儿童部分调节性内斜视术前戴镜时限对术后效果的影响
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摘要
目的探讨儿童部分调节性内斜视术前戴镜时限对术后效果的影响。方法对2015年10月至2016年10月期间来我院就诊的60例部分调节性内斜视儿童,散瞳后进行验光全矫配镜。按术前戴镜时限分为A、B两组,A组为术前戴镜0.5a且斜视度稳定的患儿30例; B组为术前戴镜1.0a且斜视度稳定的患儿30例。每组患儿分别记录术前和术后0.5a的视力、眼位、同视机及Titmus立体视检查结果并进行相关统计分析。结果术后0.5a随访时,戴镜正位54例,过矫1例,欠矫5例。术后0.5a复查时,患儿术后双眼视功能较术前明显改善(P=0. 000),其中,A组无同时视及拥有一级视功能、二级视功能、三级视功能者分别为10例、2例、4例、14例,拥有近立体视功能者14例; B组无同时视及拥有一级视功能、二级视功能、三级视功能者分别为5例、3例、4例、18例,拥有近立体视功能者18例。A、B两组术后最佳矫正视力、眼位的正位率、各级视功能保留率、拥有近立体视功能的比例相比差异均无统计学意义(均为P> 0. 05)。结论对于部分调节性内斜视的患儿术前戴镜0.5a即可以行手术矫正眼位,以期尽早改善眼位及双眼视功能。若因各种主、客观因素限制不能在戴镜0.5a时手术,则宜在戴镜1.0a时手术可取得较好的效果。
Objective To evaluate the influence of preoperative wearing time on postoperative effect in children with partially accommodative esotropia. Methods Sixty children with partially accommodative esotropia who visited our hospital from October 2015 to October 2016 were placed in full cycloplegic refraction by using 10 g · L~(-1) Atropine eye gel and then wore full hyperopic correction glasses. The children were divided into A and B group according to preoperative wearing time. A group were thirty patients who wore glasses half a year before the operation and whose esotropia angle was stable. B group were thirty patients who wore glasses one year before the operation and whose esotropia angle was stable. The visual acuity, eye position and the results of synoptophore and Titmus stereoacuity test were recorded before and half a year after the surgery in each group, and the related statistical analysis were carried out. Results Half a year after the operation, fifty-four patients achieved orthotropia when wearing full hyperopic correction glasses. One patient was overcorrected. Five patients were undercorrected. The postoperative binocular visual function of the children improved obviouslyduring the reexamination half a year after the operation(P = 0.000), Among A group, there were 10 patients,2 patients,4 patients,14 patients had no binocular visual function and had primary visual function, secondary visual function and tertiary visual function.There were 14 patients had near stereopsis. Among B group, there were 5 patients, 3 patients,4 patients, 18 patients had no binocular visual function and had primary visual function, secondary visual function and tertiary visual function. There were 18 patients had near stereopsis. There were no statistically significant difference of the best corrected visual acuity, the positivity of eye position, the retention of visual functions at all levels and the proportion of near stereopsis between A and B group (all P > 0. 05). Conclusion To children with partially accommodative esotropia, we should do the operation to correct the eye position when wearing full hyperopic correction glasses for half a year so as to improve the eye position and binocular vision as early as possible. If we cannot operate when they wear glasses for half a year due to various of subjective and objective factors, a good postoperative effect can be achieved if the procedure is performed when they wear glasses for one year.
Objective To evaluate the influence of preoperative wearing time on postoperative effect in children with partially accommodative esotropia. Methods Sixty children with partially accommodative esotropia who visited our hospital from October 2015 to October 2016 were placed in full cycloplegic refraction by using 10 g · L~(-1) Atropine eye gel and then wore full hyperopic correction glasses. The children were divided into A and B group according to preoperative wearing time. A group were thirty patients who wore glasses half a year before the operation and whose esotropia angle was stable. B group were thirty patients who wore glasses one year before the operation and whose esotropia angle was stable. The visual acuity, eye position and the results of synoptophore and Titmus stereoacuity test were recorded before and half a year after the surgery in each group, and the related statistical analysis were carried out. Results Half a year after the operation, fifty-four patients achieved orthotropia when wearing full hyperopic correction glasses. One patient was overcorrected. Five patients were undercorrected. The postoperative binocular visual function of the children improved obviouslyduring the reexamination half a year after the operation(P = 0.000), Among A group, there were 10 patients,2 patients,4 patients,14 patients had no binocular visual function and had primary visual function, secondary visual function and tertiary visual function.There were 14 patients had near stereopsis. Among B group, there were 5 patients, 3 patients,4 patients, 18 patients had no binocular visual function and had primary visual function, secondary visual function and tertiary visual function. There were 18 patients had near stereopsis. There were no statistically significant difference of the best corrected visual acuity, the positivity of eye position, the retention of visual functions at all levels and the proportion of near stereopsis between A and B group (all P > 0. 05). Conclusion To children with partially accommodative esotropia, we should do the operation to correct the eye position when wearing full hyperopic correction glasses for half a year so as to improve the eye position and binocular vision as early as possible. If we cannot operate when they wear glasses for half a year due to various of subjective and objective factors, a good postoperative effect can be achieved if the procedure is performed when they wear glasses for one year.
