不同屈光度间歇性外斜视患者生活质量及影响因素分析

目的： 评估不同屈光度间歇性外斜视（ IXT）患者及其家长的生活质量及其影响因素。 方法： 横断面 调查研究。选取2019 年10 月至2020 年11 月于南京医科大学第一附属医院门诊就诊的368 例IXT患 者及其家长作为研究对象进行研究。通过问卷调查获取每例患者的一般情况、中文版间歇性外斜视 生存质量评估量表（ CIXTQ）得分情况,测量斜视度、立体视、眼位控制能力并进行评分。根据屈光 度（ SE）将患者分为远视组（ SE≥ +2 D）、正视组（ SE -0.5～ +2 D）、近视组（ SE≤-0.5 D）。采用单因 素分析及多重线性回归分析生活质量的影响因素。 结果： 正视组、近视组与远视组之间家长代理量 表、家长量表的功能分量表得分存在明显差异,差异具有统计学意义（ F=5.351, P=0.005; F=3.363, P=0.036）。单因素分析显示,患者年龄、家长年龄、家长学历、家庭月收入、看近斜视度、看远斜视度、 屈光参差、纽卡斯尔眼位控制能力评分标准（ NCS）控制力对家长代理量表得分有影响（均P<0.20）; 代理人身份、家长学历、看近斜视度、看远斜视度、屈光参差、 NCS控制力对家长功能量表得分有 影响（均P<0.20）。一元线性回归分析结果显示近视对家长代理量表及家长功能量表得分有影响（ β=- 7.445, P=0.001; β=-6.523, P=0.020）。调整了家庭情况及相关客观检查对量表得分的影响,多重线 性回归分析显示,近视对家长代理量表及家长功能量表得分有影响（ β=-5.599, P=0.024; β=-5.767, P=0.041）。 结论： 屈光不正是IXT患者生活质量的重要影响因素;与远视和正视患者相比,合并近视 的IXT患者及其家长的生活质量较低。戴镜对IXT患者及其家长的生活质量无影响。
     

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。     

不同类型间歇性外斜视儿童调节集合功能研究

目的：通过观察集合不足型、基本型、分开过强型间歇性外斜视(IXT)儿童的调节幅度(AMP)、调节灵活度(AF)、集合近点(NPC)、调节性集合/调节(AC/A)及正相对集合(PRC)测量值,并与非斜视儿童对比,研究其调节与集合功能差异。

方法：临床回顾性研究。收集2018-12/2020-06我院就诊的6～12岁IXT儿童40例,根据6m及33cm斜视度测量差值,将患者分为三组：集合不足型12例、基本型18例、分开过强型10例。同期就诊非斜视儿童20名作为对照组。采用改良移近法及±2D翻转法分别测量双眼AMP及AF,移近法测量NPC,梯度法测量AC/A值,底朝外(BO)的棱镜测量远PRC及近PRC。比较各组患者间调节及集合参数测量值的差别。

结果： IXT儿童集合不足组、基本组、分开过强组与对照组双眼AMP、AF、NPC、AC/A、近PRC、远PRC比较有差异(P<0.05)。进一步两两比较,IXT各组AMP均低于对照组,集合不足组AMP低于其他IXT两组; 集合不足组AF低于基本组和对照组; 集合不足组NPC大于其他三组; 集合不足组和基本组AC/A低于其他两组; IXT各组近PRC均低于对照组,集合不足组近PRC低于其他IXT两组; IXT各组远PRC均低于对照组(均P<0.05)。

结论：IXT儿童不同类型之间存在调节及集合差异,集合不足型低于其他类型。IXT儿童双眼调节集合功能低于非斜视儿童。     

间歇性外斜视和恒定性外斜视术后远期疗效观察

目的：探讨间歇性外斜视、曾有间歇期的恒定性外斜视和无间歇期的恒定性外斜视术后的远期效果。

方法：回顾性分析137例已行斜视手术的间歇性外斜视和恒定性外斜视患者并分为3组。组1：74例间歇性外斜视; 组2：38例有间歇期的恒定性外斜视; 组3：25例无间歇期的恒定性外斜视。分析比较3组患者术后残余斜视度及立体视恢复情况。平均随访2.2a。

