基本型间歇性外斜视眼位控制力相关因素的临床研究

The factors related to eye position control in basic intermittent exotropia

目的探讨基本型间歇性外斜视(IXT)患者控制力的影响因素。方法收集2021年3月至2023年9月首都医科大学附属北京同仁医院眼科中心的434例(868只眼)基本型IXT患者的病例资料。其中,男性215例(430只眼),女性219例(438只眼);年龄4~20岁,年龄中位数为9.83(8.23,11.63)岁。使用纽卡斯尔(NCS)控制力评分法评估患者眼位控制力。根据NCS评分结果分为控制力良好组和控制力不佳组。检查所有患者的屈光状态、斜视度、立体视觉、调节功能及集合功能。年龄、屈光状态、斜视度、近立体视、调节功能及集合功能等经正态性检验不服从正态分布,以中位数(下四分位数,上四分位数)表示,组间比较采用秩和检验。远立体视保存率以百分比表示,组间比较采用χ2检验。采用Logistic回归分析IXT控制力的影响因素。结果控制力良好组患者主视眼的等效球镜屈光度(SE)、非主视眼SE、看近斜视度、看远斜视度及近立体视分别为-1.25(-2.75,0.50)D、-1.38(-2.78,0.75)D、-30(-40,-25)PD、-25(-35,-20)PD及2.30(2.15,2.90)Log弧秒;控制力不佳组患者分别为-0.00(-1.75,0.88)D、-0.25(-1.88,1.00)D、-50(-60,-40)PD、-50(-60,-35)PD及2.60(2.15,3.20)Log弧秒。两组比较,控制力良好组患者主视眼和非主视眼的近视屈光度均更大、看近和看远斜视度均更小而近立体视更好,其差异均有统计学意义(Z=-3.314,-3.047,-11.803,-12.328,-2.785;P<0.05)。控制力良好组和控制力不佳组患者的远立体视保存率分别为65.58%和36.79%。两组比较,控制力良好组患者远立体视保存率更高,差异具有统计学意义(χ2=33.079;P<0.05)。控制力良好组患者主视眼、非主视眼及双眼调节灵活度分别为9.00(6.63,11.00)cpm、8.50(6.50,11.00)cpm及7.75(6.00,10.00)cpm;控制力不佳组患者分别为7.50(6.00,10.00)cpm、7.50(6.00,9.25)cpm及7.00(5.00,9.00)cpm。控制力良好组患者主视眼、非主视眼及双眼调节灵活度均优于控制力不佳组,其差异具有统计学意义(Z=-4.065,-3.666,-2.690;P<0.05)。控制力良好组患者看远总集合幅度、看近总集合幅度、看远融像储备率、看近融像储备率、AC/A、看远集合储备及看近集合储备分别为50.50(35.75,59.00)、55.00(47.50,65.00)、0.76(0.51,1.16)、0.77(0.51,1.11)、2.00(1.00,4.00)、22.00(16.00,27.00)及24.00(18.00,30.00);控制力不佳组患者分别为65.00(55.25,77.00)、70.00(58.50,84.00)、0.50(0.31,0.72)、0.51(0.34,0.65)、2.33(1.00,4.00)、22.00(16.00,28.00)及24.00(18.00,30.00)。两组比较,控制力良好组患者看远总集合幅度和看近总集合幅度均更小、看远融像储备率和看近融像储备率均更大,其差异具有统计学意义(Z=-7.439,-6.435,-5.709,-6.254;P<0.05);而AC/A、看远集合储备及看近集合储备的差异无统计学意义(Z=-0.845,-0.469,-0.798;P>0.05)。多因素Logistic回归分析发现影响IXT患者眼位控制力的因素中,非主视眼SE、远立体视、看近集合幅度及看近融像储备率具有统计学意义(OR=1.220,95%CI:1.044~1.427,P<0.05)、(OR=0.399,95%CI:0.203~0.785,P<0.05)、(OR=1.050,95%CI:1.027~1.074,P<0.05)及(OR=0.149,95%CI:0.054~0.412,P<0.05)。结论基本型IXT的控制力主要由集合功能而非调节功能影响;基本型IXT的控制力可能主要通过看近的集合功能来驱动。

