双眼视训练对间歇性外斜视手术效果影响的临床观察

目的了解双眼视觉训练对间歇性外斜视手术效果的影响。方法将45例间歇性外斜视患者以术后正位、欠矫、过矫分为三组,行术后双眼视觉训练,对三组训练前后的视远立体视锐度及最后眼位正位率进行观察比较。结果三组视远立体视锐度经双眼视觉训练后比术后2周时显著改善P〈0.01;最后眼位正位率三组间比较无显著差异P〉0.05;过矫组比欠矫组最后眼位正位率显著提高P〈0.05。结论双眼视觉功能训练对间歇性外斜视手术疗效和双眼视功能改善十分重要。术前有一定双眼视功能的患者术后早期的轻度过矫,加上双眼视觉训练将有利于达到远期眼位的正位与双眼视功能的发育。     

间歇性外斜视手术前后的视功能变化分析

目的探讨间歇性外斜视患者手术前后的视功能变化。方法收集我院2007年1月至2010年10月行矫正手术的间歇性外斜视患者78例,根据外斜视类型及斜视度大小选择手术方式,分别行双眼外直肌后退缩短术、单眼外直肌后退缩短加内直肌缩短术与双眼外直肌后退缩短加内直肌缩短术,所有患者进行术前、术后1周及术后12个月三级视功能测定,检查双眼同时视、融合视及立体视Ⅲ级视功能,观察术后1周及12个月时眼位。结果术前无双眼视功能者40例、具有Ⅰ级视功能者38例、具有Ⅱ级视功能者22例。术后1周无双眼视功能者、具有Ⅰ级视功能者、具有Ⅱ级视功能者分别31例、47例、32例,术后12个月分别为14例、64例、40例;术后1周、12个月与术前比较,差异均有统计学意义(均为P<0.05)。术前具有远立体视者19例,近立体视者19例,术后1周分别为25例、22例,术后12个月分别为38例、34例;术后1周、12个月与术前相比,差异均有统计学意义(均为P<0.05)。术后1周正位64例,轻度欠矫8例,轻度过矫6例;术后12个月正位65例,轻度欠矫7例,轻度过矫5例,明显欠矫1例。结论及时行矫正手术对间歇性外斜视患者双眼视功能的恢复至关重要,尤其是立体视觉。     

不同年龄段儿童间歇性外斜视手术疗效分析

目的：探讨不同年龄段儿童间歇性外斜视手术的疗效。

方法：选择2015-03/2017-04于我院行间歇性外斜视手术的患儿300例作为研究对象,根据患儿年龄分为A组110例,年龄3～5岁; B组100例,年龄6～8岁; C组90例,年龄9～12岁。三组患儿均行间歇性外斜视手术。比较三组患儿的临床疗效、手术前后斜视度数、融合功能及立体视锐度。

结果：术后6wk,A组临床疗效总有效率为92.7%,明显高于B组(67.0%)和C组(68.9%),三组患儿临床疗效总有效率差异有统计学意义(P<0.05)。术前,三组患儿斜视度数、融合功能、立体视锐度水平差异均无统计学意义(P>0.05); 术后6wk,三组患儿斜视度数下降,立体视锐度与融合功能均明显改善,且A组患儿斜视度数和立体视锐度弧秒值均明显低于B组和C组,融合功能明显高于B组和C组,差异均有统计学意义(P<0.05)。

结论：间歇性外斜视患儿的年龄与术后双眼视觉恢复、重建有密切关系,年龄越小术后视觉恢复越好。     

中文版间歇性外斜视生活质量量表对间歇性外斜视生活质量的评估

目的：使用中文版间歇性外斜视生活质量量表(CIXTQ)评估间歇性外斜视(IXT)对患者及其家属生活质量的影响。

方法：搜集2020-06/2021-06于南京市儿童医院眼科住院的IXT患者及同等数量年龄匹配的正常儿童的CIXTQ得分资料。即儿童量表(CIXTQ,用于儿童评估自己的生活质量)得分,家长代理量表(pp-CIXTQ,用于家长评估儿童的生活质量)得分和家长量表(p-CIXTQ,用于家长评估自身的生活质量)得分。分析：(1)IXT儿童与正常儿童CIXTQ,pp-CIXTQ及p-CIXTQ得分的差异;(2)IXT儿童CIXTQ与pp-CIXTQ评分之间的关系;(3)IXT患儿生活质量影响因素。