结果：组1、组2、组3的眼位矫正成功率分别为78%、68%、64%(组1 vs 组2,P=0.249; 组1 vs 组3,P=0.153; 组2 vs 组3,P=0.716)。组1、组2、组3术后获得双眼视者分别有57例(77%)、5例(13%)、1例(4%)(组1 vs 组2,P<0.001; 组1 vs 组3,P<0.001; 组2 vs 组3,P=0.440)。组1、组2、组3分别有66(89%)、27(71%)、8(32%)例获得粗糙立体视(组1 vs 组2,P=0.015; 组1 vs 组3,P<0.001; 组2 vs 组3,P=0.002)。获得远立体视者组1、组2、组3分别有29例(56%)、5例(24%)、1例(7%)(组1 vs 组2,P=0.013; 组1 vs 组3,P=0.001; 组2 vs 组3,P=0.366)。

结论：曾有间歇期的恒定性外斜视患者术后远期粗糙立体视的恢复优于无间歇期的恒定性外斜视,与间歇性外斜视相比,双眼视、粗糙立体视和远立体视的恢复均较差。有间歇期的恒定性外斜视可能错失了最佳治疗时机,早期手术可优化术后感觉功能结果。     

间歇性外斜视术后中远期眼位的相关因素分析

目的：探讨间歇性外斜视患者术后中远期眼位的影响因素。

方法：回顾性分析我院眼科2017-01/2018-08收治的间歇性外斜视患者78例的临床资料,收集患者的斜视类型、手术年龄、术前有无近立体视和斜视度及术后第1d斜视度等资料,探讨术后中远期眼位的影响因素。

结果：本研究纳入患者术后中远期眼位正位者47例(60%),其中术前集合不足型患者43例,术后中远期眼位正位者18例(42%); 基本型患者31例,术后中远期眼位正位者26例(84%); 分开过强型患者4例,术后中远期眼位正位者3例(75%)。单因素分析结果显示,术后中远期眼位正位者与无效者斜视类型、术前视近斜视度具有差异(P<0.05); 多因素Logistic回归分析显示,斜视类型(基本型)是影响间歇性外斜视患者术后中远期眼位的危险因素(OR=5.769,95%CI：1.790～18.595,P<0.05)。

结论：斜视类型是间歇性外斜视患者术后中远期眼位的独立影响因素,临床应引起足够重视。     

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。     

中文版儿童间歇性外斜视生存质量量表的Rasch分析

目的通过Rasch分析提炼和优化中文版儿童间歇性外斜视量表（CIXTQs）,以更好地评估中国间歇性外斜视儿童和家长的生存质量状况。方法横断面研究。在2016年6-8月期间收集5~17岁间歇性外斜视儿童青少年211例,平均年龄（9.7±3.0）岁。其中5~7岁54例,8~17岁157例。分别按要求对儿童和家长采用CIXTQs进行调查,分为5~7岁儿童、8~17岁儿童、家长代理和家长问卷4个量表。根据每一量表的每一条目得分情况使用Winsteps 3.72.3软件的等级模式进行Rasch分析,分析条目及答案的心理计量特征。各量表分析的项目包括分解维度、选项排序、局部独立性、适合度分析、项目适中性分析、最终确定维度等。结果选项排序发现5~17岁儿童青少年量表的选项均为3个,分别是“从来没有”、“有时”、“总是”,家长代理量表和家长问卷量表保留的选项排序和原量表相同,为5个。家长问卷量表仍保留3个维度,分别为功能维度、社会心理维度和手术维度;项目适合度分析发现需要删减家长问卷量表的功能维度中的条目1,社会心理维度中的条目5;删减条目后发现家长问卷量表中的手术维度的个体分离指数较差（＜1.5）。项目适中性分析发现各量表项目难度和研究对象个体能力之间的匹配情况均很好。结论提炼和优化后的CIXTQs将能更明确地反映间歇性外斜视对儿童青少年及其家长生存质量影响的因素,更敏感地评估间歇性外斜视儿童及其家长的生存质量状况。     

间歇性外斜视手术139例临床分析

目的：探讨间歇性外斜视手术时机及治疗效果。

方法：选取我院2014-05/2016-12期间收治入院的139例间歇性外斜视患儿进行前瞻性研究,根据年龄分3组：3～7岁58例(A组),8～12岁41例(B组),>12岁40例(C组),观察各组治疗效果。

