原发性上斜肌亢进眼球客观旋转与近立体视功能的分析

Analysis of ocular objective torsion and near stereopsis function in primary superior oblique overaction

目的:探讨原发性上斜肌亢进(PSOOA)患者眼球客观旋转与双眼近立体视功能之间的关系。方法:回顾性研究。收集2019-01/2023-11于我院行斜视手术并存在PSOOA的斜视患者共59例,采集眼底照相图片,根据黄斑中心凹与视乳头水平经线的相对位置将眼球分为内旋、外旋和无旋转组,进一步测量黄斑-视乳头夹角(FDA),并分析眼球客观旋转情况及FDA与患者近立体视功能的关系。结果:患者59例92眼存在上斜肌亢进。眼球外旋0例,眼球无旋转32例,眼球内旋27例,眼球无旋转组双眼总FDA明显小于眼球内旋组(2.83°±2.89°vs 16.12°±5.74°,P<0.001)。眼球无旋转组和内旋组近立体视保存率分别为66%和15%,差异显著(P<0.001);眼球无旋转组和内旋组精细近立体视保存率分别为38%和11%,差异显著(P=0.02)。所有患者近立体视与双眼总FDA存在相关性(r=-0.526,P<0.001),与内旋眼FDA相关性最大(r=-0.546,P<0.001);眼球内旋组近立体视与双眼总FDA无相关性(r=-0.366,P=0.060),与内旋眼FDA和亢进眼FDA负相关(r=-0.424,P=0.028;r=-0.485,P=0.010);眼球无旋转组近立体视与双眼总FDA、主导眼FDA、非主导眼FDA、亢进眼FDA和非亢进眼FDA均无相关性。结论:PSOOA患者出现眼球内旋者较眼球无旋转者近立体视功能保存率更低,近立体视功能与双眼总FDA负相关,尤其是内旋眼和亢进眼FDA越大,近立体视功能越差。

AIM:To investigate the relationship between objective ocular torsion and near stereopsis in patients with primary superior oblique overaction(PSOOA).METHODS:Retrospective study.A total of 59 strabismus patients with PSOOA who underwent strabismus surgery at Renmin Hospital of Wuhan University between January 2019 and November 2023 were collected.Based on the collected fundus photographs and the position of the fovea relative to the horizontal line through the optic disc,the eyes were categorized as incyclotorsion,excyclotorsion,or no cyclotorsion.Additionally,the fovea-disc angle(FDA)and the relationship between objective ocular torsion status,FDA,and near stereopsis function in the patients were further measured and analyzed.RESULTS:Totally 59 patients(92 eyes)showed superior oblique overaction.There were no cases of excyclotorsion,32 cases with no cyclotorsion,and 27 cases with incyclotorsion.The total binocular FDA was significantly smaller in the no-cyclotorsion group compared with the incyclotorsion group(2.83°±2.89°vs 16.12°±5.74°,P<0.001).The preservation rates of near stereopsis were 66% and 15% in the no-cyclotorsion and incyclotorsion groups,respectively,with a significant statistical difference(P<0.001),and the preservation rates of fine near stereopsis were 38% and 11% in the no-cyclotorsion and incyclotorsion groups,respectively,with a significant statistical difference(P=0.02).Among all patients,near stereopsis was correlated with total binocular FDA(r=-0.526,P<0.001),with the strongest correlation observed with the FDA of the incyclotorsion(r=-0.546,P<0.001).In the incyclotorsion group,there was no correlation between near stereopsis and total binocular FDA(r=-0.366,P=0.060),with a negative correlation between near stereopsis and the FDA of both the incyclotorsion and the overaction(r=-0.424,P=0.028;r=-0.485,P=0.010).In the no-cyclotorsion group,near stereopsis was not correlated with total binocular FDA,incyclotorsion FDA,or overaction FDA.CONCLUSION:PSOOA patients with incyclotorsion have a lower preservation rate of near stereopsis than those without cyclotorsion.Near stereopsis function of patients with PSOOA is negatively correlated with total binocular FDA,especially the greater the FDA of the incyclotorsion and overaction,the worse the near-stereoscopic function.