Comparison of bilateral/unilateral lateral rectus recession and unilateral recession-resection for intermittent exotropia:a Meta-analysis

AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence rate.RESULTS: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [<2 y, OR 0.56(0.33-0.94) for success rate; OR 2.11(1.17, 3.81) for undercorrection rate]. However, BLR achieved a higher success rate [OR 2.49(1.61, 3.86)] and a lower undercorrection rate [OR 0.40(0.23, 0.71)], compared to that of R&R at a long-term followup(>2 y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85(0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37(0.18, 0.74)] and a lower undercorrection [OR 3.50(1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T)(20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08(0.65, 1.79)] and undercorrection rate [OR 0.89(0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic typeIX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.

Long-term postoperative outcomes of bilateral lateral rectus recession vs unilateral recession-resection for intermittent exotropia

AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.

Survival analysis following early surgical success in intermittent exotropia surgery

AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success[≤5 prism diopters(PD)esophoria(E)to≤10 PD exophoria(X)on the postoperative sixth month]were enrolled in this study.Their consecutive survival on the postoperative first year,second year and third year and at the last visit of fourth year or more,and the factors that might affect their survival,were analyzed.The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group(≤5 PD E to≤10 PD X)and the failure group(】5 PD esodeviation or】10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%,92.89%,83.70%and 50.49%on the postoperative first,second and third years and fourth year or more,respectively.None of the clinical factors was determined to have affected the survival.The amount of the exodrift was largest(2.29 PD)between the first year and the second year,and smallest(1.47 PD)between the fourth year and the last visit.Sixty-three patients had their final visit after the postoperative fourth year,and 29 of them were in the failure group.Twentyfive patients in the failure group had an intermittent exotropia(IXT)of【20 PD with good to fair distant fusion;two had an IXT of【20 PD with poor distant fusion;one had an IXT of≥20 PD with fair distant fusion;and another had delayed-onset consecutive esotropia.The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group(2.81 PD vs 5.86 PD,P=0.012).The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift,but the amount of the exodrift decreases with long-term follow-up.The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients.A smaller deviation on the postoperative sixth month is associated with long-term survival.

Evaluation of dynamic stereopsis in intermittent exotropia patients

AIM: To delineate the characteristics of the dynamic stereopsis test and analyze related parameters in intermittent exotropia [X(T)] patients. METHODS: Fifty-seven X(T) patients and 55 normal subjects were enrolled in this study. The normal and X(T) groups were used to test the reproducibility and reliability of the dynamic stereopsis test, and Bangerter filters with densities of 0.2 were then used to simulate suppression to test for traditional and dynamic stereopsis. In the X(T) group, the measurements included 1) dynamic stereopsis test comprising three parts: motion+disparity, motion only and disparity only; 2) ocular deviation angle; 3) Bagolini striated lens test; 4) disease course; and 5) Titmus stereopsis test. RESULTS: The test-retest reliability of the dynamic stereopsis method was 0.901 in the normal and X(T) groups, and none of the X(T) patients were able to pass the static and dynamic stereopsis tests after using the 0.2 Bangerter filter. The accuracy rate was greater than 80% in the normal group and 31.81%, 36.36%, and 45.45% for the motion+disparity, motion-only and disparityonly components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests,respectively. Patients with a long disease course(>1 y) had worse dynamic stereopsis than those with a short disease course(<1 y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparityonly, or the motion-only test components(all P>0.05, Chisquare test). CONCLUSION: Dynamic stereopsis is preserved in certain X(T) patients diagnosed with stereoblindness via traditional tests. A long disease course was shown to be a negative factor for dynamic stereopsis in X(T) patients which might be associated with worse progression, and provide good references clinically.

