成人斜视患者生存质量的研究

目的：研究成人斜视患者生存质量的现状及治疗对生存质量的改善效果。
　　方法：本课题为前瞻性研究。征集2013-10/2014-05就诊于我院的符合入选和排除标准的斜视患者共45例作为试验组,另外选择最佳矫正视力及眼位正常的成人45例作为对照组。采用中文版成人斜视生存质量量表进行问卷调查,比较斜视患者与正常成人以及斜视患者术前与术后6 mo的生存质量差异。
　　结果：对照组正常成人的CAS-20社会心理评分及视功能评分都明显高于试验组斜视患者,差异均有统计学意义(P<0.01)。试验组斜视患者在术后6mo时较术前相比CAS-20社会心理评分及视功能评分都明显升高,差异均有统计学意义(P<0.01)。试验组斜视患者在术后6mo时社会心理评分及视功能评分仍显著低于对照组正常成人,差异均有统计学意义(P<0.01)。
　　结论：斜视在社会心理和视功能方面均影响了成人患者的生存质量,而斜视矫正手术有助于改善斜视患者的生存质量。     

斜视手术对间歇性外斜视患儿生存质量的短期影响

目的：：应用间歇性外斜视患者生存质量量表( intermittent exotropia questionnaire,IXTQ)研究间歇性外斜视患儿的生存质量状态,评估斜视手术对其生存质量的改善情况。方法：本研究为前瞻性研究。选择5~17岁的42例间歇性外斜视患儿作为病例组,另外选择非间歇性外斜视患儿42例为对照组,采用中文版间歇性外斜视患者生存质量量表进行问卷调查,分别比较病例组和对照组儿童、间歇性外斜视患儿术前1 d与术后3 mo以及对照组与病例组患儿术后3 mo的Child IXTQ评分,分析生存质量差异以及手术对其生存质量的改善情况。结果：对照组儿童Child IXTQ各维度评分及总评分都明显高于病例组患儿,差异有统计学意义(P<0.01);除了条目“小伙伴们因为我的眼睛取笑我”和“我因为眼睛觉得交朋友很难”无显著性统计学差异外(P>0.05),各条目比较差异有统计学意义(P<0.05);病例组术后3mo各维度评分及总评分都明显高于术前1d,差异有统计学意义( P<0.01);术后患儿Child IXTQ各维度评分及总评分仍低于对照组,差异有统计学意义(P<0.05)。结论：间歇性外斜视从视觉功能和社会心理两个方面影响患儿的生存质量,其中视觉功能影响相对较大,最显著的问题是畏光及调整眼位,而他人嘲笑、交朋友方面影响较小。斜视手术有助于改善间歇性外斜视患儿的生存质量。     

斜视对心理的影响

斜视不但影响患者的视功能、容貌,对患者的心理影响也是明显的.主要表现在斜视患者普遍存在抑郁、低自尊、社交焦虑和就业方面.另外,斜视患儿父母也因其孩子的影响而存在抑郁、紧张、焦虑.对年幼患儿斜视手术可以有效地改变他们的视功能,提高其适应社会的能力.对青少年和成年人斜视手术可改善其容貌,提高自尊水平,减少受到的社会歧视,减轻社交焦虑,更好的获得就业.     

成人斜视患者术前生存质量的研究

目的：研究成人斜视患者的健康相关生存质量,分析影响患者生存质量的因素。方法：调查研究。收集202例斜视患者（斜视组）和110例眼位正常者（眼位正常组）,采用中文版成人斜视患者生存质量量表（CAS-20）评估患者的术前生存质量,同时记录患者年龄、性别、婚姻、斜视病程、职业等个体因素信息,及斜视类型和斜视度、复视与否、弱视与否等斜视特征信息。采用独立样本t检验、单因素方差分析、Pearson相关分析、多元线性回归分析等分析不同个体信息和不同斜视特征对患者术前生存质量的影响。结果：斜视组CAS-20得分为56.8±16.7,眼位正常组得分为98.0±4.3,2组差异有统计学意义（t=-35.2,P < 0.001）。斜视患者中伴复视者的视功能维度得分显著低于无复视者（t=-1.987,P=0.047）;伴弱视的斜视患者的总量表得分均显著低于不伴弱视者（t=-2.122,P=0.004）;水平斜视度> 25△者的社会心理维度得分低于斜视度≤25△者（t=2.523,P=0.007）;不同偏斜方向的患者的生存质量得分无明显区别。年长斜视患者生存质量得分低于年轻斜视患者（r=-0.260,P < 0.001）,病程长的患者的生存质量得分低于病程短的斜视患者（r=-0.142,P=0.035）;已婚患者量表得分显著低于未婚者（t=2.981,P=0.004）;非学生斜视患者比学生斜视患者的生存质量得分低（t=-2.084,P=0.038）。多元回归分析显示年龄、斜视病程和有无伴弱视是影响患者生存质量的主要影响因素。结论：成人斜视患者健康相关的生存质量明显差于眼位正常人群;已婚、非学生族群、伴复视者或伴弱视者的生存质量量表得分低;年龄、病程和是否伴弱视是影响斜视患者术前生存质量的主要因素。     