结果：共纳入156例IXT儿童和156名年龄匹配的正常儿童。IXT组儿童的CIXTQ得分低于对照组(t=-12.915,P<0.001)。IXT组CIXTQ与pp-CIXTQ得分比较无差异(t=-0.718,P=0.473)。单条目分析发现,IXT组儿童更关注别人对他们的看法和自己的视力,而父母则更关心孩子是否需要手术,斜视是否会对孩子眼睛造成永久性损害以及斜视是否影响他们的社交生活。

结论：CIXTQ能较好地区分IXT儿童与正常儿童的生活质量,能准确预测IXT对患儿的影响,有助于制定个性化临床治疗方案。     

儿童间歇性外斜视手术前后双眼单视功能的临床分析

目的了解儿童间歇性外斜视手术前后的双眼单视功能变化,探讨手术时机。方法178例间歇性外斜视患儿,手术前后均应用同视机检测双眼视功能,并进行对比分析。结果术后所有患儿的双眼单视功能均较手术前改善,差异有显著性意义,而且7岁以下的患儿改善幅度更加明显。结论对间歇性外斜视的儿童应争取早期手术,手术治疗有助于间歇性外斜视患儿双眼视功能的重建和改善。     

间歇性外斜视疗效分析

目的探讨间歇性外斜视最佳手术时机及效果。方法将间歇性外斜视手术患者分为3组：Ⅰ组年龄2～5岁,Ⅱ组年龄6～18岁,Ⅲ组年龄19～45岁,观察不同年龄组术前眼位设计、手术前后眼位、双眼单视功能变化情况。结果Ⅰ组术后眼位满意率73.7%,建立双眼单视功能者84.2%;Ⅱ组术后眼位满意率89.2%,获双眼单视者78.4%;Ⅲ组眼位满意率75.0%,有双眼单视者50.0%。结论间歇性外斜视手术时机及设计应根据病人年龄、眼位、融合状态及视疲劳情况多方面综合考虑,才能提高术后正位率及获得双眼单视功能。     

间歇性外斜视发病与近视的关系

间接性外斜视(intermittent exotropia,IXT)患者为维持双眼视轴的平行而做出过度的辐辏时,可导致视力、屈光度的一过性改变,出现调节性近视.研究表明,IXT可能促进近视发展,在眼球正位时出现屈光状态改变,此时双眼调节力加强,表现为调节超前,而调节超前与近视有一定联系.因此临床工作中对IXT患者选择适当的干预时机及治疗方式尤为必要.     

Overcorrecting minus lens therapy for treatment of intermittent exotropia

The purpose of this paper is to determine the value of overcorrecting minus lenses in treating children with intermittent exotropia. The aim with this therapy is to secure an increase in the quality of fusion and to induce a quantitative decrease in the angle of strabismus. Thirty-five children were treated with 2.00 to 4.00 diopters of overcorrecting minus lenses for a median of 18 months duration. Of these, 46% had an improved quality of fusion during therapy; 26% had an improved quality of fusion and also had a quantitative decrease in their angle of deviation; and 28% had an inadequate improvement in their quality of fusion and decrease in the angle of their deviation with this therapy. Two children went from intermittent exotropia to esotropia while wearing their minus lenses--both had high accommodative-convergence/accommodation ratios (11.5 delta/1D and 10.7 delta/1D). Seventy percent of good responders who were followed for at least 1 year after discontinuing the therapy maintained a qualitative or quantitative improvement in their intermittent exotropia.     