引文
[1]RONEN R,FEDERICO G V,STACY L P.Risk factors influencing the outcome of strabismus surgery following retinal detachment surgery with scleral buckle[J].J AAPOS,2013,17(6):594-597.
[2]SOMER D,KARABULUT E,CINAR F G,ALTIPARMAK U E,UNLU N.Emmetropization,visual acuity,and strabismus outcomes among hyperopic infants followed with partial hyperopic corrections given in accordance with dynamic retinoscopy[J].Eye,2014,28(10):1165-1173.
[3]MURRAY A D N,ORPEN J,CALCUTT C.Changes in the functional binocular status of older children and adults with previously untreated infantile esotropia following late surgical realignment[J].JAAPOS,2007,11(2):125-130.
[4]SERPIL A,BIRSEN G,NIHAT S,AHMET D,OMER F Y.Medial rectus Faden operations with or without recession for partially accommodative esotropia associated with a high accommodative convergence to accommodation ratio[J].Br J Ophthalmol,2013,97(1):83-87.
[5]KYLE A.Long-term surgical outcome of partially accommodative esotropia[J].Am Orthopt J,2002,52(1):75-84.
[6]QI Y,YU G,WU Q,CAO W H,FAN Y W,ZHANG C Y,et al.Treatment of children partially accommodative esotropia and the use of adjustable suture in surgery[J].Ophthalmol CHN,2013,22(2):121-123.漆雅,于刚,吴倩,曹文红,樊云葳,张诚玥,等.儿童部分调节性内斜视的治疗及调整缝线在手术中的应用[J].眼科,2013,22(2):121-123.
[7]CHENG J,LI J F.Operation time selection and effect observation of the surgery for children with partially accommodative esotropia[J].Int Eye Sci,2016,16(4):791-792.程娟,李俊芳.儿童部分调节性内斜视手术时机的选择及疗效观察[J].国际眼科杂志,2016,16(4):791-792.
[8]REYNOLDS A L.Color atlas of strabismus surgery[J].Am Orthopt J,2016,66(1):136.
[9]HU C Y,YANG Y T.Treatment of strabismus in children of partial accommodative esotropia[J].CHN J Chin Ophthalmol,2012,22(4):293-294.胡翠月,杨一涛.儿童部分调节性内斜视的治疗研究[J].中国中医眼科杂志,2012,22(4):293-294.
[10]LI F M.Ophthalmology[M].Beijing:Beijing People’s Medical Publishing House,1996:2850-2851.李凤鸣.眼科全书[M].北京:人民卫生出版社,1996:2850-2851.
[11]ABDI S,THUNHOLM-HENRIKSSON I L,PANSELL T.Stepwise increase of hypermetropic correction using contact lenses in intermittent partially accommodative esotropia[J].Clin Exp Optom,2016,99(3):258-263.
[12]LEE T E,KIM S H.Accommodative and tonic convergence and anatomical contracture in partially accommodative and non-accommodative esotropia[J].Ophthalmic Physiol Opt,2012,32(6):535-538.
[13]WANG J J,LIU X L,LU C B,SONG Z X,ZHANG R,ZHANG D.Effect of 5-hydroxytryptamine 2C receptor on the long-term enhancement of the primary visual cortex in isolated brain slices in adult amblyopia deprived adult rats[J].J Xinxiang Med Univ,2018,35(6):464-468.王娇娇,刘向玲,路承彪,宋子宣,张锐,张地.5-羟色胺2C受体对形觉剥夺性成年弱视大鼠离体脑片初级视皮层长时程增强的影响[J].新乡医学院学报,2018,35(6):464-468.