斜视弱视儿童生存质量的研究

斜视、弱视是儿童视觉发育期的常见眼病.其疾病本身和各种治疗方法均明显限制患儿的日常生活和社会活动,从而影响患儿的生存质量.本文力图就目前斜视、弱视患儿生存质量的研究现状及其影响因素作一综述.     

共同性外斜视术后患者的生存质量的变化

目的：评估共同性外斜视患者斜视手术前后的生存质量变化。

方法：通过采用回顾性队列研究方法,随访18～30岁的恒定性的共同性外斜视患者65例。采用成人斜视生活质量评估量表AS-20和健康调查简表SF-36评估共同性外斜视患者术前和术后3mo时的生存质量状态。

结果：共同性外斜视患者术后3mo的AS-20社会心理评分及视功能评分都明显提高,差异均有统计学意义(P<0.01)。共同性外斜视术后3mo的SF-36评分中生理功能评分、生理功能对角色功能的影响评分、健康总体评分、活力评分、社会功能评分、情绪对角色功能的影响评分、精神健康评分及总体评分与术前相比均有明显改善,差异均有统计学意义(P<0.01),而躯体疼痛评分与术前相比,差异无统计学意义(P>0.05)。

结论：斜视手术有助于改善共同性外斜视的生存质量。临床上,应重视运用生存质量评估指导斜视的治疗。     

成人斜视术后生活质量评估

目的评估斜视手术对成人斜视患者生活质量的影响。方法前瞻性研究。对2013年11月至2014年9月在四川大学华西医院眼科就诊的89例成人斜视患者,分别在其术前1 d及术后（83.6±34.0）d采用成人斜视生存质量量表（AS-20）进行生活质量评价。分析手术前后AS-20分值的变化情况,并评估年龄、性别、斜视类型、双眼视觉和手术前后AS-20分值及其变化值的关系。对数据进行独立样本t检验,秩和检验和Spearman相关分析。结果患者术前AS-20得分为（50.3±18.5）分,术后得分为（80.8±20.6）分,差异有统计学意义（t=9.975,P<0.01）。相比男性,女性在术前的AS-20得分偏低,在术后提升快,差异均有统计学意义（t术前=2.050,t变化=-2.593,P<0.05）;而无论术前术后,不同斜视类型（t术前=-0.480,t术后=0.237,t变化=1.495,P>0.05）、双眼视觉是否为阳性（t术前=0.446,t术后=0.498,P>0.05）患者间的AS-20得分差异均无统计学意义,患者年龄与手术前后AS-20总分值的差值无相关性（r=0.021,P>0.05）。结论成人斜视患者术后生活质量有明显提高。女性相比男性在术前的生活质量偏低,在术后提升快。内外斜视患者、是否存在双眼视觉患者及不同年龄患者的生活质量改善情况并无明显差异。     

高度近视性斜视的研究进展

高度近视性斜视是一种特殊类型的斜视,以固定性内斜视和下斜视多见.本文系统描述了该病的临床特征,并初步总结了针对该疾病的特征性检查,分析比较了近期国内外对高度近视性斜视的治疗方法.     

成人斜视患者术后生存质量分析

目的：探讨成功接受斜视矫正手术的成人患者术后生存质量水平，分析其生存质量水平的影响因素。方法：回顾性病例对照研究。92例于2011年1-12月在温州医科大学附属眼视光医院接受斜视手术并获得成功效果，随诊1年以上的患者，通过中文版成人斜视生存质量评估量表（CAS-20）调查其术前、术后生存质量，同时收集患者的临床特点、年龄、性别和受教育程度等。并与其年龄和性别匹配的89例无斜视病史的普通人群进行比较。采用Wilcoxon秩和分析、单因素方差分析、配对t检验和独立样本t检验分析术后CAS-20得分的差异，多因素方差分析术后CAS-20得分的相关因素。结果：92例患者术后CAS-20得分显著提高，包括社会心理维度（Z = 3.25，P = 0.001）、视功能维度（Z = 3.19，P= 0.001）和总量表（Z = 3.60，P= 0.001）。术后立体视功能水平更好者，其CAS-20得分更高（F= 4.33，P= 0.016），40例获得感觉性融像功能者，其CAS-20得分比无融合功能者更高（Z = 2.60， P= 0.009）。68例术后自我感觉无斜视者，其CAS-20得分高于其余24例仍自我感觉有斜视者（Z = 3.69， P< 0.001）。与对照的普通人群相比，斜视患者术后生存质量水平仍较差（Z = 11.23，P< 0.001），32% 的患者术后生存质量得分达到正常人群的最低阈值。患者自我感觉有无斜视是影响其术后生存质量状况的主要因素。结论：斜视成功矫正的成人患者，其生存质量显著改善，但仍显著低于普通无斜视病史的人群。术后恢复一定双眼视功能者，其生存质量评分更高。术后自我感觉有无斜视是影响患者生存质量的主要因素。     

