共同性斜视患儿手术前后三级视功能的临床观察

目的观察共同性斜视患者手术前后双眼视觉功能的变化,探讨手术矫正在共同性斜视患者双眼视觉功能重建中的重要性。方法收集了37例共同性斜视患者,手术前后分别进行眼部常规检查,屈光检查和三棱镜加交替遮盖法测定远、近斜视度;同时视、融合功能采用同视机检测,立体视功能采用颜少明编绘的《立体视觉检查图》检测。有屈光不正的患者须戴眼镜矫正后进行检测。记录术前、术后1、3、6个月各项检查数据,并对数据资料进行统计分析。结果术前所有患者中,有同时视功能者8例,占21.6%,有融合功能者7例,占18.9%,平均融合范围1.90°±4.15°,有立体视功能者0例;术后1个月同时视功能较术前有明显恢复（P〈0.05）,融合功能及融合范围、立体视无明显恢复（P〉0.05）;术后3、6个月同时视、融合功能及融合范围、立体视均较术前有明显改善（P〈0.05）。结论 （1）共同性斜视患者视觉三级功能都受到了严重损害。（2）术后视觉三级功能较术前均有明显提高,手术矫正眼位是双眼视觉功能恢复和重建的前提因素。（3）我国斜视患者手术年龄偏大,病程较长,应加强科普宣传,加大全国斜弱视的普查,尽可能做到早发现、早诊断、早治疗。

Outcomes of binocular vision after surgical corrections in concomitant strabismic patients

Objective To observe the changes of binocular vision in concomitant strabismic patients before and after surgical correction,and to discuss the importance of binocular vision reconstruction for concomitant strabismic patients.Methods Thirty-seven patients with constant comitant strabismus were enrolled. Patients received routine refraction and ophthalmic examinations. Distance and near esotropia were measured by prism-covering method. The simultaneous perception and fusion were examined with a synoptophore,and the stereacuity was measured with stereograms. The patients who have ametropia must wear glasses when being examined. These data were recorded before surgery and 1 month,3 months,and 6 months after surgery. Results Before surgery,eight patients exhibited simultaneous perception（ 21. 6%）,and seven patients showed binocular fusion（ 18. 9%）. The average fusion range was 1. 90 ± 4. 15○. No patient had measurable stereopsis. Simultaneous perception significantly improved among the patients 1 month after surgery（ P〈 0. 05）. At 3month and 6 month,simultaneous perception as well as binocular fusion and stereopsis all significantly improved（ P〈 0. 05）. Conclusion The loss of binocular vision in patients with comitant strabismus is severe. After surgical correction,binocular vision could improve significantly. Patients with constant comitant strabismus in China usually have longer disease course and are treated at older ages. Early screening,diagnosis and surgical correction for strabismus should be advocated.