部分调节性内斜视术后远期疗效的观察  

Long-term surgical outcome of partially accommodative esotropia

作　　者：李辉[1] 许江涛[1] 

机构地区：[1]昆明市儿童医院眼科,云南省昆明市650228

出　　处：《中国实用眼科杂志》2016年第10期1054-1057,共4页Chinese Journal of Practical Ophthalmology

摘　　要：【摘要】目的了解儿童部分调节性内斜视矫正术后的远期功能治愈率及其影响因素，以利于斜视手术时机的选择。方法临床病例回顾性研究。对1992年8月至2015年8月期间在昆明市儿童医院眼科进行斜视矫正手术、随访2年以上且随访资料完整的部分调节性内斜视儿童55例纳入研究。使用同视机、同视机专用随机点立体视觉检查图及Titmus立体视觉检查图，对其进行双眼视觉三级功能和远、近距离定量立体视觉的检测。结果平均发病年龄是（2．25±1．24）岁，平均手术年龄是（6．15±2．22）岁，平均随访时间（4．81±2．50）年，平均末次随访年龄是（10．96±3．16）岁。末次随访时，55例戴镜平均最佳矫正视力：右眼（1．06±0．23）；左眼（1．05_±0．25）。术后有51例（92．73％，51／55）保持眼正位，4例（7．27％，4／55）出现继发性外斜视行二次手术后获得正位。末次随访有52例（94．54％，52／55）有Ⅲ级双眼视功能，3例有Ⅱ级视功能。49例（89．09％，49155）获得不同程度的远距离定量立体视，其中7例（12．73％，7／55）获得远距离中心凹立体视（立体视锐度≤60”）。有38例（69．09％，38／55）获得不同程度的近距离定量立体视，其中4例（7．27％，4／55）获得近距离中心凹立体视（立体视锐度≤60”）。术后远立体视锐度的秒弧与随访时间差异有统计学意义（r=-0．36，P〈0．05）。结论部分调节性内斜视手术矫正眼位后远期功能治愈情况良好，远立体视恢复优于近立体视，但仅有少部分例能获得中心凹立体视。随术后随访期限延长，定量立体视觉逐渐敏锐，因而在学龄前期尽早手术矫正眼位，为患者争取充裕的双眼视觉发育时间，对术后获得敏锐的立体视觉至关重要。Objective To explore the long-term therapy effect of children partially accommoda- tive esotropia after surgery and the impact factors of acquired binocular vision. Methods A total of 55 children with partially accommodative esotropia were accepted the orthopia surgery. Before the surgery and 1 month or over 1 year after the surgery, position of eye, binocular vision and far and near stereoscopic vision were determined. Routine follow-up examinations after surgery were per- formed for at least 2 years. Results The average age of onset was 2.25 years. The mean age at time of surgery was 6.15 years. Mean total follow-up was 4.81 years. The average age of last fol- low-up was 10.96 years. At the last visit, the right of average best corrected vision acuity （BCVA） was 1.01, the left BCVA was 1.05. Fifty-one patients （92.73%） were surgical successes following one procedure, Four （7.27%） developed a persistent consecutive exotropia≥ 10^△ necessitating further surgery. 89.09% （49/55） of all the children acquired the final far stereoscopic vision≤ 3000 seconds of arc, including 7 patients （12.73%） with ≤60 seconds of arc. 69.09% （38/55） of those acquired the final near stereoscopic vision〈 3000 seconds of arc, including 4 patients （7.27%） with ≤ 60 seconds of arc. Conclusions The binocular vision of children partially accommodative esotropia are improved after esotropia surgery, but the improvement of far stereoscopic vision is better than the near one. The longer follow-time are, the better stereoscopic vision become. So the best opportunity for surgery is in pre-school age.

关 键 词：部分调节性内斜视 双眼视 手术治疗 

分 类 号：R777.41[医药卫生—眼科]