视觉训练系统联合传统综合疗法对屈光不正性弱视治疗的临床效果评价  

Clinical evaluation of vision therapy system 4 combined with traditional comprehensive training for ametropic amblyopia

作　　者：迟英杰 王华君[1] 李霄 骆瑶 郑广瑛[1] Chi Yingjie;Wang Huajun;Li Xiao;Luo Yao;Zheng Guangying(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Children's Eye Disease Prevention and Control Engineering Research Center of Henan Province,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省儿童眼病防治工程研究中心,郑州450052

出　　处：《中华实验眼科杂志》2022年第6期541-547,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：河南省科技攻关项目(152102310052)。

摘　　要：目的评估视觉训练系统4(VTS4)联合传统综合疗法对屈光不正性弱视的治疗效果。方法采用非随机对照临床研究方法,于2018年1月至2021年3月在郑州大学第一附属医院纳入4~10岁屈光不正性弱视受试者168例。根据患儿监护人意愿将受试者分为传统+VTS4疗法组84例和传统治疗组84例,其中传统+VTS4疗法组行传统综合疗法联合VTS4治疗,传统治疗组仅接受传统综合疗法,2个组受试者均连续训练1年以上。采用国际标准视力表检查治疗前后最佳矫正视力(BCVA,LogMAR);采用扩瞳后电脑验光仪和视网膜检影法测定等效球镜度(SE);采用同视机检查同时视觉和融合视觉;采用Titmus立体图检查立体视;采用IOLMaster 500检查眼轴长度(AL)和角膜曲率(Km)。比较2个组受试者治疗1年后的基本治愈率、BCVA、三级视功能恢复率、△SE、△AL和△Km,评估2种治疗方法的治疗效果及近视漂移情况。将传统+VTS4疗法组受试者按年龄分成4~5岁组42例和6~10岁组42例,比较不同年龄亚组受试者基本治愈率、BCVA、三级视功能恢复率的差异。基本治愈为视力提高至0.9及以上、屈光度明显改善、治疗6个月后无复发,基本治愈率为基本治愈例数/总例数×100%。结果传统+VTS4疗法组受试者基本治愈率为58.33%(49/84),优于传统治疗组的40.48%(34/84),差异有统计学意义(χ^(2)=5.358,P=0.021)。传统+VTS4疗法组BCVA优于传统治疗组,差异有统计学意义(Z=-2.537,P=0.011)。传统+VTS4疗法组受试者同时视、融合视和立体视恢复率分别为87.93%(51/58)、78.33%(47/60)和70.77%(46/65),高于传统治疗组的65.57%(40/61)、57.81%(37/64)和52.86%(37/70),差异均有统计学意义(χ^(2)=8.259、5.968、4.566,均P<0.05)。2个组受试者0x0E䥺SymbolDA@0x0FSE、0x0E䥺SymbolDA@0x0FAL、0x0E䥺SymbolDA@0x0FKm比较差异均无统计学意义(均P>0.05)。传统+VTS4疗法治疗1年,4~5岁组基本治愈率为69.05%(29/42),高于6~10岁组的47.62%(Objective To assess the effectiveness of Vision Therapy System 4(VTS4)combined with traditional comprehensive training for ametropic amblyopia.Methods A non-randomized controlled clinical study was performed.A total of 168 children aged 4-10 years with ametropic amblyopia were enrolled in The First Affiliated Hospital of Zhengzhou University from January 2018 to March 2021.The children were assigned to conventional comprehensive training combined with Vision Therapy System 4 group(conventional+VTS4 group)and conventional group according to the preference of their guardian.Patients in conventional+VTS4 group(84 children)received conventional comprehensive training combined VTS4 and patients in conventional group(84 children)were treated with conventional comprehensive training only,and the intervention was continuously used for over a year.Best corrected visual acuity(BCVA)of the patients converted to the logarithm of the minimum angle of resolution(LogMAR)units was examined by international standard visual acuity chart before and after therapy.Spherical equivalent of the patients was detected by optometry under cycloplegic conditions and skiascopy.Binocular and fusion vision was examined with a synoptiscope.The stereopsis was evaluated using Titmus Stereogram.The ocular axial length(AL)and mean keratometry(Km)were measured with the IOLMaster 500.The basic cure rate,BCVA,reconstruction rate of stereopsis,△SE,△AL and△Km following training were compared to evaluate the effectiveness and myopic shift between two groups.The patients in conventional+VTS4 group were divided into 4-5 years old group and 6-10 years old group,with 42 cases in each group,and the basic cure rate,BCVA,reconstruction rate of stereopsis were compared to evaluate the therapeutic effect between the two groups.The basic cure was defined as acuity improved to≥0.9,with reduced myopic diopter and stable therapy outcome over 6 months.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The

关 键 词：弱视/治疗 儿童 屈光不正 视知觉游戏 视力 双眼视觉/生理 立体视/生理 近视漂移 

分 类 号：R777.44[医药卫生—眼科]