间歇性外斜视手术时机探讨

目的 通过观察不同年龄、双眼视功能状态手术前后变化,探讨间歇性外斜视的手术时机.方法 将56例间歇性外斜视患者根据手术时年龄≤5岁、5～9岁和≥9岁分为A、B、C三组,再根据术前有无融合功能及远或近立体视分组,统计分析不同年龄组手术前后眼位、双眼视功能变化,以及手术前后融合功能变化、远或近立体视功能变化.结果 术后眼位正位率A组77.8%、B组91.7%、C组85.7%,差异无统计学意义.双眼视觉功能的恢复率A组88.9%、B组87.5%、C组50.0%,差异显著有统计学意义.结论 B组术后正位率优于A组,但双眼视觉功能的恢复却A组优于B组.术前具有融合点及融合范围者,术后双眼视功能恢复率高.近立体视丧失、远立体视保存者术后远立体视锐度恢复好,术后立体视的恢复由远立体视开始.间歇性外斜视的手术时机应根据病人眼位、年龄、融合状态及立体视功能多方面综合考虑.     

影响成人间歇性外斜视术后立体视功能重建情况分析

目的:调查成人间歇性外斜视术后立体视功能重建情况,并分析影响患者立体视功能重建的相关因素。方法:回顾性研究。选择2019-01/2021-01我院收治间歇性外斜视成人患者196例,所有患者均行斜视矫正手术,收集患者术前一般资料和术后患者立体视功能重建情况。结果:纳入患者196例术前均无近远立体视觉功能,术后近立体视觉功能重建率为52.6%(103/196),远立体视功能重建率为50.5%(99/196)。近立体视功能重建(103例)与未重建患者(93例)手术年龄、发病年龄、病程、术后水平斜视量等因素比较存在统计学意义(P<0.001);多因素Logistic回归分析显示发病年龄、病程、术后水平斜视量是影响近立体视功能重建的因素(P<0.05);受试者操作特征(ROC)曲线显示,发病年龄、病程、术后水平斜视量用于预测患者近立体视功能重建曲线下面积(AUC)分别为0.757、0.737、0.727(P<0.001)。远立体视功能重建(99例)与未重建患者(97例)在手术年龄、发病年龄、病程、术后水平斜视量比较存在统计学意义(P<0.001),多因素Logistic回...     

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. Twenty-seven 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.     

知觉学习对于间歇性外斜视儿童视功能影响的研究

目的 观察知觉学习训练对于儿童间歇性外斜视双眼视功能的影响.方法 42例间歇性外斜视患儿,行知觉学习训练.训练前及训练1个月、2个月、3个月后应用同视机检测Ⅰ级、Ⅱ级、Ⅲ级视功能,Titmus立体视觉检查图观察近立体视,同时进行间歇性外斜视斜视角检查.并对数据进行统计学分析.结果 42例患儿中,经同视机检查训练前Ⅰ级视功能20例,训练后1个月、2个月、3个月分别增加到24、27、32例,训练前与训练3个月后比较,差异有统计学意义(P＜0.05);训练前Ⅱ级视功能20例,训练后1个月、2个月、3个月分别增加至23、26、30例,训练前与训练3个月后比较,差异有统计学意义(P＜0.05);训练前Ⅲ级视功能18例,训练后1个月、2个月、3个月分别增加至23、25、30例,训练前与训练3个月后比较,差异有统计学意义(P＜0.05);Titmus立体视觉检查图发现,训练前近立体视19例,训练后增加至21、23、29例,训练前与训练后3个月后比较,差异有统计学意义(P＜0.05).训练前远方斜视角为28.33△±11.15△,训练1个月、2个月、3个月后分别为27.81△±10.87△,27.98△±11.28△,27.69△±11.56△,与训练3个月后比较,差异有统计学意义(P＜0.05).结论 知觉学习训练治疗有助于间歇性外斜视患儿双眼视功能的重建,减少斜视度,对于未达到手术指证患者可以应用.     

