成人废用性外斜视患者临床特征及生存质量的研究

Clinical characteristics and quality of life of adult patients with sensory exotropia

目的观察成人废用性外斜视患者的临床特征和生存质量,分析影响患者生存质量的因素。设计前瞻性病例对照研究。研究对象2023年1-9月北京同仁医院成人废用性外斜视患者27例作为病例组,54例其他类型的斜视患者作为斜视对照组,54例眼位正常者作为正常对照组。方法分析废用性外斜视患者废用眼致病原因,18~40岁患者做复方托吡卡胺散瞳验光,40岁以上患者做显然验光检查屈光度,采用标准对数视力表检查最佳矫正视力(BCVA);颜式立体视图谱检查近立体视,同视机检查远立体视,三棱镜+交替遮盖或三棱镜角膜映光法(Krimsky法,视力低下、不能注视者)测量水平和垂直斜视度。采用中文版成人斜视患者生存质量量表(CAS-20)评估患者的生存质量。分析三组之间的一般特征、视功能情况以及生存质量的差异;分析个体因素及视功能情况对废用性外斜视患者生存质量的影响。主要指标矫正视力、屈光度、斜视度、远近立体视、病程;社会心理和视觉功能两个维度的生存质量评分。结果27例废用性外斜视患者废用眼BCVA均<0.1。平均斜视度(84.60±12.73)^,明显高于其他斜视组患者的斜视度(57.45±17.65)^(Z=5.063,P=0.014)。致病原因以后天为主(眼外伤最常见);有家族史的患者比例(0%)低于其他类型斜视组(16.67%)(P=0.024)。所有废用性外斜视患者均无远近立体视,显著低于正常组及其他斜视组(P<0.001)。废用性外斜视患者的病程长于其他斜视组(Z=9.556,P=0.002);三组患者的社会心理得分和视觉功能得分整体有统计学差异,废用性外斜视组的社会心理总分显著低于正常组(Z=-7.368,P<0.001),也显著低于其他斜视组(Z=-3.139,P=0.020);废用性外斜视组视觉功能总分显著低于正常组(Z=-7.286,P<0.001),但与其他斜视组无统计学差异(Z=-1.540,P=0.124)。废用性外斜视患者废用眼届光度与社会心理得分呈现负向关系(r=-0.375,P=0.002),与视觉功能得分呈现负向关系(r=-0.366,P=0.003);废用眼矫正视力与社会心理得分呈现正向关系(r=0.326,P=0.005),与视觉功能得分呈现正向关系(r=0.313,P=0.006)。斜视病程越长,社会心理得分越低(Z=7.037,P=0.021)。结论与正常人及其他类型斜视患者相比,成人废用性外斜视患者患眼视觉功能严重损伤甚至丧失,完全不具备双眼视觉功能,健康相关的生存质量明显降低;废用眼屈光度较高和矫正视力较差、斜视病程较长是影响患者生存质量的主要因素。

Objective To study the clinical characteristics and quality of life of adult patients with sensory exotropia in China,and to analyze the factors affecting the quality of life of patients.Design Prospective case-control study.Participants Twenty-seven adult patients with sensory exotropia were enrolled in Beijing Tongren Hospital from January 2023 to September 2023 as the case group,and 54 patients with other types of strabismus were collected as the strabismus control group,and 54 orthotropic people were enrolled as the normal control group.Methods The causes of disused eyes in patients with sensory exotropia were analyzed.Patients aged 18-40 years were treated with compound topiramate mydriasis refraction,patients aged over 40 years were treated with apparent refraction,best corrected visual acuity(BCVA)was tested by standard logarithmic visual acuity chart.The near stereopsis was tested by Yan-style stereogram,the far stereopsis was tested by synoptophore,and the horizontal and vertical deviations were measured by prism+alternate covering or prism+corneal reflection(low vision,unable to gaze).The quality of life of patients was evaluated by the Chinese version of the Adult Strabismus Patients Quality of Life Scale(CAS-20).The differences in general characteristics,visual function and quality of life among normal control group,sensory exotropia group and other type's strabismus group were analyzed.The effects of individual factors and visual function on the quality of life of patients with sensory exotropia were analyzed.Main Outcome Measures BCVA,refraction,deviation,far and near stereopsis.course of disease,the quality of life scores of social psychology and visual function.Results The BCVA of 27 patients with disused exotropia was lower than 0.1.The average deviation was(84.60±12.73).The average deviation of other strabismus group was(57.45±17.65)-,the difference was statistically significant(Z=5.063.P=0.014).The main causes of sensory exotropia were acquired(ocular trauma was the most common).The proportion of patients with family history(0%)was lower than that of other types of strabismus group(16.67%)(P=0.024).All patients with sensory exotropia had no stereopsis.which was significantly lower than that of normal group and other strabismus groups(P<0.001).The course of sensory exotropia was longer than that of other strabismus groups(Z-9.556.P=0.002).There were statistically significant differences in the social psychological scores and visual function scores among the three groups.The total score of social psychological score insensory exotropia group was significantly lower than that of normal group(Z=-7.368,P<0.001)and other strabismus groups(Z=-3.139,P-0.020).The total score of visual function in sensory exotropia group was significantly lower than that of normal group(Z=-7.286.P<0.001),but there was no statistically significant difference between sensory exotropia group and other strabismus groups(Z=-1.540.P=0.124).Among the influencing factors of the quality of life of patients with sensory exotropia,the diopter of the disused eye was negatively correlated with the social psychological score(r=-0.375,P=0.002).The diopter of the disused eye was negatively correlated with the visual function score(r=-0.366,P=0.003).The BCVA of the disused eye was positively correlated with the social psychological score(r=0.326,P=0.005).The BCVA of the disused eye was positively correlated with the visual function score(r=0.313,P=0.006).The longer the course of strabismus was,the lower the social psychological score was(Z=7.037.P=0.021).Conclusion Compared with the normal population and other strabismus patients,the visual function of the affected eye in Chinese adult patients with sensory exotropia is seriously damaged,completely without binocular visual function,and the health-related quality of life is significantly reduced.The higher diopter of the disused eye,the poorer corrected visual acuity,and the longer course of strabismus are the main factors affecting the quality of life of patients.