斜视矫正术对共同性斜视患者双眼视觉功能的影响

目的 探讨共同性斜视患者接受斜视矫正手术前后双眼视觉功能的改变及其影响因素。设计 回顾性病例系列。研究对象 北京同仁医院2013年12月至2014年8月进行斜视矫正术的共同性斜视患者191例。方法 将患者按斜视类型分为共同性内斜视组、恒定性外斜视组和间歇性外斜视组；按手术时年龄分为≤9岁组和＞9岁组。观察术前、术后1、3个月双眼视觉功能。主要指标 同视机双眼视觉三级功能及近立体视功能。结果 191例患者中，术前分别有26.7%、19.4%、11.0%及41.9%的患者具备同视机Ⅰ、Ⅱ、Ⅲ级及近立体视功能，术后1个月分别提高至90.1%、64.4%、33.0%及57.1%，术后3个月分别提高至94.8%、79.1%、37.7%及63.9%，与术前相比均有统计学差异（P均＜0.001）。术前，间歇性外斜视组38.1%、29.5%及72.4%的患者具备同视机Ⅰ、Ⅱ级及近立体视功能，高于另两组（P＜0.01）。术后3个月，间歇性外斜视组93.3%、48.6%及87.6%的患者具备同视机Ⅱ、Ⅲ级及近立体视功能，高于另两组（P均＜0.05）；恒定性外斜视组55.8%的患者具备近立体视功能，共同性内斜视组为14.0%（P＜0.001）。＞9岁组，术前28.1%、21.9%、14.6%及31.3%的患者具备同视机Ⅰ、Ⅱ、Ⅲ级及近立体视功能，术后3个月分别提高至93.8%、75.0%、37.5%及58.3%，与术前相比均有统计学差异（P＜0.01）。结论 斜视矫正术有助于共同性斜视患者双眼视觉功能的改善；间歇性外斜视患者术前术后双眼视觉功能优于其他类型斜视；大龄斜视患者术后也可能获得双眼视觉功能的改善。

Effect of strabismus surgery on binocular vision of comitant strabismus patients

Objective To analyze the changes and its influence factors of binocular vision in patients with comitant strabismus after strabismus surgery. Design Retrospective case series. Participants 191 patients undergoing strabismus surgeries in Beijing Tongren Hospital from Dec 2013 to Aug 2014 are involved. Methods All patients are categorized into three groups according to the type of strabismus: concomitant esotropia, constant exotropia and intermittent exotropia; into two groups according to surgery age: ≤9 year and ＞9 year. Binocular visual function preoperation, one-month and three-month postoperation was observed. Main Outcome Measures Grade I, II, III binocular function and near stereoacuity. Results Of all 191 cases, 26.7%, 19.4%, 11.0% and 41.9% patients have Grade I, II, III binocular function and near stereoacuity preoperation, which improve to 90.1%, 64.4%, 33.0% and 57.1% one-month postoperation (P＜0.001) and 94.8%, 79.1%, 37.7% and 63.9% three-month postoperation (P＜0.001). Preoperatively, 38.1%, 29.5% and 72.4% patients of intermittent exotropia group have Grade I, II binocular vision and near stereoacuity, which are better than the other two groups (P＜0.01). At three-month postoperation, 93.3%, 48.6% and 87.6% patients of intermittent exotropia group have Grade II, III binocular vision and near stereoacuity, which are better than the other two groups (P＜0.05); 55.8% patients of constant exotropia group have near stereoacuity, which is better than concomitant esotropia group (P＜0.001). In ＞9 year group, 28.1%, 21.9%, 14.6% and 31.3% patients have Grade I, II, III binocular function and near stereoacuity preoperation, which improve to 93.8%, 75.0%, 37.5% and 58.3% three-month postoperation (P＜0.01). Conclusion Strabiusmus surgery is an effective way to rebuild binocular vision. Intermittent exotropia patients have better binocular vision than patients with other types of strabismus. For the elder patients, strabismus surgery should also be performed if necessary.