成人共同性斜视术后双眼视觉功能重建的临床研究

目的:探讨成人共同性斜视术后双眼视觉功能的重建。方法:观察21例成人共同性斜视患者,用同视机测定三级视功能,用《颜少明立体视检查图》检查近立体视锐度、交叉视锐度及非交叉视锐度,分析比较患者术前,术后3d;6wk;6mo双眼视觉功能的变化。结果:术前16例患者存在单眼抑制,术后6wk有6例患者消除单眼抑制,双眼视觉功能得到重建,差别具有统计学意义(P<0.05);术前具有同视机双眼视觉功能者5例,术后6wk增加至11例,其中7例得到改善,改善率36.8%,差别具有统计学意义(P<0.05);术前存在近立体视者3例,术后6wk增加至7例,其中4例得到改善,改善率22.2%,差别具有显著统计学意义(P<0.01);术前存在正常交叉视锐度者3例,术后6wk增加至7例,其中4例得到改善,改善率22.2%,差别具有显著统计学意义(P<0.01);术前存在正常非交叉视锐度者4例,术后6wk增加至7例,其中3例得到改善,改善率17.6%,差别具有显著统计学意义(P<0.01)。结论:成人共同性斜视术后双眼视觉功能得到不同程度的改善,主要体现在同时视和融合功能,但立体视难以重建,尤其是远立体视;对错过双眼视觉发育敏感期的成人共同性斜视手术,也不应忽视重建患者的双眼视觉功能。

Clinical study of binocular vision rebuilding after surgery in adult comitant strabismus

AIM: To investigate the rebuilding of binocular vision in adult comitant strabismus patients.

METHODS: Twenty-one cases of adult comitant strabismus were examined before operation, 3 days, 6 weeks, 6 months after operation respectively. Three degree binocular vision was tested by Synoptophore and near stereoacuity, crossed disparity and uncrossed disparity were tested by Yan Shaoming stereogram.

RESULTS: Sixteen cases had uniocular suppression before operation, among them, 6 cases removed uniocular suppression 6 weeks postoperatively, the difference was significant(P<0.05); Five cases had synoptophore binocular vision before operation and it increased to 11 cases 6 weeks postoperatively, among them, 7 cases were improved, improved 36.8%, the difference was statistically significant(P<0.05); Three cases had near stereopsis before operation and it increased to 7 cases 6 weeks postoperatively, among them, 4 cases were improved, improved rate 22.2%, the difference was statistically significant(P<0.01); Three cases had normal crossed disparity before operation and it increased to 7 cases 6 weeks postoperatively, among them, 4 cases were improved, improved 22.2%, the difference was statistically significant(P<0.01); Four cases had normal uncrossed disparity before operation and it increased to 7 cases 6 weeks postoperatively, among them, 3 cases were improved, improved 17.6%, the difference was statistically significant(P<0.01).

CONCLUSION: Binocular vision has been improved in different degrees postoperatively for adult comitant strabismus, mainly in simultaneous perception and synoptophore fusion, but stereopsis is hard to be built, especially the distance stereopsis; it is not clever to neglect the reconstruction of binocular vision just because of missing right time of surgery.