共同性斜视的遗传学研究进展

共同性斜视的病因多样且发病机制复杂,家族聚集发病现象并不少见,遗传因素在其发病中具有重要作用。其遗传模式复杂且遗传异质性高,内斜视和外斜视在不同的研究中表现出了不同的遗传模式与遗传度。7q31.2和4q28.3基因位点、ARIX等基因的变异、NPLOC4-TSPAN10-PDE6G基因簇等与共同性斜视发病相关,未来需要更多的大样本研究和家系研究及更多基因的验证。     

The effect of strabismus on a young child''s selection of a playmate

PURPOSE: This study investigated the effect of strabismus on a child's playmate selection. METHODS: Photographs of orthotropic children aged 3-6 years were altered to simulate various magnitudes of strabismus. The pictures were arranged in pairs, one orthotropic child and one with strabismus. One hundred children aged 3-8 years viewed the photographs and were asked to select a playmate from each pair. RESULTS: Chi-squared analysis found 23 children showed evidence that strabismus influenced their choices (p < 0.07). Of these 23, 12 preferred playmates with strabismus and 11 preferred orthotropic playmates. Chi-squared analysis of all subjects combined found decisions were not based on the magnitude or direction of strabismus. CONCLUSIONS: As only 11% of the children consistently selected against playmates with strabismus, and about the same percentage preferred playmates with strabismus (12%), the presence of strabismus does not appear to be a significant factor in peer acceptance in this age group.     

Gain beyond cosmesis: Demonstration of psychosocial and functional gains following successful strabismus surgery using the adult strabismus questionnaire adult strabismus 20

Background:

Strabismus adversely affects psychosocial and functional aspects; while its correction impacts positively.

Aim:

The aim was to evaluate the gains in scores: Overall scores (OASs), psychosocial subscale scores (PSSs) and functional subscale scores (FSSs) following successful surgical alignment.

Settings and Design:

We evaluated changed scores in the adult strabismus 20 (AS-20) questionnaire, administered before and after successful surgery.

Materials and Methods:

Thirty adults horizontal strabismics, were administered the AS-20, at baseline, and at 6-week and 3-month. Group-wise analysis was carried out based on gender, strabismus type (esotropia [ET] or exotropia [XT]), back-ground and amblyopia.

Statistical Analysis:

We used Wilcoxon, and Mann-Whitney U-tests. Significance was set at P ≤ 0.05.

Results:

At baseline, there were no significant differences within the groups, except that those with amblyopia significantly scored less than nonamblyopes in OAS (median scores: 53.8 vs. 71.3; P = 0.009) and FSS (56.3 vs. 85.3; P = 0.009). OAS, PSS and FSS showed significant gains at 6-week and 3-month (all Wilcoxon P < 0.001). Compared with males, females showed significantly more gain at 3-month (OAS: 37.9 vs. 28.7; P = 0.02), on account of PSS gain (49.6 vs. 37.5; P = 0.01). The ET performed better than XT only on the FSS at 6-week (28.7 vs. 15.0; P = 0.02). Vis-à-vis the nonamblyopes, the amblyopes showed significantly more benefit at 6-week alone (OAS: 18.7 vs. 28.7; P = 0.04), largely due to gains in PSS.

Conclusions:

Successful strabismus surgery has demonstrated significant gains in psychosocial, functional and overall functions. There is some evidence that gains may be more in females; with a trend to better outcomes in ET and amblyopes up to 6-week.     

The perceived personality traits of adults with digitally induced large angle strabismus and the impact of its correction

Purpose:

To ascertain the effect of digitally induced large angle strabismus and its correction on social bias against strabismic adults.

Subjects and Methods:

This prospective, observational study included 10 orthotropic subjects whose face photographs were digitally altered to produce esotropia, exotropia, and hypertropia. Three batches of non-medical professionals, each consisting of 14 subjects, adjudged personality traits of the altered face photographs on a 10-item questionnaire. The same evaluators effected the appraisal of the orthotropic photographs. The personality score of the strabismic photograph of a subject was compared with its own orthotropic photograph.