Surgery at early versus late for intermittent exotropia:a Meta-analysis and systematic review

AIM:To compare the outcomes between early surgery and late surgery for intermittent exotropia(IXT)with a Metaanalysis.METHODS:Scientific databases including PubMed,Embase,Web of Science,Cochrane and China National Knowledge Infrastructure were searched prior to December 16,2019.From this broad database search,we performed some Meta-analysis including eleven independent studies,to further evaluate the outcome(s)when comparing early versus late surgery for IXT.The boundaries between early and late surgery and the surgery methods were not inconsistent,so subgroup analyses were conducted by different boundaries of age at surgery and different surgical approaches.The pooled odds ratios(ORs)and the 95%confidence interval(CI)were estimated according to the random-effects model for high heterogeneity between studies.RESULTS:Eleven retrospective studies were included in this Meta-analysis.No significant difference between early and late surgery was observed for IXT patients(OR_(First follow-up)=0.88,95%CI 0.53-1.44,P=0.61;OR_(Final follow-up)=1.48,95%CI 0.94-2.31,P=0.09).However,sensitivity analysis performed by sequentially omitting individual studies showed that the final follow-up result was not stable.Subgroup analyses revealed that an earlier surgical procedure could lead to a better outcome in the 4-year boundary subgroup as well as the bilateral lateral rectus recession(BLR)subgroup for the final follow-up(OR_(4y)=2.64,95%CI 1.57-4.44,P=0.00;OR_(BLR)=2.25,95%CI 1.36-3.74,P=0.00).CONCLUSION:Early surgery for IXT provides a better long term follow-up outcome when patients are younger than 4 years old or choose the BLR surgical method.

Post-operative strabismus control and motor alignment for basic intermittent exotropia

AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test,and had moderate to good strabismus control.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.

Factors affecting residual exotropia after two muscle surgery for intermittent exotropia

AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.

Quality of life in adult intermittent exotropia and the risk factors

AIM: To study the quality of life of adult patients with intermittent exotropia(IXT) in China and analyze the factors affecting the quality of life in IXT patients.METHODS: Total y 109 cases of normal eye(control group), 77 cases of IXT(IXT group) and 115 cases of strabismus control group(except IXT) were collected. The quality of life of the patients was assessed by Chinese version of adult strabismus patient’s quality of life scale(CAS-20). The differences of general characteristics, visual function and quality of life were analyzed, and the effects of individual factors and visual function on quality of life of patients with IXT were analyzed.RESULTS: The IXT group had a high proportion of patients with family history, low proportion of patients with amblyopia compared with strabismus control group. The proportion with normal near and far stereopsis of IXT group were lower than that of normal control group. The best corrected visual acuity of IXT group was higher than that of strabismus control group, but lower than the control group. In addition, the median strabismus degree in IXT group was higher than that in other strabismus control group. The median psychosocial scores and median visual function scores of the IXT group was lower than that of the normal control group, but not different from strabismus control group. Occupation status, course of disease, far stereopsis and near stereopsis significantly affected the quality of life in IXT patients.CONCLUSION: Adult IXT patients in China have a certain proportion of family history and lower quality of life, The main factors affecting the quality of life of IXT patients is stereopsis, course of disease and occupation status.

Comparison of contrast sensitivity based on the surgical results for intermittent exotropia

AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent bilateral lateral rectus muscle recession for IXT between 4 and 12 years old were reviewed retrospectively. They were categorized based on the surgical results;successful correction group(n=36) and overcorrection group(esotropia ≥10 PD at 3 mo postoperatively, n=18). Using CGT-2000 test for CS was performed binocularly, and subjective reports of photophobia was investigated preoperatively and at 3 mo postoperatively. Objective photophobia was defined as a significant decrease in CS in the presence of glare.RESULTS: Preoperatively, there was no difference in CS between the groups. Postoperatively, under mesopic conditions, significant improvement of CS was observed at 6.3°, 4°, and 2.5° in the successful correction group and at 6.3° and 4° in the overcorrection group, regardless of glare. Under photopic conditions, at all visual angles except 0.64°, improvement in CS was noted in both groups while CS worsened significantly at 0.64° in the overcorrection group postoperatively. At all visual angles under photopic conditions postoperatively, regardless of glare, CS in the overcorrected group was significantly worse than that in the successful correction group, and CS was significantly decreased by addition of glare in both groups. All patients except one(96.4%) in the successful correction group and 8 patients(61.5%) in overcorrection group showed improvement of photophobia postoperatively, which correlated with CS under photopic conditions(P=0.001, 0.03).CONCLUSION: After surgery for IXT, CS under photopic conditions improve at all visual angles except 0.64°, while CS is significantly worse in the overcorrection group postoperatively at 0.64°. Subjective photophobia havesignificant correlation with CS under photopic conditions, and may be used as an objective indicator of photophobia.

