青年和成人弱视视觉系统可塑性的临床研究

Clinical study of visual plasticity in teenage and adults with amblyopia

目的 研究青年和成人弱视的治疗方法和效果 ,进一步探讨人的视觉系统可塑性。方法 按照全国统一弱视诊断标准 ,收集 15～ 17岁弱视患者 4 7例 (5 7只眼 )和 18～ 4 5岁弱视患者5 5例 (6 8只眼 )。治疗前进行矫正视力、激光干涉条纹视力 (IVA)、弱视类型和程度、注视性质检查 ,采用准确验光配戴矫正眼镜法和光学药物压抑疗法 (远、近距离压抑和微量压抑 )联合遮盖疗法 ,同时辅以后像红光法进行综合治疗。随访时间 1～ 5年 ,平均 2 9年。结果 治愈 5 5只眼 (44 0 % ) ,其中痊愈 2 3只眼 ,基本痊愈 32只眼 ;进步 37只眼 (2 9 6 % ) ,无效 33只眼 (2 6 4 % ) ;治疗总有效率为73 6 %。不同年龄患者疗效比较 ,差异无显著意义 (P >0 0 5 ) ;中心注视和中心凹旁注视患者的疗效明显优于黄斑旁注视和周边注视患者 (P <0 0 1) ;不同弱视程度患者的疗效差异有非常显著意义 (P<0 0 1) ;屈光不正性和屈光参差性弱视患者的疗效明显优于斜视性和形觉剥夺性弱视患者 (P <0 0 1)。IVA预测疗效的准确率为 92 8% ,IVA与患者治疗后视力呈显著正相关 (r =0 886 2 ,P <0 0 1)。结论 人的视觉系统可塑性可能终身存在。采取压抑联合遮盖并辅以其他疗法综合治疗青年和成人弱视行之有效 ,其疗效与患者的弱视程度和类?

Objective Human visual plasticity was studied by the observation of the effects of treatment in teenage and adult amblyopia. Methods One hundred and two cases (125 eyes) were diagnosed as amblyopia according to the national criteria of amblyopia. These patients were divided into teenage group (15-17 years old, 47 cases and 57 eyes) and adult group (18-45 years old, 55 cases and 68 eyes). Eye examination, including best correct visual acuity, laser interference fringes visual acuity (IVA), degree and patterns of amblyopia, and nature of fixation were performed in these two groups before amblyopic treatment. Patients were treated with correct spectacle, optical and drug penalization (including far and near penalization, as well as light penalization), combined with occlusion and assisted with red light pleoption. All patients were followed up for 1-5 years, with an average of 2.9 years. Results Fifty five eyes (44%) were cured (23 eyes recovered, 32 eyes basically cured), 37 eyes (29.6%) were improved, 33 eyes (26.4%) were nullified and the total improvement rate was 73.6%. Different ages did not influence the results of treatment significantly ( P >0.05). Outcome of foveal fixation and parafoveal fixation was much better than that of paramacular fixation and peripheral fixation ( P <0.005). The curative efficiency of amblyopia was also dependent on the degree of amblyopia ( P <0.005). Curative effects of ametropic and anisometropic amblyopia were better than that of strabismic and deprivable amblyopia ( P <0.01). Visual acuity predicted by IVA before the treatment was the same as real results after the treatment in 112 eyes among 125 eyes (92.8%) . The correlation efficient between the predicted and real vision was statistically significant ( r =0.886 2, P <0.000 1). Conclusions Vision in most teenage and adult amblyopia can be improved by amblyopic therapy. Therefore, it seems that human visual plasticity exists permanently during the whole life. Visual acuity after the treatment can be predicted by pre-treatment IVA. Results of amblyopia treatment are closely related with the degree and patterns of amblyopia and are also dependent on the cooperation of the patients.