结果：三组术后3d,1、3、6mo手术正位情况差异有统计学意义(P<0.05); 术后不同时间点A组正位率均显著高于其余两组,组间差异有统计学意义(P<0.05); 且B组术后3d,1mo正位率显著高于C组,组间差异有统计学意义(P<0.05)。术后6mo各组立体视功能均较术前显著改善,组间差异有统计学意义(P<0.05); 且A组恢复立体视患者所占比例显著高于B组和C组,组间差异均有统计学意义(P<0.05)。术前各组斜视度数比较差异无统计学意义(P>0.05)。术后6mo各组斜视度数差异有统计学意义(P<0.05); 且A组斜视度数≤30^△所占比例高于其余两组(均P<0.05)。术后三组BCVA变化情况差异均有统计学意义(P<0.01); 且A组术后各时间点BCVA均优于其余两组,差异均有统计学意义(P<0.05)。各组患儿术后3mo与术后6mo组内BCVA差异均无统计学意义(P>0.05)。术后6mo随访三组眼位回退发生率差异有统计学意义(P<0.05),且A组低于B组和C组,B组较C组低,差异均有统计学意义(P<0.05)。

结论：间歇性外斜视应尽早根据斜视分型选择适当术式,促进术后眼位及视功能恢复,继而提高视力,避免眼位回退。     

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。     

间歇性外斜视儿童动态和静态立体视觉的对比分析

目的：对比分析间歇性外斜视儿童在动态与静态刺激背景下的立体视功能。

方法：选取5～12岁的间歇性外斜视儿童56例,其中男26例,女30例,采用多维空间感知觉训练软件分别进行动态与静态刺激背景下的立体视功能检查,比较不同刺激下的立体视功能。

结果：动态与静态立体视均存在的患者17例(30%),动态或/和静态立体视功能有缺损者39例(70%),在39例有立体视缺损的患儿中,仅存在静态立体视的患者10例(26%),仅存在动态立体视者25例(64%),立体视缺失者4例(10%)。间歇性外斜视患儿动态立体视的检出率高于静态立体视的检出率,差异有统计学意义(P<0.05)。

结论：间歇性外斜视儿童动态背景下的立体视功能优于静态背景下的立体视功能。     

Vergence and accommodation responses in the control of intermittent exotropia

Purpose

Individuals with different types of intermittent exotropia (IXT) may use neurally coupled accommodation and vergence responses differently from those without exotropia to achieve eye alignment. This study examined the relationship between simultaneously recorded accommodation and vergence responses in children and young adults with a range of types of IXT while aligned and deviated.

Methods

Responses of 29 participants with IXT (4–31 years) and 24 age-matched controls were recorded using simultaneous eye-tracking and eccentric photorefraction while they watched a movie in binocular or monocular viewing at varying viewing distances. Gradient response AC/A ratios and fusional vergence ranges were also assessed. Eight participants had divergence or pseudo-divergence excess type IXT, 5 had convergence insufficiency and 16 had basic IXT.

Results

Control and IXT participants accommodated similarly both in monocular and binocular-aligned conditions to visual targets at 80 and 33 cm. When deviated in binocular viewing, most participants with IXT exhibited changes in accommodation <0.5D relative to alignment. Gradient response AC/A ratios were similar for control [0.56 MA/D (IQR: 0.51 MA/D)] and IXT participants [0.42 MA/D (0.54 MA/D); p  = 0.60]. IXT participants showed larger vergence to accommodation ratios with changes from distance to near fixation [1.19 MA/D (1.45 MA/D)] than control participants [0.78 MA/D (0.60 MA/D); p = 0.02], especially among IXT participants with divergence or pseudo-divergence excess. Participants with IXT exhibited typical fusional divergence ranges beyond their dissociated position [8.86 Δ (7.10 Δ)] and typical fusional convergence ranges from alignment [18 Δ (15.75 Δ)].

Conclusions

This study suggests that control of IXT is typically neither driven by accommodative convergence alone nor associated with over-accommodation secondary to fusional convergence efforts. These simultaneous measurements confirmed that proximal vergence contributed significantly to IXT control, particularly for divergence or pseudo-divergence excess type IXT. For IXT participants in this study, achieving eye alignment did not conflict with having clear vision.     