Effect of Bilateral Lateral Rectus Recession in Intermittent Exotropia according to the Limbus Insertion Distance

Purpose: The aim of this work was the evaluation of the effect of the limbus insertion distance (LID) of the lateral rectus on the surgical results of bilateral lateral rectus recession in intermittent exotropia (IXT) in children and adults. Patients and Methods: This retrospective study included 76 patients. The patients were divided into two groups: group I (age 5 - 13 y), group II (>13 y). All the patients had basic type of intermittent exotropia (IXT) and all of them underwent bilateral lateral recessions according to the preoperative angle of deviation. Intraoperatively, the distance of limbus insertion was measured by surgical calipers. The dose response effect was calculated as the difference between the preoperative angle and postoperative angle divided by total amount of recession and cases were followed at 1 month, 3 months, 6 months and 12 months postoperative. Results: The mean LID in group I was (6.2 ± 0.61 mm) and (6.1 ± 0.55 mm) in group II. The mean dose response (MDR) at 1 year postoperative was (2.32 ± 0.25 mm) in group I and (2.26 ± 0.23) in group II. In patients with LID 6.25 mm who had larger mean dose response (2.52 ± 0.15). There was a significant positive correlation between the LR muscle LID and the dose-response effect. Conclusion: There is positive correlation between the LID of the LR muscle and the recession effect in bilateral lateral rectus recession in treatment of IXT.

Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre(PD)] were retrospectively reviewed. Two groups of patients were identified;Group Ⅰ(21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A(BTA) injection into the recessed muscles and group Ⅱ(30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group Ⅰ(47.6%) and 20 patients in group Ⅱ(66.7%) achieved esotropia/esophoria <5 PD or exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant(P=0.1) but there was a statistically significant higher rate of undercorrection in group Ⅰ(P=0.03). On the other hand, 3 patients in group Ⅰ(14.3%) and 5 patients in group Ⅱ(16.7%) had improved stereopsis;this difference in the sensory outcome was not statistically significant(P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate(P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilateral medial rectus resection in the correction of large angle intermittent exotropia. The surgical success rate in BTA augmented surgery group is observed to be higher in patients with preoperative smaller angle of deviation and in patients with good stereoacuity.

TREATMENT OF IRON DEFICIENCY ANEMIA IN CHILDREN BY IRONSUPPLEMENTATION TWICE WEEKLY AND WEEKLY

Objective The effect of intermittent iron supplementation weekly and twice weekly was studied in children with iron deficiency anemia(IDA). Methods Subjects were 58 children who were randomly divided into two groups. One group received a dosage of 2mg/kg Fe every 3d for 9 weeks. The other group received the same dose Fe once a week for 12 weeks. Results Hemoglobin and serum ferrltin increased significantly after treatment in both groups (P <o.o5), and zinc protoporphyrin decreased significantly (P <o. o5). But serum rerrltin of both groups was different after 6 weeks of treatment (P<o. o1). The side effect of the group supplemented once every 3d was higher than that of the group once a week, but there was no statistically significant difference. Conclusion Iron supplementation every 3d has a similar effect to once a week for treatment of IDA. The former should be used for the serious patients for 6 weeks. The later should be used for infants and the patients whose resistance of intestines and stomach are not good.

Advances in surgery procedures for convergence insufficiency-type intermittent exotropia

Intermittent exotropia with convergence insufficiency is defined as a greater exodeviation measured at near than at distance of at least 10 prism diopters and it is harmful to binocular vision at earlier time. This paper mainly introduces three operation patterns including lateral rectus recession(s) with or without a slanting procedure, unilateral lateral rectus recession with medial rectus resection, and medial rectus resection(s) with or without a slanting procedure.

