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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2020, Vol. 10 ›› Issue (01) : 20 -26. doi: 10.3877/cma.j.issn.2095-2007.2020.01.004

论著

不同训练方式对间歇性外斜视患者术后斜视度及双眼视觉功能的疗效观察
李蕾1, 付晶1,†(), 孟昭君1, 赵博文1, 阎丽2   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　眼科学与视觉科学北京市重点实验室
    2. 510500　广州，国家医疗保健器具工程技术研究中心
  • 收稿日期:2020-01-16 出版日期:2020-02-28
  • 通信作者: 付晶
  • 基金资助:
    首都特色临床应用研究专项课题(Z171100001017066); 北京市卫生系统高层次卫生技术人才-学科骨干(2015-3-023)

Effect of different training methods on strabismus and binocular visual function for postoperative patients with intermittent exotropia

Lei Li1, Jing Fu1,†(), Zhaojun Meng1, Bowen Zhao1, Li Yan2   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
    2. National Engineering and Technology Research Center for Medical and Health Care Appliances, Guangzhou 510500, China
  • Received:2020-01-16 Published:2020-02-28
  • Corresponding author: Jing Fu
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引用本文：

李蕾, 付晶, 孟昭君, 赵博文, 阎丽. 不同训练方式对间歇性外斜视患者术后斜视度及双眼视觉功能的疗效观察[J]. 中华眼科医学杂志(电子版), 2020, 10(01): 20-26.

Lei Li, Jing Fu, Zhaojun Meng, Bowen Zhao, Li Yan. Effect of different training methods on strabismus and binocular visual function for postoperative patients with intermittent exotropia[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2020, 10(01): 20-26.

目的

比较不同训练方式对间歇性外斜视患者术后斜视度及双眼视觉功能的疗效。

方法

前瞻性研究。收集北京同仁医院北京同仁眼科中心2017年1月至2017年9月间歇性外斜视且进行斜视矫正术者312例。其中，男性162例，女性150例，年龄3~36岁，平均(11.3±7.3)岁。根据术后1周开始不同训练的需要，采用数字表法随机将患者分为观察组(102例)、传统训练组(105例)及视感知训练组(105例)。检查并记录患者训练前、训练后1个月、训练后3个月及训练后6个月时的远近斜视度、同视机三级功能恢复率及近立体视恢复率。采用广义线性混合效应线性模型，对上述指标进行比较。

结果

训练前、训练后1、3个月及6个月三组平均看近斜视度分别为(0.68±2.08)△、(1.45±3.19)△、(1.74±3.69)△及(2.36±4.48)△。训练后1个月、3个月及6个月与训练前比较差异有统计学意义(t＝2.57，2.98，3.54；P<0.05)。看远斜视度分别为(0.70±2.15)△、(1.45±3.19△、(1.78±3.72)△及(2.42±4.51)△。训练后1个月、3个月及6个月与训练前比较差异有统计学意义(t＝2.35，2.75，3.67；P<0.05)。同视机Ⅰ级功能恢复率，术后均达到95%以上，三组的组间差异无统计学意义(F＝0.92，P>0.05)。同视机Ⅱ级功能恢复率，训练后3个月比训练前增加16例(占9.25%)，其差异有统计学意义(F＝4.32，P<0.05)；训练后6个月比训练前及训练后1个月分别增加23例(占13.29%)及20例(占11.56%)，其差异有统计学意义(F＝6.15，5.17；P<0.05)。同视机Ⅲ级功能恢复率，视感知觉组训练后3个月及6个月比训练前分别增加17例(占31.48%)及21例(占38.89%)，其差异有统计学意义(F＝10.80，16.34；P<0.05)；传统训练组训练后3个月及6个月比训练前分别增加13例(占20.64%)及14例(占22.20%)，其差异有统计学意义(F＝5.36，6.22；P<0.05)。近立体视恢复率，训练后3个月比训练前增加22例(占12.87%)，其差异有统计学意义(F＝6.28，P<0.05)；训练后6个月比训练前、训练后1个月及3个月分别增加46例(占26.90%)、40例(占23.39%)及24例(占14.03%)，其差异有统计学意义(F＝12.35，9.54，5.78；P<0.05)。

