改良性融合性集合指标在间歇性外斜视中的应用  

Application of modified fusion convergence index in intermittent exotropia

作　　者：李天玺 张童 左晓霞 刘虎[1] 王子衿 Li Tianxi;Zhang Tong;Zuo Xiaoxia;Liu Hu;Wang Zijin(Department of Ophthalmology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院眼科,南京210029

出　　处：《中华眼科杂志》2024年第1期56-63,共8页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(82273159);江苏省科技计划项目(BE2020722)。

摘　　要：目的探讨改良性融合性集合指标——融合性集合幅度/斜视度数与间歇性外斜视患儿的外斜视控制情况、立体视功能及其他视功能之间的关系。方法横断面研究。纳入2020年8月至2021年6月在南京医科大学第一附属医院诊断为间歇性外斜视的患儿。将同视机法测量的融合性集合幅度与看远三棱镜法测量的斜视度数结合,获得改良性指标——融合性集合幅度/斜视度数。使用间歇性外斜视控制评分评估患儿看远及看近时的外斜视控制情况,分为控制良好(评分0~1)和控制较差(评分2~5)。采用Spearman相关分析、Mann-Whitney U检验、Fisher精确检验、χ^(2)检验、Logistic回归分析和中介效应分析进行统计学处理。结果本研究共纳入212例患儿,其中105例(49.5%)为男性,107例(50.5%)为女性;年龄为9.0(8.0,10.0)岁;201例(94.8%)有双眼融合视功能,11例(5.2%)无双眼融合视功能。有双眼融合视功能的患儿中,融合性集合幅度/斜视度数与看远看近外斜视控制评分均呈负相关(看远:r=-0.427,P<0.001;看近:r=-0.194,P=0.006)。融合性集合幅度/斜视度数是看远(OR=0.195;95%CI:0.060~0.630;P=0.006)和看近(OR=0.252;95%CI:0.085~0.746;P=0.013)外斜视控制情况的独立影响因素。看远(OR=3.110;95%CI:1.311~7.379;P=0.010)和看近(OR=2.780;95%CI:1.401~5.517;P=0.003)立体视功能也是看远外斜视控制情况的影响因素。但中介分析显示,立体视功能不是融合性集合幅度/斜视度数与看远外斜视控制情况之间关联的中介因素(看远:P=0.066;看近:P=0.181)。15例融合性集合幅度/斜视度数≥1.5°/PD的患儿均表现为外斜视控制良好。相反,融合性集合幅度/斜视度数<1.5°/PD的患儿表现为外斜视控制更差(看远:P=0.001;看近:P=0.040)、斜视度数更大(看远:P<0.001;看近:P<0.001)。结论改良性融合性指标——融合性集合幅度/斜视度数结合了同视机与三棱镜的测量结果,可用于评估间歇性外Objective To investigate a modified fusional convergence parameter-total convergence amplitude/distance angle and its relationship with exotropia control,stereoacuity,and other visual functions in intermittent exotropia.Methods The cross-sectional study included children diagnosed with intermittent exotropia at the First Affiliated Hospital of Nanjing Medical University from August 2020 to June 2021.A modification was made by combining total convergence amplitude using synoptophore and distance angle at distance using prism bars to calculate total convergence amplitude/distance angle.Exotropia control at distance and near measured by Office-based Scale for Assessing Control was classified as good control(scale 0-1)and poor control(scale 2-5).Statistical analysis was performed using Spearman correlation analysis,Mann-Whitney U test,Fisher′s exact test,χ^(2) test,logistic regression analysis,and mediation effect analysis.Results The study included 212 patients,of which 105(49.5%)were male and 107(50.5%)were female.The median(interquartile range)age was 9.0(8.0,10.0)years.Of 211 cases,201(94.8%)had binocular fusional function,while 11 cases(5.2%)did not have binocular fusional function.Among patients with binocular fusional function,inverse correlation was observed between total convergence amplitude and exotropia control scores for both distance(r=-0.427,P<0.001)and near(r=-0.194,P=0.006).Total convergence amplitude/distance angle was an independent predictive factor for exotropia control at distance(OR=0.195;95%CI,0.060-0.630;P=0.006)and near(OR=0.252;95%CI,0.085-0.746;P=0.013).Stereoacuity at distance(OR=3.110;95%CI,1.311-7.379;P=0.010)and near(OR=2.780;95%CI,1.401-5.517;P=0.003)were also factors associated with distance exotropia control.Mediation analysis revealed that stereoacuity was not a mediating factor between the ratio and distance control(distance:P=0.066;near:P=0.181).In patients with ratio≥1.5°/PD,all the 15 patients demonstrated good control.On the contrary,patients with ratio<1.5°/PD showed w

关 键 词：外斜视 会聚 眼 深度知觉 视觉 双眼 视敏度 疾病严重程度指数 

分 类 号：R777.41[医药卫生—眼科]