Clinical investigation of surgery for intermittent exotropia

Objective:To investigate the time and postoperative binocular vision of strabismus surgery for children with inter- mittent exotropia(X(T).Methods:A retrospective investigation was conducted in 80 child patients with intermittent exotropia. Pre-and postoperative angles of deviation fixating at near(33 cm)and distant targets(6 m)were measured with the prolonged alternate cover testing.The binocular function was assessed with synoptophore.Twenty-one patients took the postoperative synoptophore exercise.Results:(1)A week after surgery,96.2%of the 80 patients had binocular normotopia,while a year after surgery,91.3%of the 80 patients had binocular normotopia;(2)Preoperatively,58 patients had near stereoacuity,while post- operatively,72 patients achieved near stereoacuity(P<0.05);(3)Preoperatively,64 patients had Grade I for the synoptophore evaluation and postoperatively,76 patients achieved Grade I.Meanwhile,55 patients had Grade II preoperatively and 72 achieved Grade II postoperatively.For Grade III,there were 49 patients preoperatively and 64 patients postoperatively(P<0.05);(4)Pa- tients of 5～8 years old had a significantly better recovery rate of binocular vision than those of 9～18 years old(P<0.05);(5) Patients taking postoperative synoptophore exercise had a better binocular vision than those taking no exercise(P<0.05).Con- clusions:(1)Strabismus surgery can help to preserve or restore the binocular vision for intermittent exotropia;(2)Receiving the surgery at young ages may develop better postoperative binocular vision;(3)The postoperative synoptophore exercise can help to restore the binocular vision.

Prevalence of intermittent exotropia among primary and secondary school students in Shantou,China

Background: Few prevalence studies on intermittent exotropia(IXT) based on Chinese populations. Furthermore, longitudinal change in this pattern within a local setting has not been reported in the past. This study aims to determine the profile of children with IXT in China.Methods: A total of 7,537 subjects from nine multi-layer primary and secondary schools participated in this investigation. The position of eyes was examined by using Hirschberg test and alternate cover test. The obtained results were classified according to respective features and analyzed statistically. Results: The prevalence of IXT among the participants was 7.98%, accounting for 73.04% of all types of strabismus. Junior high school students had a lower prevalence of IXT than elementary and senior high school counterparts. Logistic regression analysis showed that IXT was mainly found in male pupils at high grades in rural areas and in male secondary students at high grade in urban regions. Conclusions: IXT was shown to be more prevalent than other types of strabismus in Chinese children. Furthermore, the distribution and characteristics of IXT greatly varied among participants.

基本型间歇性外斜视患儿单眼遮盖试验前后斜视度的变化

目的:比较单眼遮盖试验前后基本型间歇性外斜视患儿斜视度的变化。方法:前瞻性临床研究。选取2021-07/2022-09在我院行斜视矫正术的基本型间歇性外斜视患儿258例,其中男122例,女136例,年龄5-12(平均8.0±3.1)岁。术前均采用三棱镜加交替遮盖法进行视远(6 m)及视近(33 cm)的斜视度的测量,然后遮盖患儿非主导眼40 min后再次测量视远及视近斜视度,遮盖期间患儿不能闭眼及视近,打开遮盖眼之前需遮盖另眼,再交替遮盖测量斜视度。结果:单眼遮盖试验前后看远(6 m)斜视度分别为28.23^(△)±10.79^(△)、29.79^(△)±10.85^(△)(t=-0.903,P=0.368),看近(33 cm)斜视度分别为33.14^(△)±8.89^(△)、36.90^(△)±10.76^(△)(t=-2.377,P=0.019)。结论:基本型间歇性外斜视患儿术前单眼遮盖试验对视近斜视度影响大,可以暴露最大斜视度,降低斜视术后欠矫率,为斜视手术方案提供更可靠的依据。

基于CiteSpace的间歇性外斜视的文献计量学及可视化分析

目的:通过文献计量学方法分析间歇性外斜视的研究现状和未来发展趋势。方法:检索2003-2022年Web of Science数据库核心合集中收录的文献计量学相关文献,运用文献计量学方法,使用CiteSpace6.2.R2软件对年发文量、国家、机构、杂志、作者、参考文献和关键词进行可视化分析。结果:2003-2022年共检索到620篇间歇性外斜视相关文献,年发文量呈稳定增加的趋势。韩国和美国为发文量最多的国家,最具有生产力的机构为梅奥诊所。发文量最多的作者为Holmes JM。刊文量最多的期刊是The Journal of American Association for Pediatric Ophthalmology and Strabismus(J AAPOS)(共计78篇文献)。关键词和突现词分析可总结出目前该领域的研究热点为间歇性外斜视的手术治疗、流行病学、正位、复发。结论:应用CiteSpace软件进行可视化分析,可客观反映出2003-2022年间歇性外斜视文献数量变化及分布情况,间歇性外斜视的研究热点已从其手术和流行病学逐渐转移到融合和复发等方面。

