转换注视眼治疗分离垂直性偏斜的疗效观察

Treatment of dissociated vertical deviation by shifting fixating eye

目的 探讨转换注视眼方法治疗单眼分离垂直性偏斜 (DVD)或双眼不对称性DVD患者上斜视的效果。方法 收集弱视眼矫正视力≥ 0 5的儿童DVD患者 2 3例 (9例为单眼 ,14例为双眼 ) ,采用戴镜后遮盖和光学方法使原注视眼视力低于现注视眼视力 2或 3行 (国际标准视力表 ) ,以达到转换注视眼的目的。观察治疗前、后患者的视力、眼位及视网膜对应情况。结果 采用转换注视眼方法治疗后 ,原注视眼视力无明显下降 ,现注视眼视力提高 2行者 10例 ;19例患者眼位达到外观美容效果 ,4例双眼上斜视度数相差不明显 (≤ 10 △)患者原注视眼出现上飘现象 ;3例近距离注视具有正常视网膜对应、远距离注视表现为高位眼抑制的患者恢复正常视网膜对应。结论 转换注视眼方法可有效矫正DVD患者的上斜视症状 ,尤其对于单眼DVD和双眼不对称性DVD一侧眼为上斜视、对侧眼为隐性上斜视者效果较好。本方法适用于不愿接受手术治疗、且合并轻中度弱视和屈光不正的儿童DVD患者。

Objective To investigate the results of using shifting fixation eye to manage monocular or asymmetrical binocular dissociated vertical deviation (DVD). Methods Twenty-three DVD children whose corrected vision was better than 0.5 in the amblyopic eye were studied. The goal of the shifting fixation eye was gained by decreasing the vision of the primary fixation eye to 2 or 3 lines (Snellen Visual Acuity) lower than that of the fellow fixation eye by occlusion or optical methods. The vision, alignment and retinal correspondence were evaluated before and after the treatment. Results After the treatment, in 10 patients, the vision of the primary fixation eye did not decrease significantly and the vision of the fellow eye increased 2 lines. In 19 patients, a cosmetic result was achieved; the primary fixation eye was shifted in 4 patients that had similar hepertropia in two eyes (≤10 △). Normal retinal correspondence was restored in 3 patients who had normal retinal correspondence at near while depressed at distance. Conclusions Shifting fixation eye is an effective treatment for DVD hepertropia, especially in patients with monocular or asymmetrical binocular DVD with hepertropia in one eye and latent hepertropia in the fellow eye. This method is suitable to DVD children who do not accept the surgical treatment and have slight to moderate amblyopia and ametropia.