探讨屈光参差性弱视和屈光不正性弱视患儿视力和双眼视觉屈光矫正的效果。

选取2017年11月至2018年9月于首都医科大学附属北京同仁医院眼科中心就诊且未经屈光参差性弱视和屈光不正性弱视治疗的患儿156例(312只眼)进行前瞻性非随机对照研究。其中，男性70例(140只眼)，女性86例(172只眼)；年龄3~12岁，平均年龄(5.7±1.6)岁。依据双眼屈光参差和屈光不正的性质不同，将患儿分为屈光参差组和屈光不正组。矫正前，检查所有患儿的裸眼视力和最佳矫正视力(BCVA)并行睫状肌麻痹下检影验光。所有患儿根据年龄和屈光状态予以处方配镜，屈光矫正3个月后，再检查患儿的BCVA并再行睫状肌麻痹下检影验光、远近立体视及视感知觉检查。年龄、等效球镜、BCVA、立体视锐度、交叉视差、非交叉视差及静态立体视等计量资料进行正态性检验，符合正态分布的连续变量采用±s描述，组间比较采用独立样本t检验，同一患儿的不同眼别和屈光矫正前后的比较采用配对t检验；不符合正态分布时采用中位数和上下四分位数描述，组间比较采用非参数检验。性别、远立体视及动态立体视等计量资料采用例数和百分比描述，组间比较采用卡方检验。

屈光参差组112例(224只眼)，屈光不正组44例(88只眼)。两组患儿性别比较的差异无统计学意义(χ²＝2.88，P>0.05)。两组患儿平均年龄比较的差异有统计学意义(t＝-5.28，P<0.05)。屈光参差组患儿弱视眼行屈光矫正前后的BCVA分别为(0.42±0.23)和(0.29±0.16)；屈光不正组分别为(0.49±0.18)和(0.33±0.15)。屈光矫正3个月后两组患儿的BCVA较矫正前均有明显提高，差异有统计学意义(t＝-6.84，-7.50；P<0.05)。远视、散光及远视合并散光等不同类型屈光参差性弱视屈光矫正后患儿的BCVA分别为(0.28±0.16)、(0.23±0.13)及(0.37±0.17)；屈光不正组分别为(0.37±0.14)、(0.27±0.12)及(0.39±0.19)。两组不同亚型屈光矫正前后比较的差异均有统计学意义(t＝-3.25，-4.02，-6.48，-4.62，-6.08，-2.91；P<0.05)。屈光参差性弱视和屈光不正性弱视患儿行屈光矫正后获得远立体视(+)者分别有33例和21例，分别占29.46%和47.73%，差异有统计学意义(χ²＝4.65，P<0.05)。屈光参差组患儿近立体视(立体视锐度、交叉视差及非交叉视差)、静态立体视及知觉眼位(眼位大-水平、眼位大-垂直、眼位小-水平及眼位小-垂直)分别为(2.38±0.57)″、(3.45±0.41)″、(3.44±0.40)″、(2.56±0.34)″、(47.10±43.17)像素、(23.39±20.23)像素、(45.24±36.08)像素及(25.30±20.60)像素。屈光参差性弱视组患儿在近立体视方面表现更好，而屈光不正性弱视组患儿的远立体视和视感知觉表现更优。经t检验，两组比较的差异均有统计学意义(t＝3.20，-2.72，-2.69，-2.87，-2.66，-2.13，-3.26，-2.02；P<0.05)。屈光参差组患儿动态立体视未通过者、低通过者及高通过者分别为51例、29例及32例，分别占45.54%、25.89%及28.57%。经卡方检验，两组比较的差异无统计学意义( χ²＝4.43，P>0.05)。

短期屈光矫正对儿童屈光性弱视的治疗有效。屈光不正性弱视和屈光参差性弱视的患儿矫正后远近立体视改变不同，屈光参差性弱视患儿在近立体视方面表现更好，而屈光不正性弱视患儿的远立体视和视感知觉表现更优。视感知觉检查用于临床中，可以更全面地评价双眼视觉功能。

The aim of this study was to investigate effects of refractive correction on the visual acuity and binocular visual function in ametropic children.