[14]FRAINE L.Strabismic amblyopia:When to treat the amblyopia,when to operate[J].Am Orthopt J,2007,57(1):30-34.
[15]DEN T I,HENKES H H,VAN L G K.Binocular vision and squint,Part 1[J].Strabismus,2017,25(1):43-46.
[16]JAN-MAARTEN L,MARC V,JAN K.Stereopsis,visuospatial ability,and virtual reality in anatomy learning[J].Anat Res Int,2017,2017:1493135.
[17]ZENG S M,YAN Y M.Treatment of strabismus in children of partial accommodative esotropia[J].Int Eye Sci,2010,10(9):1795-1796.曾思明,闫玉梅.部分调节性内斜视手术远近立体视觉恢复的临床分析[J].国际眼科杂志,2010,10(9):1795-1796.
[18]ZHOU L J,WANG Y.Effect of treatment of partial accommodative esotropia[J].Chin Pract Med,2011,6(35):36-37.周丽君,王怡.儿童部分调节性内斜视手术治疗[J].中国实用医药,2011,6(35):36-37.
[19]WU H X,SUN J N,XIA X,XU L,XU X.Binocular status after surgery for constant and intermittent exotropia[J].Am J Ophthalmol,2006,142(5):822-826.
[20]QIN Y F,ZHU W J,GUO Z.Study on the effect of partial accommodative esotropia using internal rectus muscle suspension suture retrograde[J].CHN J Clin Res,2015,28(5):639-641.秦云凤,朱伟杰,郭臻.部分调节性内斜视应用内直肌悬吊缝线后退术效果研究[J].中国临床研究,2015,28(5):639-641.
[21]MITCHELL L,KOWAL L.Medial rectus muscle pulley posterior fixation sutures in accommodative and partially accommodative esotropia with convergence excess[J].J AAPOS,2012,16(2):125-130.
[22]FENG J H,JIA X G,FU Q.Effect of treatment for 72 cases of partial accommodative esotropia[J].Chin J Strab Pediat Ophthalmol,2010,18(2):66-68.冯建辉,贾新国,付青.72例部分调节性内斜视的治疗分析[J].中国斜视与小儿眼科杂志,2010,18(2):66-68.
[23]LIU X L,CAO X Y.The surgical treatment of partially accommodative esotropia in children[J].Chin J Ocul Traum Occupat Eye Dis,2006,(9):703-704.刘小林,曹晓燕.儿童部分调节性内斜视的手术探讨[J].眼外伤职业眼病杂志(附眼科手术),2006,(9):703-704.
[24]LIANG Y L.Long-term efficacy analysis of partially accommodative esotropia[J].Chin Med Cosmetol,2015,5(1):143-144.梁衍麟.部分调节性内斜视远期疗效分析[J].中国医疗美容,2015,5(1):143-144.
[2]SOMER D,KARABULUT E,CINAR F G,ALTIPARMAK U E,UNLU N.Emmetropization,visual acuity,and strabismus outcomes among hyperopic infants followed with partial hyperopic corrections given in accordance with dynamic retinoscopy[J].Eye,2014,28(10):1165-1173.
[3]MURRAY A D N,ORPEN J,CALCUTT C.Changes in the functional binocular status of older children and adults with previously untreated infantile esotropia following late surgical realignment[J].JAAPOS,2007,11(2):125-130.
[4]SERPIL A,BIRSEN G,NIHAT S,AHMET D,OMER F Y.Medial rectus Faden operations with or without recession for partially accommodative esotropia associated with a high accommodative convergence to accommodation ratio[J].Br J Ophthalmol,2013,97(1):83-87.
[5]KYLE A.Long-term surgical outcome of partially accommodative esotropia[J].Am Orthopt J,2002,52(1):75-84.
[6]QI Y,YU G,WU Q,CAO W H,FAN Y W,ZHANG C Y,et al.Treatment of children partially accommodative esotropia and the use of adjustable suture in surgery[J].Ophthalmol CHN,2013,22(2):121-123.漆雅,于刚,吴倩,曹文红,樊云葳,张诚玥,等.儿童部分调节性内斜视的治疗及调整缝线在手术中的应用[J].眼科,2013,22(2):121-123.
[7]CHENG J,LI J F.Operation time selection and effect observation of the surgery for children with partially accommodative esotropia[J].Int Eye Sci,2016,16(4):791-792.程娟,李俊芳.儿童部分调节性内斜视手术时机的选择及疗效观察[J].国际眼科杂志,2016,16(4):791-792.