结论

间歇性外斜患者术后经过训练，其同视机Ⅰ级功能恢复率、Ⅱ级功能恢复率及近立体视恢复率均比训练前提高；视感知觉训练组及传统训练组患者的同视机Ⅲ级功能恢复率，训练后3个月及6个月均显著高于训练前。而观察组患者，不但其同视机三级功能恢复率无提高，而且随着时间的延续其远近斜视度却均表现为增大的情况。

关键词: 间歇性外斜视, 视感知觉训练, 双眼视觉功能, 重复测量
Objective

To compare the effect of different training methods on strabismus and binocular visual function for postoperative patients with intermittent exotropia.

Methods

Prospective randomized controlled study. 312 patients with intermittent exotropia who underwent strabismus surgery from January to September 2017 in Beijing Tongren Hospital were recruited, including 162 males and 150 females, age (3 to 36) with an average age of (11.3±7.3) years-old. According to the table of Random Numbers, patients were divided into three groups, including observation group (102), traditional binocular vision training group (105) and visual perception training group (105). The patients were followed up at before and 1, 3 and 6 months after training. Generalized Linear Mixed Effect Linear Model was used to the strabismus and binocular visual function before and 1, 3, and 6 months after training.

Results

The near strabismus before training, after training in 1, 3, and 6 months was (0.68±2.08)△, (1.45±3.19)△, (1.74±3.69)△ and (2.36±4.48)△, respectively. The comparison between 1, 3 and 6 months after training and before training was statistically significant (t=2.57, 2.98, 3.54; P<0.05). The far strabismus before training, after training in 1, 3, and 6 months were (0.70±2.15) △, (1.45±3.19)△, (1.78±3.72) △ and (2.42±4.51) △, respectively. The comparisons between 1, 3 and 6 months after training and before training were statistically significant (t=2.35, 2.75, 3.67; P<0.05). The recovery rate of grade Ⅰ binocular function after operation was more than 95%; there were no significant differences in groups(F=0.92, P>0.05). The recovery rate of grade Ⅱ binocular function from 16 cases accouting for 9.25% was higher at 3 months after training than at before training, and their comparisons were statistically significant(F=4.32, P<0.05). The recovery rates of grade Ⅱ binocular function from 23 cases accouting for 13.29% and 20 cases accouting for 11.56% were higher at 6 months after training than at 1 month after training, and their comparisons were statistically significant (F=6.15, 5.17; P<0.05). The recovery rates of grade Ⅲ binocular function from 17 cases accouting for 31.48% and 21 cases accouting for 38.89% were higher at 3 months and 6 months after training compared with that before training in visual perception training group, and their comparisons were statistically significant(F=10.80, 16.34; P<0.05). The recovery rates of grade Ⅲ binocular function from 13 cases accouting for 20.64% and 14 cases accouting for 22.20% were higher at 3 and 6 months after the training compared with that before the training in traditional binocular vision training group, and their comparisons were statistically significant (F=5.36, 6.22; P<0.05). The recovery rates of near stereopsis from 122 cases accouting for 12.87% were higher at 3 months after training compared with that before training, and their comparisons were statistically significant(F=6.28, P<0.05). The recovery rates of near stereopsis from 46 cases accouting for 26.90%, 40 cases accouting for 23.39% and 24 cases accouting for 14.03% were higher at 6 months after the training compared with that before the training, 1 month and 3 months after training, and their comparisons were statistically significant (F=12.35, 9.54, 5.78; P<0.05).

