基于Gabor视标的视知觉学习治疗难治性弱视的临床疗效观察

Clinical observation of visual perception learning based on Gobar visual standard in the treatment of refractory amblyopia

目的探讨基于Gabor视标的视知觉学习治疗难治性弱视的临床疗效。方法收集2021年1月至2021年12月深圳市眼科医院小儿眼科门诊中经传统弱视治疗12个月后最佳矫正视力(BCVA)无提升或年龄已超过视觉敏感期的弱视患者76例(152只眼)的临床资料进行研究。其中,男性44例(88只眼),女性32例(64只眼)。年龄5~33岁,平均年龄(10.6±7.0)岁。全部患者的弱视眼使用基于Gabor视标的视知觉学习软件进行系统训练。以标准对数远视力表检查训练前后的BCVA,以训练前后的BCVA平均提升幅度评估治疗有效率。患者整体和屈光参差性弱视患者的BCVA数据经正态性检验不符合正态性分布,采用中位数及上下四分位数[M(P25,P75)]进行描述;屈光不正性弱视、斜视性弱视及形觉剥夺性弱视患者的BCVA数据,采用例数(眼数)及百分比进行描述。患者整体和屈光参差性弱视患者健眼与弱眼BCVA的比较采用Mann-WhitneyU秩和检验,训练前后的比较采用wilconxon符号秩和检验。相关性分析的方法,数据符合正态性分布的数据,采用Pearson直线相关分析;数据不符合正态性分布的,采用Spearman秩相关分析。结果训练前整体患者的BCVA中位数为0.5(0.3,0.7),训练后为0.7(0.5,0.9),训练后整体患者的BCVA提高,其差异具有统计学意义(Z=7.282,P<0.05)。其中,屈光不正性弱视共9例(18只眼),训练后BCVA有提高的有8例(15只眼),占83.3%(15/18);斜视性弱视共12例(14只眼),训练后BCVA有提高的有10例(11只眼),占78.6%(11/14);形觉剥夺性弱视共10例(12只眼),训练后BCVA有提高的有6例(8只眼),占66.7%(8/12);屈光参差性弱视共43例(43只眼),训练前患者的BCVA中位数为0.50(0.16,0.70),训练后为0.70(0.50,0.90),训练后较训练前BCVA提高,其差异具有统计学意义(Z=5.106,P<0.05)。其余患者合并眼球震颤共2例(4只眼),未单独分析。全部患者年龄与BCVA提升幅度的相关性分析显示两者呈负相关(r=-0.350,P<0.05);训练前BCVA与BCVA提升幅度呈负相关(r=-0.396,P<0.05);训练次数与BCVA提升幅度呈正相关(r=0.480,P<0.05)。结论基于Gabor视标的视知觉学习治疗可提升难治性弱视患者弱视眼的BCVA,但对不同类型的难治性弱视,其平均提升幅度与治疗有效率不同。训练时年龄越小、训练前BCVA越低及训练次数越多,训练后其BCVA的提升幅度越高。

ObjectiveThe aim of this study is to explore the clinical efficacy of Gabor based visual perception learning in the treatment of refractory amblyopia.MethodsSeventy-six amblyopia patients(152 eyes)who did not improve their best corrected visual acuity(BCVA)after 12 months of traditional amblyopia treatment or whose age has exceeded the visual sensitivity period from January 2021 to December 2021 in the Pediatric Ophthalmology Department of Shenzhen Eye Hospital were collected.Among them,there were 44 males(88 eyes)and 32 females(64 eyes)with an average age of(10.6±7.0)years-old(ranged from 5 to 33 years-old).All patients′amblyopic eyes were trained systematically using Gabor based visual perception learning software.The BCVA before and after training using a standard logarithmic visual acuity chart was examined,and the treatment effectiveness based on the average improvement in BCVA before and after training was evaluated.The patients′BCVA with overall and anisometropic amblyopia did not conform to normal distribution through normality testing,and were described using median and upper and lower quartiles[M(P25,P75)].The BCVA of patients with ametropic amblyopia,strabismus amblyopia,and form deprivation amblyopia were described by the number of cases(eyes)and percentage.The BCVA between healthy and weak eyes in patients with overall and anisometropic amblyopia was compared using Mann-Whitney U rank sum test,and before and after training was compared using the wilconxon signed rank sum test.The method of correlation analysis was to use Pearson linear correlation analysis for data that conforms to a normal distribution,ortherwise was used by Spearman rank correlation analysis.ResultsThe median BCVA of the overall patient before and after training was 0.5(0.3,0.7),and 0.7(0.5,0.9),respectively.After training,the BCVA of the overall patient increased,and the difference was statistically significant(Z=7.282,P<0.05).Among them,there were 9 cases(18 eyes)with ametropic amblyopia,12 cases(14 eyes)with strabismus amblyopia,10 cases(12 eyes)with form deprivation amblyopia.After training,there were 8 cases(15 eyes)with improvement in BCVA for ametropic amblyopia,10 cases(11 eyes)for strabismus amblyopia,6 cases(8 eyes)for form deprivation amblyopia,accounting for 83.3%(15/18),78.6%(11/14),66.7%(8/12),respectively.The BCVA of patients for 43 cases(43 eyes)with anisometropic amblyopia before and after training was 0.50(0.16,0.70),0.70(0.50,0.90),respectively.After training,the BCVA increased compared to before training,and the difference was statistically significant(Z=5.106,P<0.05).There were 2 cases(4 eyes)of other patients with concomitant nystagmus,which were not analyzed separately.The correlation analysis between the increase in BCVA and the age of all patients,the baseline BCVA showed a negative correlation(r=-0.350,-0.396;P<0.05);the number of training sessions was positively correlated with the increase in BCVA(r=0.480,P<0.05).ConclusionsVisual perception learning therapy based on Gabor visual standard can improve BCVA of amblyopia in patients with refractory amblyopia.However,for different types of refractory amblyopia,the average improvement and treatment effectiveness is various.Patients with younger the age during training,the lower the baseline BCVA,and the more training times,show the higher the improvement in BCVA after training.