先天性上斜肌麻痹儿童术后视觉功能的临床分析

Clinical analysis of postoperative visual function in children with congenital superior oblique palsy

目的分析不同年龄先天性上斜肌麻痹患儿术后双眼视功能的恢复情况。方法回顾性队列研究。纳入武汉大学人民医院2019年6月至2022年2月先天性上斜肌麻痹146例(200只眼)。按年龄分成3组:2~6岁组83例,7~9岁组36例,10~12岁组27例。根据术前第一眼位斜视度及眼球运动情况选择合适的手术方式。记录患儿手术前后的最佳矫正视力、代偿头位、Bielschowsky征及斜视度,使用同视机检查手术前后的同时视、融合功能及远立体视,使用Titmus立体图检查近立体视。随访6个月。结果术后6个月,最佳矫正视力≥0.8者由术前的70例增至92例(χ^(2)=6.71,P=0.010);75.29%(72/85)的患者代偿头位减轻或消失,未出现新的异常头位,较术前明显改善(χ^(2)=79.62,P<0.001);Bielschowsky征转阴率为58.22%(85/146),手术前后差异有统计学意义(χ^(2)=119.90,P<0.001);存在同时视、融合功能、远立体视及近立体视分别增加了25例、14例、14例、34例,较术前明显好转(χ^(2)=8.57、6.13、4.59、15.84,均P<0.005)。3个年龄组间术后6个月的融合功能和远立体视比较,总体差异无统计学意义(P>0.05);同时视和近立体视比较,总体差异有统计学意义(P=0.033),其中2~6岁组同时视、近立体视功能的恢复程度明显优于10~12岁组(χ^(2)=6.82、6.12,均P<0.05)。结论先天性上斜肌麻痹患儿及时手术能改善其最佳矫正视力、代偿头位及双眼视功能。低龄患儿手术矫正眼位后立体视功能重建率高。

Objective To analyze the recovery of binocular visual function after surgery in children with congenital superior oblique palsy at different ages.Methods This was a retrospective cohort study.The clinical data of 200 eyes of 146 patients with congenital superior oblique palsy from Jun.2019 to Feb.2022 in the Renmin Hospital of Wuhan University were included.The patients were divided into 3 groups based on age:2-6 years in 83 cases,7-9 years in 36 cases,and 10-12 years in 27 cases.Operation plan was determined by the obliquity of the eye position and the movement of the eyeball.The best corrected visual acuity,compensated head position,Bielschowsky’s sign and strabismus degree were recorded before and after operation.The simultaneous perception,fusion function and distance stereoacuity were examined by synoptophore,while near stereoacuity were examined by Titmus stereogram.The follow-up time was 6 months.Results At 6 months after operation,the number of children whose best corrected visual acuity≥0.8 was 92,which was higher than the 70 before operation(χ^(2)=6.71,P=0.010);75.29%(72/85)patients’compensated head position abated or disappeared without new abnormal head position,which were significantly improved as compared with preoperation(χ^(2)=79.62,P<0.001);the negative conversion rate of Bielschowsky’s sign was 58.22%(85/146),the difference was statistically significant before and after surgery(χ^(2)=119.90,P<0.001);the number of patients with simultaneous perception,fusion function,distance stereoacuity and near stereoacuity increased by 25,14,14 and 34 respectively,which were significantly improved compared with those before operation(χ^(2)=8.57,6.13,4.59,15.84;all P<0.005).There was no significant difference in fusion function and distance stereoacuity among three age groups at 6 months after surgery(P>0.05).There were significant differences in simultaneous perception and near stereoacuity among the three age groups(P=0.033),and the recovery in the 2-6 years group was significantly better than that in the 10-12 years group(χ^(2)=6.82,6.12,both P<0.05).Conclusion Timely surgery for children with congenital superior oblique palsy can improve their best corrected visual acuity,compensatory head position and binocular visual function.Young children have a higher rate of stereopsis reconstruction after surgery to correct eye position.