儿童间歇性外斜视手术前后双眼调节功能变化

目的：比较儿童间歇性外斜视患者术前与术后调节反应、正/负相对调节（PRA/NRA）、调节灵敏度的变化。方法：前瞻性临床研究。收集2020年9─12月在北京大学人民医院眼科中心就诊并行手术治疗的儿童间歇性外斜视患者24例，分别于术前、术后1个月和术后3个月测量患者双眼注视40 cm处调节视标的调节反应、PRA/NRA、调节灵敏度和单眼注视40 cm处调节视标的调节灵敏度。采用重复测量的方差分析进行数据分析。结果：患者术后3个月双眼调节反应为（0.28±0.24）D，比术前[（0.08±0.24）D]显著提高了0.2 D[95%置信区间（CI）：0.033～0.363 D，P=0.015]。术后3个月的NRA为（2.46±0.39）D，比术前[（2.17±0.36）D]显著提高了0.29 D（95%CI：0.012～0.571 D，P=0.039）；PRA术前为（-2.08±0.95）D，术后3个月为（-3.13±1.65）D，比术前显著改善了-1.05 D（95%CI：0.125～1.979 D，P=0.023）。患者术后1个月和术后3个月双眼调节灵敏度分别为（8.58±2.21）cpm和（9.33±2.39）cpm，比术前[（6.00±2.00）cpm]分别显著提高了2.58 cpm[95%CI：1.485～3.681 cpm，P<0.001]和3.33 cpm[95%CI：1.937～4.729 cpm，P<0.001]。患者术后1个月时主导眼调节灵敏度比术前显著增加了2.58 cpm（95%CI：1.644～3.523 cpm，P<0.001）；术后3个月时主导眼调节灵敏度比术前显著增加了4.88 cpm（95%CI：3.665～6.085 cpm，P<0.001）。术后1个月时非主导眼调节灵敏度比术前显著增加了1.96 cp（95%CI：1.019～2.898 cpm，P<0.001）；术后3个月时非主导眼调节灵敏度比术前显著增加了5.13 cpm（95%CI：3.915～6.335 cpm，P<0.001）。术后1个月主导眼调节灵敏度比非主导眼显著提高了1.33 cpm（95%CI：0.130～2.537 cpm，P=0.031）。结论：间歇性外斜视儿童经过手术治疗后，双眼聚散-调节系统联动功能逐渐恢复正常，调节功能得以改善。

Analysis of the Accommodative Ability in Pediatric Patients with Intermittent Exotropia Concomitant after Surgery

Objective:To investigate accommodative ability in pediatric patients with intermittent exotropia concomitant after surgery.Methods:Twenty-four pediatric patients with intermittent exotropia were recruited for a prospective study at the Eye Center, People's Hospital, Peking University, from September 2020 to December 2020. Binocular and monocular accommodative facility was tested using a ±2.00 diopter (D)flip. Accommodative responses and negative/positive relative accommodation under binocular viewing conditions at 40 cm were tested. The evaluation parameters were measured before surgery and 1 and 3 months after surgery. The data were analyzed by repeated measures ANOVA.Results:The binocular accommodative response was 0.28±0.24 D 3 months after surgery compared to 0.08±0.24 D before surgery, the former was signi?cant higher than the latter (95%CI: 0.033-0.363 D,P=0.015). The NRA was 2.46±0.39 D 3 months after surgery, which was signi?cantly higher than that before surgery, which was 2.17±0.36 D (95%CI: 0.012-0.571 D,P=0.039). The PRA before surgery was-2.08±0.95 D,-2.56±1.14 D and -3.13±1.65 D, respectively, at 1 and 3 months after surgery. The PRA before surgery was signi?cant higher than the data 1 month after surgery (95%CI: 0.125-1.979 D,P=0.023). The binocular accommodative facility was 8.58±2.21 and 9.33±2.39 cycles per minute (cpm) at 1 and 3 months, respectively, after surgery. This was significantly higher than the data before surgery, which was 6.00±2.00 cpm [95%CI:1.485-3.681 cpm,P<0.001; 95%CI: 1.937-4.729 cpm,P<0.001]. The accommodative facility of the dominant eye 1 month after surgery was significant higher than the data before surgery (95%CI:1.644-3.523 cpm,P<0.001), which was the same as 3 months after surgery (95%CI: 3.665-6.085 cpm,P<0.001). The accommodative facility of the non-dominant eye before surgery was signi?cant higher than the data 1 month after surgery (95%CI: 1.019-2.898 cpm,P<0.001), which was the same as 3 months after surgery (95%CI: 3.915-6.335 cpm,P<0.001). The accommodative facility of the dominant eyes 1 month after surgery was also signi?cant higher than the data of the non-dominant eyes (95%CI: 0.130-2.537 cpm, P=0.031).Conclusions:The binocular vergence-accommodation system and the accommodative abilities of children with intermittent exotropia concomitant obviously improve after surgery.