Objective To explore the factors related to eye position control in basic intermittent exotropia(IXT).Methods A total of 434 patients(868 eyes)with basic type IXT from the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from March 2021 to September 2023 were collected.Among them,there were 215 males(430 eyes)and 219 females(438 eyes)with a median age of 9.83(8.23,11.63)years(ranging from 4 to 20 years old).The eye position control was performed by Newcastle control scale(NCS).According to the NCS results,they were divided into good control group and poor control group.The refractive status,strabismus,stereoscopic vision,adjustment function,and convergence function of all patients were performed.Age,refractive status,strabismus,near stereoscopic vision,adjustment function,and collection function did not follow a normal distribution after normality testing,and were expressed as M(Q1,Q3)and compared by rank sum test for inter group.Far stereoscopic vision was expressed by percentages,and compared byχ2 for inter group.The factors of IXT control force was to analyze by logistic regression.Results The equivalent spherical refractive index(SE)of the main eye,non main eye SE,near and far strabismus,and near stereopsis of patients with good control were-1.25(-2.75,0.50)D,-1.38(-2.78,0.75)D,-30(-40,-25)PD,-25(-35,-20)PD,and 2.30(2.15,2.90)Log arc seconds,respectively.The patients in the group with poor control were-0.00(-1.75,0.88)D,-0.25(-1.88,1.00)D,-50(-60,-40)PD,-50(-60,-35)PD,and 2.60(2.15,3.20)Log arc seconds,respectively.The group with good control had higher myopia diopter in both the primary and non primary eyes,smaller near and far strabismus,and better near stereoscopic vision,and the differences were statistically significant(Z=-3.314,-3.047,-11.803,-12.328,-2.785;P<0.05).The far standing stereoscopic preservation rates of patients with good control and poor control were 65.58%and 36.79%,respectively.The patients with good control had a higher preservation rate of distant stereoscopic vision,and the difference was statistically significant(χ2=33.079,P<0.05).The adjustment flexibility of the dominant eye,non dominant eye,and binocular vision in patients with good control were 9.00(6.63,11.00)cpm,8.50(6.50,11.00)cpm,and 7.75(6.00,10.00)cpm,respectively.The patients in the poor control group had 7.50(6.00,10.00)cpm,7.50(6.00,9.25)cpm,and 7.00(5.00,9.00)cpm,respectively.The patients with good control had better primary vision,non primary vision,and binocular adjustment flexibility than those in the group with poor control,and the differences were statistically significant(Z=-4.065,-3.666,-2.690;P<0.05).The patients with good control had a total range of far and near images,a reserve rate for far and near images,an accommodative convergence/accommodation(AC/A)ratio,a reserve rate for far and near images,and a reserve rate for far and near images,which were 50.50(35.75,59.00),55.00(47.50,65.00),0.76(0.51,1.16),0.77(0.51,1.11),2.00(1.00,4.00),22.00(16.00,27.00),and 24.00(18.00,30.00),respectively;The patients with poor control were 65.00(55.25,77.00),70.00(58.50,84.00),0.50(0.31,0.72),0.51(0.34,0.65),2.33(1.00,4.00),22.00(16.00,28.00),and 24.00(18.00,30.00),respectively.The patients with good control had smaller total collection amplitude at far and near distances,and larger reserve rates for far and near distance fusion images,with statistically significant differences(Z=-7.439,-6.435,-5.709,-6.254;P<0.05);However,there was no statistically significant difference in AC/A,far set reserve,and near set reserve(Z=-0.845,-0.469,-0.798;P>0.05).After multivariate logistic regression analysis,the factors that affect the control of eye position in IXT patients,non dominant eye SE,distant stereo vision,near range collection amplitude,and near fusion image reserve rate were statistically significant(OR=1.220,95%CI:1.044 to 1.427,P<0.05),(OR=0.399,95%CI:0.203 to 0.785,P<0.05),(OR=1.050,95%CI:1.027 to 1.074,P<0.05),and(OR=0.149,95%CI:0.054 to 0.412,P<0.05).Conclusions The control in basic IXT is primarily influenced by convergence rather than accommodation.The control in basic IXT may be primarily driven by the near convergence.