Group A was(11.73±1.64)D.There was no significant difference when compared with the non-dominant eyes of emmetropia children(P>0.05).The accommodative amplitude of the cured amblyopic eyes in Group B and C were(10.27±1.41)D and(9.90±1.50)D,respectively,which were lower than that of the non-dominant eyes in emmetropic children,and the differences were statistically significant(t_(B)=4.724,t_(C)=4.865,all P=0.000).When compared between different age groups,there was no significant difference in the accommodative amplitude between the young group and the middle age groups(P>0.05).However,the accommodative amplitude in the elderly group were lower than those in the young and the middle age groups,with statistically significant differences(t_(young age)=4.079,P=0.000;t_(middle age)=3.073,P=0.004).(2)Accommodative lag:The accommodative lag of the cured amblyopic eyes in Group A was(0.59±0.32)D.There was no significant difference when compared with the non-dominant eyes of emmetropia children(P>0.05).The accommodative lag of the cured amblyopic eyes in Group B and C were(0.86±0.38)D and(1.00±0.31)D,respectively,which were higher than that of the non-dominant eyes in emmetropia children,and the differences were statistically significant(t_(B)=2.422,P=0.020;t_(C)=4.214,P=0.000).When compared between different age groups,there was no significant difference in the accommodative lag between the young group and the middle age groups(P>0.05).The accommodative lag in the elderly group was higher than that in the young and the middle age groups,with statistically significant differences(t_(young age)=-3.181,P=0.003;t_(middle age)=-2.546,P=0.016).(3)Correlation analysis:The accommodative amplitude was negatively correlated with diopter(r=-0.760,P=0.000)and anisometropia(r=-0.815,P=0.000).The accommodative lag was positively correlated with diopter(r=0.593,P=0.000)and anisometropia(r=0.703,P=0.000),which were both statistically significant.However,there was no correlation between the accommodative amplitude and the accommodative lag with the cure time.CONCLUSIONS After the best corrected visual acuity of the children with different degrees of hyperopia anisometropia amblyopia recovered,the recovery of the accommodative function of the cured amblyopia eyes was inconsistent.The adjustment function of the children with mild amblyopia could basically recover,while those of the children with moderate and severe amblyopia still had defects.