个性化显微斜视矫正术矫正儿童斜视的临床研究

目的探讨个性化显微斜视矫正术对儿童斜视患者眼表症状、散光及泪膜稳定性的影响。方法 40例(60眼)儿童斜视患者行斜视矫正术,随机分为A、B2组。A组采用常规角膜缘结膜切口斜视矫正术20例(30眼),B组在角膜地形图引导下做穹隆部结膜切口斜视矫正术20例(30眼),分别于术前、术后1周及2周时检测2组患者眼表症状、眼表指数(ocular surface disease index,OSDI)、泪膜四项、前表面平均屈光度(Km)和散光值。结果术前2组角膜前表面平均屈光度、散光值、眼表症状、OSDI及泪膜四项相比,差异均无统计学意义(均为P>0.05)。术后1周患者角膜前表面平均屈光度及散光值与术前相比:A组明显增加,差异均有统计学意义(均为P<0.05),B组变化不明显,差异均无统计学意义(均为P>0.05);术后2周2组患者角膜前表面平均屈光度及散光值与术前相比:A组恢复至术前水平,差异均无统计学意义(均为P>0.05),B组变化不明显,差异也均无统计学意义(均为P>0.05)。术后1周2组患者眼表症状眼数、OSDI、泪膜破裂时间(break-up,time,BUT)及角膜荧光素染色(fluorescein staining,FL)相比,差异均有统计学意义(均为P<0.05),基础泪液分泌试验(schirmerⅠtest,ST)及泪河高度相比,差异均无统计学意义(均为P>0.05);术后2周时患者的眼表症状眼数、OSDI、BUT、ST及泪河高度已基本恢复至术前水平(均为P>0.05)。术后1周与术前相比:2组患者眼表症状眼数、OSDI、FL、BUT、ST及泪河高度均变化明显,差异均有统计学意义(均为P<0.05);术后2周与术前相比:2组患者眼表症状眼数、OSDI、BUT、ST、泪河高度及FL均恢复至术前水平,差异均无统计学意义(均为P<0.05)。结论对于儿童斜视患者,个性化显微斜视矫正术可以部分矫正患者部分角膜散光,并可以较早稳定泪膜、减轻眼表症状,提高患者的视觉质量。

Clinical research of topography-guided squint correction by microscopy for children with strabismus

Objective To observe the symptom of ocular surface,corneal thickness,tear film stability and astigmatism of children with strabismus after squint correction by microscopy guided by corneal topography.Methods In a prospective randomized sample controlled clinical study,forty children(60 eyes) with strabismus were randomly divided into two groups,patients in group A were taken traditional limbal conjunctiva incision squint correction by microscopy(20 cases,30 eyes) and patients in group B were taken corneal topography guiding incision squint correction by microscopy(20 cases,30 eyes).The vision,symptom of ocular surface,ocular surface disease index(OSDI),tear film 4 functions,central average diopter(Km) and astigmatism were performed before operation and at 1 week and 2 weeks after operation.Results There were no significant difference for average diopter,corneal astigmatism,the symptom of ocular surface,OSDI and tear film 4 functions between the two groups after operation(all P>0.05).Compared with that before operation,the average diopter and astigmatism at anterior corneal surface obviously increased in group A(both P<0.05) but no difference was found in group B(both P>0.05) at 1 week after operation;And they recovered to the degree as before operation in group A,but without change in group B at 2 weeks after operation(all P>0.05).At 1 week after operation,eye number with symptom of ocular surface,OSDI,BUT and FL had statistical differences between the two groups(all P<0.05),while no difference was found in ST or lacrimal river height(both P>0.05).At 2 weeks after operation,eye numbers with symptom of ocular surface,OSDI,BUT,ST and lacrimal river height were basically recovered to the degree as before operation(all P>0.05).Compared with before operation,eye numbers with symptom of ocular surface,OSDI,FL,BUT,ST and lacrimal river depth had statistical differences in two groups at 1 week after operation(all P<0.05),while no difference was found in eye numbers with symptom of ocular surface,OSDI,BUT,ST,lacrimal river height and FL,which were basically recovered(all P>0.05).Conclusion Topography-guided squint correction by microscopy is a more favorable solution for children with strabismus,which can correct the corneal astigmatism,stabilize the tear film,mitigate the symptom of ocular surface and therefore improve the visual quality.