小角度间歇性外斜视伴近视患者使用不同类型镜片控制近视及斜视的作用

目的:比较小角度间歇性外斜视伴近视患者使用多点近视离焦镜片、角膜塑形镜、单光镜片的临床有效性。方法:回顾性研究。选取2021-06/2022-09在我院就诊的小角度间歇性外斜视伴近视患者150例(均取主导眼数据进行分析,其中三棱镜检查为双眼所测数据),年龄8-15岁,斜视度-10^(△)--20^(△)(块镜),等效球镜度(SE)为-1.00--5.50 D,按照自愿原则分为三组:HAL组50例配戴多点近视离焦镜片;OK镜组50例夜间配戴角膜塑形镜;SVL组50例配戴普通单光镜片。比较三组患者戴镜前及戴镜1 a的眼轴、裸眼及戴镜棱镜度(取33 cm处三棱镜)、近水平正融像性集合(模糊点)、近立体视变化,采用纽卡斯尔(NCS)评分标准评估三组患者的眼位控制能力。结果:HAL组、OK镜组、SVL组戴镜前眼轴分别为24.83±0.91、24.93±0.97、24.98±0.68 mm(P>0.05),戴镜1 a为25.02±0.90、25.18±0.97、25.45±0.65(P<0.05),与SVL组戴镜1 a眼轴增加0.47±0.30 mm相比,HAL组和OK镜组眼轴分别增加0.19±0.06、0.25±0.21 mm(均P<0.05);戴镜前33 cm处HAL组、OK镜组、SVL组三棱镜检查斜视度分别为-15.00^(△)±3.12^(△)、-14.34^(△)±3.00^(△)、-14.06^(△)±3.22^(△),戴镜1 a戴镜测三组棱镜度分别为:-9.34^(△)±3.84^(△)、-18.42^(△)±4.41^(△)、-19.58^(△)±5.21^(△),与戴镜前相比分别增加了5.66^(△)±2.13^(△)、-4.08^(△)±3.34^(△)、-5.52^(△)±3.70^(△)(P<0.05);戴镜前HAL组、OK镜组、SVL组近立体视分别为89.20″±54.65″、93.00″±52.54″、88.40″±55.31″(P>0.05),戴镜1 a分别为76.00″±20.40″、81.20″±18.91″、100.60″±51.41″(P<0.05);戴镜前三组近水平正融像性集合(模糊点)分别为:15.04±1.97、15.14±1.67、14.62±1.47(P>0.05),戴镜1 a为17.10±2.02、13.12±1.41、13.26±2.45(P<0.05);戴镜1 a HAL组眼位控制能力较OK镜组和SVL组明显增强(P<0.05)。结论:小角度间歇性外斜视伴近视患者配戴HAL组与OK镜组、SVL组相比,可有效控制斜视度及眼轴的变化,尤其对戴镜后斜视度有较好的控制效果,而戴OK镜与SVL均出现外斜视漂移,且HAL组戴镜后立体视觉及正融性集合得到明显改善。

间歇性外斜视儿童术后视力恢复的危险因素及防范对策

目的:分析影响间歇性外斜视(Intermittent exotropia,IXT)儿童术后视力恢复的危险因素并制定防范措施。方法:回顾性分析2020年5月-2022年5月在笔者医院进行手术治疗的IXT患儿145例,根据中华眼科分会全国弱视与斜视防治学组制定的斜视疗效评价标准评估患者手术疗效,过矫:≥+15PD;欠矫:≤-15PD;正位:第一眼位±15PD以内。以欠矫、过矫记为无效组(60例),以正位患者记为有效组(85例)。收集患者资料,采用单因素及多因素Logistic回归分析影响IXT儿童术后视力恢复的影响因素,绘制ROC曲线评估各影响因素的准确度。结果:两组手术年龄、术前视近斜度、斜视类型及每天观看电子设备时间比较差异有统计学意义(P<0.05);进一步多因素Logistic回归分析显示,手术年龄、术前视近斜度、集合不足型IXT为影响IXT患儿术后视力恢复的因素(P<0.05);绘制ROC曲线评估各因素对IXT患儿术后视力恢复的影响准确度,术前视近斜度、斜视类型、手术年龄ROC曲线下AUC均在0.75以上,具有中等水平的准确度。结论:术前视近斜度、斜视类型、手术年龄为影响IXT患儿术后视力恢复的因素,应针对患儿情况实施针对性措施,进而改善患儿术后视力恢复。

