目的 探讨间歇性外斜视患者注视眼和偏斜眼的调节反应特点及其保持双眼融像时的调节反应变化.方法 前瞻性队列研究.纳入2016年10月至2017年1月在温州医科大学附属眼视光医院就诊的基本型间歇性外斜视患者24例以及健康志愿者24名,年龄10～ 27岁,分为病例组和对照组,其中病例组男性11例,女性13例;对照组男性7名,女性17名.采用开放视野式自动验光仪分别测量受试者在双眼注视和单眼注视条件下视近(40 cm)和远距(5 m)视标时右眼和左眼的调节反应,测量过程中患者配戴视远全矫框架眼镜.采用配对t检验或配对资料的Wilcoxon符号秩和检验比较双眼注视和单眼注视条件下病例组患者注视眼及偏斜眼的调节反应及对照组右眼和左眼的调节反应,并采用独立样本t检验或两样本比较的Wilcoxon秩和检验比较病例组和对照组之间调节反应、调节不对称性和调节负荷量变化值.结果 视近(40 cm)时,在双眼注视条件下,病例组注视眼的调节反应为(-1.915±0.301)D,偏斜眼调节反应为-1.649(-2.020,-0.304)D,两者之间差异有统计学意义(Z=-3.714,P＜0.001);单眼注视条件下,病例组注视眼的调节反应为(-1.653±0.271)D,偏斜眼调节反应为-1.565(-2.031,-0.667)D,两者之间差异有统计学意义(Z=-2.971,P=0.003);双眼注视时病例组患者两眼之间调节反应不对称性值为0.389(0.102,1.458)D与对照组0.155(0.009,0.573)D相比差异有统计学意义(Z=-3.505,P＜0.001),而在单眼注视条件下两组患者的两眼调节反应不对称性的差异无统计学意义(Z=-1.908,P=0.056).病例组患者的注视眼的调节负荷量变化值为-0.228(-0.796,0.382)D大于对照组右眼相应的变化值-0.086(-0.606,0.628)D,差异有统计学意义(Z=-2.279,P=0.023).视远(5 m)时,病例组患者在双眼注视及单眼注视条件下注视眼与偏斜眼之间的调节反应差异无统计学意义(t=-1.525,-1.729;P＞0.05),病例组和对照组的调节反应不对称性在双眼注视和单眼注视条件下差异均无统计学意义(Z=-1.433,-0.938;P＞0.05),病例组患者注视眼与对照组右眼以及偏斜眼与左眼的调节负荷量变化值相比差异亦无统计学意义(Z=-0.041,-1.433;P＞0.05).结论 间歇性外斜视患者双眼视近目标时注视眼和偏斜眼之间的调节反应不对称,偏斜眼表现出调节反应降低.间歇性外斜视患者保持双眼融像时所增加的调节反应比健康人群明显增多.%Objective To evaluate the accommodative response of patients with intermittent exotropia (IXT) objectively,and study the changes of accommodative response of intermittent exotropia patients when maintaining binocular fusion.Methods The prospective cohort study was used in this study.Twenty-four patients diagnosed with basic intermittent exotropia who visited the eye hospital of Wenzhou Medical University during October 2016 through January 2017 together with 24 normal volunteers were included,the 48 participants aged from 10 to 27 years old.The participants were divided into the case group and the control group.There were 11 males and 13 females in the case group,and 7 males and 17 females in the control group.The Open-filed autorefractor WAM-5500 (Grand Seiko,Japan) was used to measure the accommodative response of each eye under binocular and monocular viewing conditions at 5 m and 40 cm respectively.During the measurement,patients wore full correction spectacles to achieve distant best-corrected visual acuity of both eyes.The accommodative responses of each eye under binocular and monocular viewing conditions at distance or near between fellow eyes and groups were compared.Results Under near fixation (40cm) binocular viewing conditions,the accommodative response of the fixating eye (-1.915 ± 0.301)D was different from the deviating eye-1.649(-2.020,-0.304)D in the case group (Z=-3.714,P＜0.001).Under near fixation monocular viewing conditions,the accommodative response of the fixating eye (-1.653±0.271)D was also different from the deviating eye-1.565 (-2.031,-0.667)D in the case group (Z=-2.971,P=0.003).During binocular viewing,the asymmetric value of the accommodative response between both eyes of the case group was 0.389(0.102,1.458)D which was more significant than the normal controls' 0.155(0.009,0.573)D (Z=-3.505,P＜0.001),but during monocular viewing,there was no significant difference between the groups (Z=-1.908,P=0.056).Under near viewing conditions,the variation value of the fixating eyes of the case group was-0.228(-0.796,0.382)D,which was greater than the variation value-0.086(-0.606,0.628)D of the right eye of the normal controls,such difference is of statistical significance (Z=-2.279,P=0.023).Under distance viewing conditions,there was no significant difference in the accommodative response between fixating eyes and deviating eyes in case group neither during monocular viewing nor binocular viewing (t=-1.525,-1.729,P＞0.05).Besides,the asymmetric values of accommodative response between groups were not significantly different (Z=-1.433,P=0.152.Z=-0.938,P=0.348).Under distance viewing conditions,the changes in accommodative response of each eye during both monocular viewing and binocular viewing were not significantly different between case group and normal controls (Z=-0.041,P=0.967.Z=-1.433,P=0.152).Conclusions The accommodative responses of the fixating eye and deviating eye of patients with intermittent exotropia were asymmetric under near fixation binocular viewing conditions,and the accommodative response of the deviating eye tends to decrease.Besides,the change of accommodative response of the patients with intermittent exotropia when maintaining binocular fusion is more significant than that of the normal controls.
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