[8]REYNOLDS A L.Color atlas of strabismus surgery[J].Am Orthopt J,2016,66(1):136.
[9]HU C Y,YANG Y T.Treatment of strabismus in children of partial accommodative esotropia[J].CHN J Chin Ophthalmol,2012,22(4):293-294.胡翠月,杨一涛.儿童部分调节性内斜视的治疗研究[J].中国中医眼科杂志,2012,22(4):293-294.
[10]LI F M.Ophthalmology[M].Beijing:Beijing People’s Medical Publishing House,1996:2850-2851.李凤鸣.眼科全书[M].北京:人民卫生出版社,1996:2850-2851.
[11]ABDI S,THUNHOLM-HENRIKSSON I L,PANSELL T.Stepwise increase of hypermetropic correction using contact lenses in intermittent partially accommodative esotropia[J].Clin Exp Optom,2016,99(3):258-263.
[12]LEE T E,KIM S H.Accommodative and tonic convergence and anatomical contracture in partially accommodative and non-accommodative esotropia[J].Ophthalmic Physiol Opt,2012,32(6):535-538.
[13]WANG J J,LIU X L,LU C B,SONG Z X,ZHANG R,ZHANG D.Effect of 5-hydroxytryptamine 2C receptor on the long-term enhancement of the primary visual cortex in isolated brain slices in adult amblyopia deprived adult rats[J].J Xinxiang Med Univ,2018,35(6):464-468.王娇娇,刘向玲,路承彪,宋子宣,张锐,张地.5-羟色胺2C受体对形觉剥夺性成年弱视大鼠离体脑片初级视皮层长时程增强的影响[J].新乡医学院学报,2018,35(6):464-468.
[14]FRAINE L.Strabismic amblyopia:When to treat the amblyopia,when to operate[J].Am Orthopt J,2007,57(1):30-34.
[15]DEN T I,HENKES H H,VAN L G K.Binocular vision and squint,Part 1[J].Strabismus,2017,25(1):43-46.
[16]JAN-MAARTEN L,MARC V,JAN K.Stereopsis,visuospatial ability,and virtual reality in anatomy learning[J].Anat Res Int,2017,2017:1493135.
[17]ZENG S M,YAN Y M.Treatment of strabismus in children of partial accommodative esotropia[J].Int Eye Sci,2010,10(9):1795-1796.曾思明,闫玉梅.部分调节性内斜视手术远近立体视觉恢复的临床分析[J].国际眼科杂志,2010,10(9):1795-1796.
[18]ZHOU L J,WANG Y.Effect of treatment of partial accommodative esotropia[J].Chin Pract Med,2011,6(35):36-37.周丽君,王怡.儿童部分调节性内斜视手术治疗[J].中国实用医药,2011,6(35):36-37.
[19]WU H X,SUN J N,XIA X,XU L,XU X.Binocular status after surgery for constant and intermittent exotropia[J].Am J Ophthalmol,2006,142(5):822-826.
[20]QIN Y F,ZHU W J,GUO Z.Study on the effect of partial accommodative esotropia using internal rectus muscle suspension suture retrograde[J].CHN J Clin Res,2015,28(5):639-641.秦云凤,朱伟杰,郭臻.部分调节性内斜视应用内直肌悬吊缝线后退术效果研究[J].中国临床研究,2015,28(5):639-641.
[21]MITCHELL L,KOWAL L.Medial rectus muscle pulley posterior fixation sutures in accommodative and partially accommodative esotropia with convergence excess[J].J AAPOS,2012,16(2):125-130.
[22]FENG J H,JIA X G,FU Q.Effect of treatment for 72 cases of partial accommodative esotropia[J].Chin J Strab Pediat Ophthalmol,2010,18(2):66-68.冯建辉,贾新国,付青.72例部分调节性内斜视的治疗分析[J].中国斜视与小儿眼科杂志,2010,18(2):66-68.
[23]LIU X L,CAO X Y.The surgical treatment of partially accommodative esotropia in children[J].Chin J Ocul Traum Occupat Eye Dis,2006,(9):703-704.刘小林,曹晓燕.儿童部分调节性内斜视的手术探讨[J].眼外伤职业眼病杂志(附眼科手术),2006,(9):703-704.
[24]LIANG Y L.Long-term efficacy analysis of partially accommodative esotropia[J].Chin Med Cosmetol,2015,5(1):143-144.梁衍麟.部分调节性内斜视远期疗效分析[J].中国医疗美容,2015,5(1):143-144.