视功能训练对间歇性外斜视术后小角度外斜视的疗效

目的观察和探讨视功能训练对间歇性外斜视术后小角度外斜视患者的疗效。方法前瞻性研究。对在温州医科大学附属眼视光医院就诊的间歇性外斜视术后的小角度外斜视患者（远距客观外斜视≤25 PD且近距客观外斜视≤35 PD），随机选取有意愿在医院内行每周2～3次视功能训练的40例患者作为治疗组，随机选取40例患者仅予配镜治疗作为对照组。所有患者年龄7～14岁，排除眼部其他疾病，视力正常。由同一位医生进行治疗前和治疗后3个月的调节功能、主观和客观斜视度、融像功能、立体视功能、Newcastel Control Score（NCS）等的检查和评估。采用t检验、卡方检验等进行数据分析。本研究定义治愈标准为：日常无显性斜视，有良好融像功能，具有远距、近距立体视觉。结果治疗前，对照组和治疗组的术前斜视度、术后时间、远距和近距外斜角度、融像功能、立体视检查结果分布、NCS、近视比例等方面差异均无统计学意义（P＞0.05）。治疗后，治疗组在远距客观外斜视度、近距客观外斜视度、远距主观外斜视度、近距主观外斜视度、远距集合功能、近距集合功能、集合近点、NCS等的改变量均优于对照组，差异有统计学意义（t=-2.74、-3.00、-3.33、-4.25、5.81、7.01、-6.40、-7.84，P<0.05）；治疗组立体视改善率（TNO、Titmus、Optec3500）明显高于对照组，差异有统计学意义（χ2＝21.59、19.95、34.94，P<0.05）；治疗组的治愈率也明显高于对照组，差异有统计学意义（χ2＝16.67，P<0.01）。治疗组经视功能训练后，远距客观外斜视度无明显变化，差异无统计学意义（P＞0.05）；其余视功能参数均优于训练前，差异有统计学意义（P<0.05）；治疗组外斜视度≤20 PD患者的治愈率（77％）优于外斜视度>20 PD患者（22％），差异有统计学意义（χ2＝4.55，P<0.05）；NCS<3分患者的治愈率（67％）优于NCS≥3分患者（32％），差异有统计学意义（χ2＝4.91，P<0.05）。结论视功能训练能有效提高小度数残余性外斜视患者的日常眼位控制能力，加强集合功能，改善立体视。开展视功能训练对于间歇性外斜视术后20 PD以内的外斜视患者有积极意义。

Efficacy of vision training for patients with small-angleexo deviation after surgery for intermittent exotropia

Objective To observe and discuss the efficacy of vision training for patients with small-angle exo deviation after surgery for intermittent exotropia.Methods Patients from the Eye Hospital of Wenzhou Medical University who presented with small-angle exo deviation (≤25 PD at distance and ≤35 PD at near by objective examination) after surgery for intermittent exotropia were randomly recruited for a prospective study.Forty patients who volunteered to undergo vision training at the hospital for about 2～3 times a week for 3 months were assigned to the treatment group.Forty patients who were prescribed eyeglasses only served as the control group.All patients were aged 7-14 years,had normal vision and eye disease was ruled out.The oculomotor parameters were assessed by the same doctor before the study and 3 months after the study.Testing parameters included accommodation,magnitude of deviation,vergence,stereopsis,and the Newcastle Control Score (NCS).All data were statistically analyzed by a t test or x2 test.The criteria for cure in the experiment:no daily manifest deviation,good fusion function and stereovision at distance and near.Results There was no difference in the magnitude of the exo deviation between the treatment and control group before surgery or after surgery,the magnitude of the exo deviations at distance and near,the fusion function,the stereoacuity test results,NCS,or the proportion with myopia (P＞0.05).The results for the treatment group after the experiment were significantly better than the results for the control group for the magnitude of the exo deviations at distance (t=-2.74,P＜0.05) and at near (t=-3.00,P＜0.05) using objective testing methods,and the magnitude of the exo deviation at distance (t=-3.33,P＜0.05) and at near (t=-4.25,P＜0.05) using subjective testing methods.The differences in convergence at distance (t=5.81,P＜0.05) and at near (t=7.01,P＜0.05),stereoacuity examination x2=21.59,19.95,34.94,P＜0.05],nearpoint of convergence (t=-6.40,P＜0.05),NCS (t=-6.40,P＜0.05),and the cure rate (x2=16.67,P＜0.05),were statistically significant.After the experimental period,there was a significant difference for the treatment group in the magnitude of the exo deviation at distance using objective testing (P＜0.05),while other oculomotor parameters improved (P＜0.05).Patients in the treatment group whose magnitude of exo deviation was ≤20 PD had a better improvement rate than patients with ＞20 PD (x2=4.55,P＜0.05);patients with an NCS of ＜3 had a better improvement rate than patients whose NCS was ≥3 (x2=4.91,P＜0.05).Conclusion Vision training can effectively promote the contol of daily eye position,improve convergence,and have a beneficial effect on stereovision.Vision training is meaningful for patients with a magnitude of exo deviation ≤20 PD after surgery for intermittent exotropia.