改良耳穴压豆联合局部按摩治疗儿童特发性异常瞬目症的临床研究

目的 观察改良耳穴压豆联合局部按摩治疗儿童特发性异常瞬目症的临床疗效。方法 纳入2019年10月—2022年4月在上海市松江区中心医院眼科门诊确诊的4~12岁特发性异常瞬目症患儿90例,随机分成观察组(A组)、中医组(B组)和对照组(C组)各30例(60只眼)。分别予改良耳穴压豆、经典耳穴压豆和常规心理—行为疗法配合滴眼液治疗。3组均观察21 d。分别于治疗前、治疗后测量患儿瞬目频率、学习能力的数据。结果(1)瞬目频率评分:3组治疗前瞬目频率评分比较,差异无统计学意义(P>0.05)。治疗后A组与B组瞬目频率评分均较治疗前降低,差异均有统计学意义(t_(A组)=19.313、t_(B组)=15.000,均P=0.000),C组较治疗前,差异无统计学意义(P>0.05)。治疗后3组间比较,差异有统计学意义(F=1093.886,P=0.000)。与C组比较,A组和B组瞬目频率评分均较低,差异均有统计学意义(t_(A组)=-11.655,t_(B组)=-11.171,均P=0.000);A组和B组比较,差异无统计学意义(P>0.05)。(2)阅读速度比较:治疗后A组与B组阅读速度均较治疗前增加,差异均有统计学意义(t_(A组)=-60.647,t_(B组)=-61.465,均P=0.000),C组较治疗前,差异无统计学意义(P>0.05)。治疗后3组间阅读速度比较,差异有统计学意义(F=19.150,P=0.000)。与C组比较,A组与B组阅读速度均较快,差异均有统计学意义(t_(A组)=4.744、t_(B组)=4.033,均P=0.000);A组与B组比较,差异无统计学意义(P>0.05)。(3)听写速度比较:治疗后A组与B组听写速度均较治疗前增加,差异均有统计学意义(t_(A组)=-115.348、t_(B组)=-109.133,均P=0.000),C组较治疗前,差异无统计学意义(P>0.05)。治疗后3组间比较,差异有统计学意义(F=91.933,P=0.000)。与C组比较,A组与B组听写速度均较快,差异均有统计学意义(t_(A组)=9.751、t_(B组)=8.203,均P=0.000);A组与B组听写速度比较,差异无统计学意义(P>0.05)。(4)中医症候积分:3组治疗前中医症候积分比较,差异无统计学意义(P>0.05)。治疗后A组与B组中医症候积分均较治疗前降低,差异均有统计学意义(t_(A组)=-4.365、t_(B组)=-4.062,均P=0.000),C组较治疗前,差异无统计学意义(P>0.05)。治疗后3组间比较,差异有统计学意义(F=17.259,P=0.000)。与C组比较,A组和B组中医症候积分均较低,差异均有统计学意义(t_(A组)=-4.979、t_(B组)=-4.625,均P=0.000);A组和B组比较,差异无统计学意义(P>0.05)。(5)临床疗效:A组(96.67%)与B组(93.33%)总有效率均优于C组(66.67%),差异均有统计学意义(χ^(2) A组=9.017,P=0.003;χ^(2) B组=6.667,P=0.010),而A组与B组比较,差异无统计学意义(P>0.05)。(6)复发率:A组(10.34%)与B组(14.29%)复发率均低于C组(80.00%),差异均有统计学意义(χ^(2) A组=24.191、χ^(2) B组=20.728,均P=0.000);而A组与B组比较,差异无统计学意义(P>0.05)。结论 改良耳穴压豆联合局部按摩治疗儿童特发性异常瞬目症临床疗效较好,具有操作简单、疗效可靠、复发率低等优势,值得临床推广。