间歇性外斜视术后正位儿童双眼视觉重建的影响因素

目的 分析术后正位的间歇性外斜视儿童双眼视觉功能重建状况及其影响因素。设计 回顾性病例系列。研究对象 北京同仁医院2009-2019年儿童间歇性外斜视矫正术后获得正位的患者414例。方法 患者术前、术后（3~6个月）采用同视机和立体视觉检查图检测双眼视觉功能。根据术前同视机三级功能、发病年龄、手术年龄、最大看远斜视度（小角度偏斜组＜40 PD；中等偏斜组40~60 PD；大角度偏斜组>60 PD）分组进行比较。双眼视觉重建是指斜视经治疗眼位达正位后，建立正常的双眼视觉功能。主要指标 同视机三级功能和近立体视功能。结果 手术前后近立体视觉功能无统计学差异（χ2=0.999，P=0.382）。术前存在同视机三级功能组，术后双眼视觉功能重建显著优于术前三级功能不同程度丢失的各组（χ2=49.929，P=0.000）。发病年龄0~3岁组的术前同视机三级功能明显低于4~8岁及9~12岁组（χ2=18.592，P=0.006）；各年龄组术后远、近双眼视觉功能均无统计学差异（P均>0.05）。手术年龄9~13岁组的术前同视机三级功能优于3~4岁及5~8岁组（χ2=16.586，P=0.011）；各手术年龄组术后远、近双眼视觉功能无统计学差异（P均>0.05）。小角度斜视组手术前后的同视机三级功能均优于中、大角度组（P均＜0.05）；各组手术前后的近立体视觉功能无统计学差异（P均>0.05）。结论 术前远立体视存在与否是术后双眼视觉功能重建的主要影响因素。发病年龄越早、斜视角度越大，对同视机三级功能的损害越重。（眼科，2021，30： 62-65）

Influencing factors of binocular vision reconstruction in postoperative orthophoric children with intermittent exotropia

Objective To analyze the binocular visual function reconstruction and its influencing factors in postoperative orthophoric children with intermittent exotropia.Design Retrospective case series.Participants 414 postoperative orthophoric children with intermittent exotropia in Beijing Tongren Hospital from 2009 to 2019.Methods The binocular vision of 414 children was detected with synoptophore and the stereogram designed by Yan Shao-ming before and after surgery.The patients were divided into several groups separately according to the binocular vision detected by synoptophore before surgery,the age of onset,the age of surgery and the maximum distant deviation.Binocular vision reconstruction refers to the establishment of normal binocular vision after strabismus treatment.Main Outcome Measures The binocular vision detected with synoptophore and the near stereoacuity.Results There was no statistical difference in the near stereoacuity before and after surgery(χ²=0.999,P=0.382).The reconstruction of binocular vision in the group with distant stereoacuity before surgery was the best(χ²=49.929,P=0.000).In terms of the age of onset,the preoperative distant binocular vision of 0~3 years old group was significantly worse than that of 4~8 years old and 9~12 years old groups(χ²=18.592,P=0.006).There was no significant difference in the distant and near binocular vision after surgery among the three age groups(all P>0.05).In terms of the age of surgery,the preoperative distant binocular vision of 9~13 years old group was better than that of 3~4 years old and 5~8 years old groups(χ²=16.586,P=0.011).There was no significant difference in the distant and near binocular vision after surgery among the three age groups(all P>0.05).In terms of the maximum distant deviation,the preoperative and postoperative distant binocular vision of small deviation group was significantly better than that of medium and large deviation groups(all P<0.05).There was no significant difference in the near stereoacuity before and after surgery among the three deviation groups(all P>0.05).Conclusion Whether there is distant stereoacuity before surgery is an important factor of the binocular vision reconstruction.The earlier age of onset,the greater deviation,the more serious damage to the distant binocular vision was.(Ophthalmol CHN,2021,30:62-65)