Subjects and Methods:

This prospective, observational study included 10 orthotropic subjects whose face photographs were digitally altered to produce esotropia, exotropia, and hypertropia. Three batches of non-medical professionals, each consisting of 14 subjects, adjudged personality traits of the altered face photographs on a 10-item questionnaire. The same evaluators effected the appraisal of the orthotropic photographs. The personality score of the strabismic photograph of a subject was compared with its own orthotropic photograph.

Results:

The 10 subjects whose photographs were digitally modified were of the same age (21 years) and had equal gender distribution. The evaluation of the photographs was performed by 42 evaluators aged 38.3 ± 14.9 years, of whom 21 were males. Different personality traits were rated negatively in the strabismic photographs. The statistically significant negative impact was apparent on more number of personality traits for esotropia (7 out of 10) as compared to exotropia (4 out of 10) or hypertropia (3 out of 10). Rating of the strabismic photographs was significantly lower by female evaluators (P = 0.006). However, there was no difference whether the subject evaluating the photograph of the strabismic individual was of the same gender or the opposite gender. Internal consistency of the questionnaire was excellent (Cronbach''s Alpha = 0.81).

Conclusion:

There was a significant negative impact of strabismus on the perceived personality traits of the digitally altered face photographs of the adults when compared to their orthotropic photograph.     

Adults with strabismus seek surgery for pyschosocial benefits

Background/PurposeThe goal of strabismus surgery is to align the eyes, help eliminate diplopia, and restore and/or expand binocular visual function. Adults with strabismus are subjected to psychosocial prejudices, and many patients seek strabismus correction for these reasons.MethodsA surgical audit was performed on 91 adult patients, by a singular surgeon. The type of strabismus, preoperative measurements, and indications for surgery were obtained from the patient notes, as were all final outcomes. Final measurements, on average, were taken at 16 weeks postoperatively, and patients were asked to comment subjectively on their outcome.ResultsThe majority of patients were seeking surgery for combined psychosocial and cosmetic reasons (78.4%), or combined psychosocial and functional indications (9.6%), whereas the remainder were seeking surgery for functional indications only. Eighty-three percent of patients reached the desired surgical outcome of <10 prism dioptres; 97.6% were satisfied or very satisfied with their surgery, with the remaining patients having a neutral standpoint, and none were dissatisfied.ConclusionAdult strabismus surgery is highly successful and provides patients with a good level of satisfaction. Many patients seek surgical correction for cosmesis and psychosocial benefits.     

Adjustable suture strabismus surgery

Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of 'no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach.     

The impact of strabismus on quality of life in adults with and without diplopia: a systematic review

Strabismus affects approximately 4% of the adult population and can cause substantial physical disturbance and changes to appearance. This article aims to examine the impact of strabismus in adults both with and without diplopia, focusing primarily on quality of life (QoL). We highlight the value of measuring QoL, assess the ways in which it can be measured, and the impact the disease, diplopia, and surgery have on the patient. QoL differs for strabismus patients based on their diplopia status. Patients with diplopia tend to have more concerns relating to functional QoL, whereas patients without diplopia have primarily psychosocial concerns. Two diplopia-specific questionnaires have been designed to assess QoL and the perceived severity of symptoms. Further research is needed to identify the variables which influence QoL so that appropriate support can be given to all patients with strabismus to improve their QoL.     

水平肌移位术治疗水平斜视并伴垂直斜视的临床效果观察

目的探讨水平肌移位术治疗水平斜视并伴垂直斜视的临床效果。方法选取我院2009年2月至2011年2月收治的诊断为水平斜视并伴垂直斜视的患者56例（83只眼）,对其临床病历资料进行回顾性分析,均采取水平肌移位术治疗,选择行内外直肌止端的上下移位量〈3 mm的患者为观察组A,共32例（51只眼）;选择行内外直肌止端的上下移位量为5～7 mm的患者为观察组B,共24例（32只眼）,再选择10例（12只眼）无进行内外直肌移位术的患者设为对照组,观察对比三组患者的视力矫正效果。结果观察组A平均矫正的垂直斜视度数为1.76°±0.45°;观察组B平均矫正的垂直斜视度数为4.57°±0.79°;对照组平均矫正的垂直斜视度数为1.24°±0.36°,3组患者平均矫正垂直斜视度数对比存在明显差异（P〈0.05）,具有统计学意义。结论水平肌移位术治疗水平斜视并伴垂直斜视的临床效果显著,水平肌的移位量均在5mm以上,平均矫正垂直斜视度数最为明显,安全可靠。