A total of 156 children (312 eyes) with anisometropic amblyopia and ametropic amblyopia recruited from November 2017 to September 2018 in Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University were analyzed prospectively with non-randomized control. Among of them, there were 70 male (140 eyes) and 86 female (172 eyes) with an average age (5.7±1.6) years-old (ranged from 3 to 12 years-old). According to the nature of anisometropia and ametropia, they were divided into anisometropic amblyopia group and ametropic amblyopia group. The uncorrected visual acuity, best corrected visual acuity (BCVA), refractive status, optometry under ciliary paralysis were examined. All children were given prescription glasses according to their age and refractive status, and the BCVA and optometry under ciliary paralysis, near and far stereopsis and perception examination were performed after refractive correction for 3 months. The age, equivalent spherical lens, best corrected visual acuity, stereoacuity, cross non cross parallax and static stereopsis were performed normality test. Continuous variables conforming to normal distribution were expressed by ±s, and compared using independent t test. Different eyes of the same patient and before and after refractive correction were compared using paired t test. Otherwise, indices were expressed by median and upper and lower quartiles, and compared using non-parametric test. Countable data such as gender, telestereopsis and dynamic stereopsis was expressed by cases and percentage, and compared using Chi-square test.

There were 112 cases (224 eyes) with anisometropic amblyopia and 44 cases (88 eyes) with ametropic amblyopia. There was no statistically significant difference in gender distribution between two groups (χ²=2.88, P>0.05). There was statistically significant difference in age distribution (t=-5.28, P<0.05). In anisometropia amblyopia group, the BCVA of children before and after the referactive correction for 3 months were (0.42±0.23), (0.29±0.16), respectively; for ametropia amblyopia group, those were (0.49±0.18), (0.33±0.15), respectively. The BCVA was significantly higher than that before correction with significant difference (t=-6.84, -7.50; P<0.05). The BCVA of different subtype′s anisometropia amblyopia group such as hyperopia, astigmatism and hyperopia combined with astigmatism were (0.28±0.16), (0.23±0.13), (0.37±0.17), respectively; for ametropia amblyopia group, those were (0.37±0.14), (0.27±0.12), (0.39±0.19). There was statistically significant difference between subgroups before and after correction (t=-3.25, -4.02, -6.48, -4.62, -6.08, -2.91; P<0.05). The positive distant stereoscopic vision of anisometropia amblyopia and ametropia amblyopia after correction were 33 cases and 21 cases, accounting for 29.46% and 47.73%, respectively with statistically difference between them (χ²=4.65, P<0.05). In anisometropia amblyopia group, near (stereopsis acuity, crossed disparity, non-crossed disparity), static stereoscopic vision and perceptual eye position (level large eye position, vertical large eye position, level small eye position, vertical smal eye position) were (2.38±0.57)″, (3.45±0.41)″, (3.44±0.40)″, (2.56±0.34)″, (47.10±43.17) pls、(23.39±20.23) pls, (45.24±36.08) pls, and (25.30±20.60) pls. The ametropia amblyopia group performed better in the distant stereo vision and perceptual eye position, while the anisometropia amblyopia group performed better in the near stereo vision. There was statistically significant difference between groups (t=3.20, -2.72, -2.69, -2.87, -2.66, -2.13, -3.26, -2.02; P<0.05). The dynamic stereovision of anisometropia amblyopia group with no pass, low pass and high pass were 51 cases, 29 cases, 32 cases, accounting for 45.54%, 25.89%, 28.57%, respectively. There was non-significant difference between groups (χ²=4.43, P>0.05).

Short-term refractive correction was effective in the treatment of amblyopia in children, and there were differences in stereoscopic vision after refractive correction between amblyopia and anisometropia. Visual perception examination could be used to evaluate binocular visual function more comprehensively in clinical practice.