间歇性外斜视手术前后双眼视觉的临床研究

目的探讨间歇性外斜视患者手术前后双眼视觉的变化规律,为选择合理的手术时机提供依据。方法171例间歇性外斜视患者按照手术年龄分为两组,〈9岁者为组1,≥9岁者为组2。检查手术前后的远、近双眼视觉并进行分析比较。结果手术后正常近双眼视觉的重建率：组1为40．0％,组2为63．8％（P=0．002）;而同样是4岁前发病,术后组1的重建率为53．1％、组2为23．8％（P=0．032）。手术后同视机远双眼视觉的重建率组1Ⅰ级98．2％、组2Ⅰ级81．9％（P=0．027）,组1Ⅱ级96．4％、组2Ⅱ级84．5％（P=0．024）组1Ⅲ级81．8％、组2Ⅲ级73．3％（P=0．844）;经Logistic相关性检验,表明手术预后与术前的近双眼视觉及发病年龄有相关性（P〈0．01）。结论手术治疗对两组远、近双眼视觉的重建均非常有效。发病年龄对术后双眼视觉的形成和恢复有一定的影响,因此对发病年龄早于4岁的患儿,应及早手术。对4岁后L越过视觉发育敏感期发病的间歇性外斜视患者,也应尽量在9岁以内手术,以提高正常远双眼视觉的重建。（中华眼科杂志,2007,43：968-971）

Clinical study on binocular vision in intermittent exotropia before and after surgery

OBJECTIVE: To give a suggestion of the timing of surgery, the change of binocular vision before and after strabismus surgery was studied in intermittent exotropia. METHODS: One hundred and seventy-one patients, with intermittent exotropia, were divided into 2 groups, based on the age of surgery, Group 1: younger than 9 years of age. Group 2: 9 and older. Binocular vision of both distance and near was checked before and after surgery. RESULTS: The rebuilding rate of near binocular vision after surgery was: 40.0% for Group 1, 63.8% for Group 2 (P = 0.002), with same onset age (< 4 years), the regain rate of Group 1 was 53.1%, Group 2 was 23.8% (P = 0.032). The distance postoperative binocular vision, using Synoptophore, were: grade I: Group 1 98.2%, Group 2 81.9% (P = 0.027), grade II: Group 1 96.4%, Group 2 84.5% (P = 0.024), grade III: Group 1 81.8%, Group 2 73.3% (P = 0.844). With logistic test, the recovery of binocular vision postoperatively is correlated with preoperative near binocular vision as well as the age of onset (P < 0.01 for both). CONCLUSIONS: The surgery will substantially help to rebuild the binocular vision of both distance and near. The age of onset has significant impact on both the forming and the rebuilding of binocular vision. Operation should not be delayed if onset is younger than 4 years old. Even if the age of onset is older than 4, which is past the critical period of vision development, operative correction no later than 9 is still highly suggested, which may help to rebuild a normal distance binocular vision.