基于CiteSpace的间歇性外斜视的文献计量学及可视化分析

目的：通过文献计量学方法分析间歇性外斜视的研究现状和未来发展趋势。

方法：检索2003-2022年Web of Science数据库核心合集中收录的文献计量学相关文献,运用文献计量学方法,使用CiteSpace6.2.R2软件对年发文量、国家、机构、杂志、作者、参考文献和关键词进行可视化分析。

结果：2003-2022年共检索到620篇间歇性外斜视相关文献,年发文量呈稳定增加的趋势。韩国和美国为发文量最多的国家,最具有生产力的机构为梅奥诊所。发文量最多的作者为Holmes JM。刊文量最多的期刊是The Journal of American Association for Pediatric Ophthalmology and Strabismus(J AAPOS)(共计78篇文献)。关键词和突现词分析可总结出目前该领域的研究热点为间歇性外斜视的手术治疗、流行病学、正位、复发。

结论：应用CiteSpace软件进行可视化分析,可客观反映出2003-2022年间歇性外斜视文献数量变化及分布情况,间歇性外斜视的研究热点已从其手术和流行病学逐渐转移到融合和复发等方面。     

Survival analysis following early surgical success in intermittent exotropia surgery

AIM:To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival.METHODS:One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success [≤5 prism diopters (PD) esophoria (E) to ≤10 PD exophoria (X) on the postoperative sixth month] were enrolled in this study. Their consecutive survival on the postoperative first year, second year and third year and at the last visit of fourth year or more, and the factors that might affect their survival, were analyzed. The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group (≤5 PD E to ≤10 PD X) and the failure group (>5 PD esodeviation or >10 PD exodeviation)RESULTS:The survival rates from the Kaplan-Meier analysis were 97.78%, 92.89%, 83.70% and 50.49% on the postoperative first, second and third years and fourth year or more, respectively. None of the clinical factors was determined to have affected the survival. The amount of the exodrift was largest (2.29 PD) between the first year and the second year, and smallest (1.47 PD) between the fourth year and the last visit. Sixty-three patients had their final visit after the postoperative fourth year, and 29 of them were in the failure group. Twenty-five patients in the failure group had an intermittent exotropia (IXT) of <20 PD with good to fair distant fusion; two had an IXT of <20 PD with poor distant fusion; one had an IXT of ≥20 PD with fair distant fusion; and another had delayed-onset consecutive esotropia. The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group (2.81 PD vs 5.86 PD, P=0.012). The reoperation rate for recurrent IXT was 3.7%.CONCLUSION:The survival rate steadily decreases with the exodrift, but the amount of the exodrift decreases with long-term follow-up. The final outcomes demonstrate favorable results via surgical success or small-angle IXT with good fusion in most of the patients. A smaller deviation on the postoperative sixth month is associated with long-term survival.     

Age-related changes of phoria myopia in patients with intermittent exotropia

Purpose  To investigate the age-related changes in a myopic shift under binocular conditions (phoria myopia) in patients with intermittent exotropia (IXT). Methods  Forty-five patients with IXT were studied: 21 were ≤9 years old (children), 11 were between 10 and 19 years (adolescents), and 13 were between 20 and 43 years (adults). The angle of strabismus was determined by the alternating prism cover test. The spherical refractive error was measured at 1 m using infrared video retinoscopy under monocular and binocular viewing conditions. Results  The change in the spherical refractive error (ΔR) between binocular and monocular conditions was significantly larger in adults (ΔR = −1.11 ± 1.01 diopters (D), average ± standard deviation) than in children (ΔR = −0.34 ± 0.34 D; P < 0.05, analysis of variance). ΔR was significantly correlated with the angle of exotropia only in adults (r = 0.55, P = 0.04). After strabismus surgery, ΔR decreased in adults (n = 3). Conclusions  Because a significant myopic shift under binocular conditions was detected in IXT patients older than 20 years, phoria myopia can occur after age 20 even if functional disturbances are not observed in children or adolescent IXT patients, a fact that specialists need to bear in mind when treating younger patients.