间歇性外斜视儿童术后视觉训练对视功能的重建效果分析

目的:探讨视觉训练用于间歇性外斜视术后患儿对其视功能重建的效果。方法:选取2016-08/2019-01于我院确诊且行眼位矫正手术治疗的间歇性外斜视患儿94例94眼,根据术后是否行视觉训练分两组,术后未予以视觉训练的患儿47例纳入对照组,术后2wk开始予双眼视觉训练的患儿47例纳入观察组。随访6mo,观察两组患儿视功能恢复及眼位回退情况。结果:术后6mo,观察组双眼同时视功能(89%)、融合功能(85%)及立体视功能(40%)恢复患儿所占比例显著高于对照组(53%、47%、19%),且观察组患儿眼位正位率明显高于对照组(91%vs 66%)。结论:儿童间歇性外斜视术后进行双眼视功能训练可促进双眼视功能恢复,同时还可降低术后眼位回退风险。     

间歇性外斜视的自然病程与治疗

间歇性外斜视占中国儿童斜视的44.9％,其自然病程的结局可能发展为恒定性外斜视,也可能眼位恢复正常,还可能患者的斜视度稳定,保持不变.目前常用的治疗方法除手术治疗外还有非手术治疗,其中非手术方法有矫正屈光不正、观察、遮盖、三棱镜矫正、A型肉毒素注射等.     

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。     

间歇性外斜视患者分型对眼位控制能力的影响

目的:分析间歇性外斜视患者分型对眼位控制能力的影响.方法:选取我院2014-06/2016-07收治的50例行斜视手术治疗的间歇性外斜视患者作为研究对象,依据所有患者视近与视远斜视度数差值将其分为基本型24例(视近斜视角与视远斜视角基本相等或相差≤15△)、分离过强型17例(视远斜视角≥视近斜视角15△)、集合不足型9例(视近斜视角≥视远斜视角15△)三组,采用注视33cm视标(视近)、注视6m视标(视远)、注视户外视标、1h遮盖试验四种检测方法对其眼位控制能力进行比较.结果:基本型间歇性外斜视患者注视33cm视标、注视6m视标、注视户外视标、1h遮盖试验四种检测结果分别为55.10±1.62、45.32±1.21、64.85±1.77、68.33±1.66PD,分离过强型间歇性外斜视患者检测结果为50.23±1.88、67.46±1.17、76.95±1.64、78.15±1.56PD,集合不足型间歇性外斜视患者检测结果为50.98±1.29、33.48±1.40、43.65±1.49、54.64±1.12PD,组间差异具有统计学意义(P＜0.05).结论:间歇性外斜视患者分型对眼位控制能力存在着显著的影响关系,确定其分型将有助于提高斜视手术治疗效果.     

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 post-operative 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 pre-operatively (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.     

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 disparity-only components of the traditional test for X(T) patients diagnosed with stereoblindness via traditional tests, respectively. Patients with a long disease course (>1y) had worse dynamic stereopsis than those with a short disease course (<1y; P<0.05, Chi-square test). The deviation angle was not correlated with the motion+disparity, disparity-only, or the motion-only test components (all P>0.05, Chi-square 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.     

间歇性外斜视眼位控制力评分综述

在间歇性外斜视患者的管理中,眼位控制力至关重要,它是评价手术时机的重要参考指标及监测和判断病情发展严重程度的必要指标之一。因此,眼位控制能力的量化成为间歇性外斜视评估中的重要环节。本文旨在对间歇性外斜视患者眼位控制力评估方法做一综述,帮助临床医生对间歇性外斜视患者制定合理的治疗方案。     

间歇性外斜视的手术治疗106例

目的　探讨间歇性外斜视手术成功的因素及术后双眼视功能恢复情况。方法　对 10 6例记录资料完整的间歇性外斜视手术情况及术后 6周到 1年情况进行分析。结果　手术后正位率 1周为 84.91%、6周为 76.42 %、1年为 75 47%。术后双眼视功能恢复与年龄有关 ,年龄越小恢复率越高 ,5～ 8岁组为 10 0 % ,9～ 14岁为 67.3 % ,>14岁组为 17.5 %。结论　间歇性外斜视手术时机越早越好 ,年龄越小双眼视觉恢复越好。术前有无融合功能对术后双眼视功能的恢复至关重要。