Conclusions

After the training of patients with intermittent exotropia, the recovery rate of grade Ⅰ, grade Ⅱ binocular function and near stereoscopic vision of was improved compared with that before training. The recovery rate of grade Ⅲ binocular function was significantly improved in the traditional binocular vision training group and the visual perception training group at 3 and 6 months after training than before training; however the recovery rate was not improved in the observation group. Both further and near strabismus had increase with the time going on.

Key words: Intermittent exotropia, Visual perception training, Binocular vision function, Repeated measurement
表1 三组患者年龄及性别的比较
组别 例数 年龄(岁) 性别[男(%)]
观察组 102 11.4±7.2 49(48.04)
传统训练组 105 11.0±7.6 54(51.43)
视感知觉组 105 11.5±7.3 59(56.19)
F/χ2值   0.12* 1.39**
P值   >0.05 >0.05
图2 三组患者各个时间点看远斜视度的变化情况
表2 各组患者看远斜视度和看近斜视度在训练前、训练后1个月、训练后3个月及训练后6个月检测结果的比较(±s，△)
组别 例数 看近斜视度 看远斜视度
训练前 训练后1个月 训练后3个月 训练后6个月 训练前 训练后1个月 训练后3个月 训练后6个月
观察组 102 0.50±1.48 1.32±2.86 1.50±3.43 2.19±4.01 0.57±1.79 1.42±3.15 1.53±3.42 2.24±3.93
传统训练组 105 0.72±2.01 1.34±2.83 1.97±4.10 2.38±4.29 0.72±2.01 1.34±2.83 1.97±4.10 2.55±4.53
视感知觉组 105 0.82±2.61 1.65±3.67 1.75±3.52 2.50±5.09 0.80±2.58 1.58±3.57 1.84±3.63 2.48±5.02
F值   0.44 0.28
P值   >0.05 >0.05
表3 各组患者训练前与训练后1个月、训练后3个月及训练后6个月同视机Ⅰ级恢复率检查结果的比较[例数(%)]
组别 例数 训练前 训练后1个月 训练后3个月 训练后6个月
观察组 56 54 (96.43) 54(96.43) 56(100.00) 55 (98.21)
传统训练组 63 63(100.00) 61(96.83) 62 (98.41) 63(100.00)
视感知觉组 54 53 (98.15) 53(98.15) 54(100.00) 54(100.00)
F值   0.92
P值   >0.05
表4 各组患者训练前与训练后1个月、训练后3个月及训练后6个月同视机Ⅱ级恢复率检查结果的比较[例数(%)]
组别 例数 训练前 训练后1个月 训练后3个月 训练后6个月
观察组 56 46(82.14) 50(89.29) 52(92.86) 55(98.21)
传统训练组 63 53(84.13) 51(80.95) 56(88.89) 60(95.24)
视感知觉组 54 38(70.37) 39(72.22) 45(83.33) 45(83.33)
F值   2.74
P值   >0.05
表5 各组患者训练前与训练后1个月、训练后3个月及训练后6个月同视机Ⅲ级恢复率检查结果的比较[例数(%)]
组别 例数 训练前 训练后1个月 训练后3个月 训练后6个月
观察组 56 28(50.00) 30(53.57) 33(58.93) 34(60.71)
传统训练组 63 25(39.68) 30(47.62) 38(60.32)* 39(61.90)*
视感知觉组 54 16(29.63) 25(46.30) 33(61.11)* 37(68.52)*
F值   2.56 0.67 0.06 0.58
P值   <0.05 >0.05 >0.05 >0.05
表6 各组患者训练前与训练后1个月、3个月及6个月近立体视恢复率检查结果的比较[例数(%)]
组别 例数 训练前 训练后1个月 训练后3个月 训练后6个月
观察组 54 16(29.63%) 21(38.89%) 25(46.30%) 32(59.26%)
传统训练组 56 13(23.21%) 15(26.79%) 19(33.93%) 30(53.57%)
视感知觉组 61 19(31.15%) 18(29.51%) 26(42.62%) 32(52.46%)
F值   4.64
P值   >0.05
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