比较不同视觉训练方式对年龄≥9岁的共同性斜视患者术后的眼位控制及双眼视觉功能重建效果。

纳入2017年1月至2017年9月于首都医科大学附属北京同仁医院眼科中心进行斜视矫正手术的共同性斜视患者133例。其中，男性67例，女性66例，年龄9~34岁，平均年龄(15.6±7.8)岁。于术后1周时，采用数字表法随机将患者分成观察组、传统双眼视觉训练组及视感知觉训练组。传统双眼视觉训练组和视感知觉训练组患者分别接受相应训练，与观察组全部完成术后1个月、3个月及6个月的眼部常规检查、斜视度检查、眼球运动检查、双眼视觉功能检查及视感知觉检查。以(±s)描述患者的年龄和斜视度，采用单因素方差分析比较三组患者的年龄；以术后1周为基线，采用GLM重复测量多因素方差分析比较不同组别不同时间点患者的斜视度；以例数和百分比描述患者的性别、斜视类型、双眼同时视功能、融合功能及立体视功能，并采用卡方检验进行比较性别和斜视类型。采用广义估计方程GEE模型分析比较不同组别不同时间点三组患者的双眼同时视功能、融合功能及立体视功能。

眼位控制方面，观察组、传统双眼视觉训练组及视感知觉训练组等三组患者术后3个月和6个月时术后组内比较看远斜视度和看近斜视度均较基线值(术后1周)显著增加，差异具有统计学意义(F_远，近＝33.65，36.84；P<0.05)；三组患者各时间点看远斜视度和看近斜视度组间及交互作用差异无统计学意义(F_远，近＝0.38，0.63，0.22，0.55；P>0.05)。术后组内比较，视感知觉训练组术后1个月、3个月及6个月时水平偏移数值均较基线值显著降低，差异具有统计学意义(F_水平＝7.80，P<0.05)；三组患者知觉眼位水平偏移和垂直偏移各时间点组间及交互作用差异无统计学意义(F_{水平，垂直}＝1.01，1.81，0.59，1.30；P>0.05)；三组患者垂直偏移各时间点术后组内比较的差异亦无统计学意义(F_垂直＝0.95，P>0.05)。双眼同时视功能方面，三组患者双眼同时视功能各时间点术后组内比较的差异无统计学意义(F＝4.38，P>0.05)；三组患者双眼同时视功能各时间点组间及交互作用的差异亦无统计学意义(F＝3.92，3.19；P>0.05)。融合功能方面，三组患者双眼融合功能各时间点组间及交互作用的差异无统计学意义(F＝1.01，2.54；P>0.05)；术后组内比较，传统双眼视觉训练组和视感知觉训练组在术后6个月时较基线值显著改善，差异具有统计学意义(F＝19.13，P<0.05)。立体视功能方面，三组患者远立体视功能和近立体视功能各时间点组间及交互作用的差异无统计学意义(F_远，近＝0.16，10.36，0.24，0.99；P>0.05)；术后组内比较，视感知觉训练组在术后3个月和6个月时远立体视功能较基线值明显改善，差异具有统计学意义(F_远＝9.05，P<0.05)；术后组内比较，三组患者近立体视功能各时间点的差异无统计学意义(F_近＝4.86，P>0.05)。

大龄儿童及成年共同性斜视患者术后通过视感知觉训练在知觉水平上可以获得更稳定的眼位控制并更好地重建远立体视功能。

The aim of this study was to compare the effect of different training methods on eye position control and binocular visual function reconstruction for concomitant strabismus patients (≥9 years-old) after surgery.

133 patients with concomitant strabismus who underwent strabismus surgery in Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University from January to September 2017 were collected. There were 67 males and 66 females with an average age of (15.6±7.8) years-old (ranged from 9 to 34 years-old). After operation for one week, the patients were randomly divided into observation group, traditional binocular vision training group and visual perception training group. All patients completed the examination of strabismus degree, eye movement, binocular visual function and visual perception after operation for 1 month, 3 months and 6 months. The age and strabismus degree of patients were described by (±s) . ANOVA was used to compare the age of three groups. GLM ANOVA of repeated measurement was used to compare the strabismus degree among different groups and time. The gender, strabismus types and the binocular visual function were described by the number and percentage. χ² testing was used to compare the gender and strabismus types of three groups. GEE model was used to compare the binocular visual function among different groups and time.

Both distant and near deviation degree of the observation group, traditional binocular vision training group and visual perception training group after operation for 3 and 6 months were significantly higher than the baseline values (after operation for 1 week ) (F_{far, near}=33.65, 36.84; P<0.05), but no significant difference was found among different groups at each time point (F_{far, near}=0.38, 0.63, 0.22, 0.55; P>0.05). The horizontal deviation degree of the visual perception training group at 1 month, 3 months and 6 months after operation was significantly lower than that of the baseline value(F=7.80, P<0.05). There was no significant difference among different groups (F_{horizontal, vertical}=1.01, 1.81, 0.59, 1.30; P>0.05). The vertical deviation was neither in each group and time point(F=0.95, P>0.05). In terms of binocular visual function, there was no significant difference among groups or time (F=4.38, 3.92, 3.19; P>0.05). In terms of fusion function, there was no significant difference among groups and interaction (F=1.01, 2.54; P>0.05). The fusion function of two training groups was significantly improved after operation for 6 months (F=19.13, P<0.05). In terms of stereopsis function, there was no significant difference in the distant and near stereopsis function among groups and interaction (F_{far, near}=0.16, 10.36, 0.24, 0.99; P>0.05). Compared with the baseline value, the far stereopsis function of the visual perception training group was significantly improved after operation for 3 months and 6 months(F=9.05, P<0.05), while non-significant difference in the near stereopsis function among different time(F=4.86, P>0.05).

The older children and adult patients after concomitant strabismus surgery could obtain more stable eye position control and reconstruct better the distant stereoacuity through visual perception training.