儿童内斜视矫正术后双眼单视的建立及影响因素

摘要

目的 观察和分析内斜视儿童眼位矫正术后双眼单视功能的建立情况及其影响因素.方法 回顾性系列病例研究.收集2008年11月至2011年9月间在山东大学附属省立医院眼科中心行共同性内斜视矫正手术并且术后随访眼位正位(≤±8△)的连续性病例111例.采用手电筒式Worth四点灯评估患儿的中心融合和周边融合;采用Titmus立体视图测定患儿的立体视锐度.采用x2检验比较不同内斜视类型之间周边融合建立的差异；采用Logistic回归分析内斜视类型、弱视治疗时间、手术年龄、两眼屈光参差差值、术后斜视度对周边融合建立的影响,并采用优势比(OR)进行比较.结果 111例内斜视儿童中,术后获得周边融合者68例(61.3％),其中获得中心融合者6例(5.4％)；56例(50.5％)建立了不同程度的立体视.手术年龄(b=-0.842,P＜0.01)、弱视治疗时间(b=-0.135,P＜0.05)、最终随访的斜视度(b=-1.305,P＜0.05)与术后周边融合的建立呈负相关；两眼屈光参差差值与术后周边融合的建立不相关(b=-19.670,P＞0.05).4种内斜视类型之间术后周边融合建立的差异有统计学意义(x2=-15.977,P＜0.01),周边融合建立的困难程度依次为先天性内斜视(OR=1.0)、非调节性内斜视(OR=3.008)、部分调节性内斜视(OR=4.475)、高AC/A型内斜视(0R=82.217).结论 内斜视儿童手术年龄愈早、术前弱视治疗时间愈短、术后斜视度愈小,术后愈易建立周边融合；4种内斜视类型中,建立周边融合的难易顺序依次为先天性内斜视、非调节性内斜视、部分调节性内斜视、高AC/A型内斜视.%Objective To investigate the binocular vision achieved in children after successful surgical alignment for esotropia and to identify clinical factors that may be associated with the outcome.Methods Consecutive cases surgically aligned within ±8 PD of orthotropia were consecutively reviewed during a follow-up period from Nov 2008 to Sept 2011 in the Eye Center of Provincial Hospital affiliated with Shandong University.The Worth 4 dots flashlight test was used to evaluate the central and peripheral fusion of the children after successful surgical alignment for esotropia,and a titmus stereogram was used to evaluate stereoacuity.A Chi-square test was used to compare the status of postoperative peripheral binocular fusion for differeut types of esotropia.A logisitic regression analysis with odds ratios comparison was used to investigate the influence of the type of esotropia:the duration of the treatment for amblyopia,age at the time of the operation,the anisometropic equivalent of the two eyes and alignment at the last follow-up on the re-establishment of postoperative peripheral fusion.Results Of the 111 children with successful surgical alignment for esotropia,sixty-eight (61.3％) achieved peripheral fusion,six (5.4％) achieved central fusion,and fifty-six (50.5％)achieved different degrees of stereoacuity.The age at the time of the operation (b=-0.842,P＜0.001),the treatment duration of the amblyopia (b=-0.135,P＜0.05),and the alignment at the last follow-up (b=-1.305,P＜0.05) showed negative correlations with the postoperative peripheral fusion.There was no significant correlation between anisometropic equivalent of the two eyes and postoperative peripheral fusion (b=-19.670,P＞0.05).This was statistically significant (x2=15.977,P＜0.01) since differences in postoperative peripheral fusion were achieved for different types of esotropia.Patients with congenital esotropia were least likely to achieve peripheral fusion (OR=1.0),followed by non-accommodative esotropia (OR=3.008),partially accommodative esotropia (OR=4.475),and high AC/A ratio esotropia (OR=82.217).Conclusion The earlier the age at the time of surgery,the more likely that surgical alignment is successful.The shorter the duration of the treatment for amblyopia and the smaller the angle of orthotropia after surgery led to a greater probability for achieving peripheral fusion.The ease of achieving peripheral fusion after successful surgical alignment for esotropia depends on high AC/A ratio of esotropia,partially accommodative esotropia,non-accommodative esotropia,and congenital esotropia.