探讨视感知觉训练对间歇性外斜视患者术后双眼视功能和知觉眼位的疗效。

选取2019年1月至2021年5月于山西省眼科医院斜视与小儿眼科接受斜视手术的70例(70只眼)间歇性外斜视患者为研究对象。其中，男性37例(37只眼)，女性33例(33只眼)；年龄4~27岁，平均年龄(9.9±4.6岁)。根据家属和患者的意愿，将患者分为训练组和对照组。其中，对照组32例(32只眼)，训练组38例(38只眼)。两组患者均行视感知觉检查，训练组检查后再训练2个月，对照组不做任何训练。检查所有患者训练前后同视机三级功能、近立体视锐度及知觉眼位。性别和具有同时视功能人数为计数资料，用例数和百分比表示，组间比较采用卡方检验或Fisher确切概率法。年龄、融合范围及知觉眼位偏移程度经正态性检验，当符合正态分布时以±s表示，组间比较采用独立样本t检验；不符合正态分布时以中位数和四分位距表示，组间比较采用非参数秩和检验。立体视锐度为等级资料，用例数和百分比表示，组间比较采用非参数秩和检验。

训练前，对照组和训练组患者中具有同时视功能者分别有25例和28例，分别占78.1%和73.7%；训练2个月后，具有同时视功能者分别有27例和37例，分别占84.4%和97.4%。经Fisher确切概率法检验，两组比较的差异无统计学意义(P>0.05)。训练前，对照组与训练组患者的融合范围分别为12.0(18.75)°与6.5(17.25)°；训练2个月后，融合范围分别为13.0(20.75)°与18.0(12.25)°。经非参数秩和检验，训练组患者训练前后和训练后两组间比较的差异均有统计学意义(Z＝-4.54，-2.49；P<0.05)。训练2个月后，训练组患者具有远立体视功能的黄斑中心凹立体视者22例，占57.9%，较训练前及对照组差异均有统计学意义(χ²＝-4.46，-2.08；P<0.05)。训练2个月后，两组患者具有近立体视功能的黄斑中心凹立体视者分别为20例和30例，分别占62.5%和78.9%，较训练前差异均有统计学意义(χ²＝-2.65，-3.26；P<0.05)。训练前，对照组患者的水平知觉和垂直知觉眼位偏移程度分别为148.5(232.25)像素和14.0(23.75)像素；训练组分别为78.5(234.25)像素和10.0(28.00)像素。训练2个月后，对照组患者的水平知觉和垂直知觉眼位偏移程度分别为43.0(155.25)像素和9.0(14.25)像素；训练组分别为13.0(27.25)像素和4.0(6.00)像素。经非参数秩和检验，训练前后患者水平和垂直知觉眼位偏移程度比较的差异均有统计学意义(Z＝-4.50，-3.43；P<0.05)；两组训练后比较的差异均有统计学意义(Z＝-3.34，-3.28；P<0.05)。

知觉眼位能够更加精准且定量地反映中枢视知觉功能受损的程度，视感知觉训练可以修复中枢视知觉功能并重建双眼视功能。

The aim of this study was to investigate the effect of visual perception training on binocular visual function recovery and the changes of perceptual eye position for postoperative patients with intermittent exotropia.

70 patients(70 eyes)with intermittent exotropia who underwent strabismus surgery from January 2019 to May 2021 in Department of Strabismus and Pediatric Ophthalmology, Shanxi Eye Hospital were recruited, including 37 males (37 eyes) and 33 females (33 eyes) with an average age of (9.9±4.6) years-old (ranged from 4 to 27 years-old). According to the choice of their parents and patients, they were divided into training group (38 cases, 38 eyes) and control group (32 cases, 32 eyes). All patients were received visual perception examination; the training group were trained for 2 months. Before and after training, visual function, near stereopsisand perceptual eye position were examined. Gender, the number of people with simultaneous visual function were countable data, and expressed by case and percentage, and compared by Chi-square test and Fisher exact probability method between groups. The age, range of fusion, and degree of perceptual eye position deviation were measurable data, and expressed as ±s after normality test and compared by independent sample t test between groups; otherwise, described by the median and quartile and compared by non-parametric rank sum test. The stereo acuity was graded data, expressed by case and percentage, and compared by non-parametric rank sum test.

Before training, there were 25 cases (78.1%) and 28 cases (73.7%) with simultaneous visual function in the control group and the training group. After training for 2 months, there were 27 patients (84.4%) and 37 patients (97.4%) with simultaneous visual function in two groups, respectively. There was no statistically significant difference between them using Fisher exact probability method (P>0.05). Before training, the fusion range of control group and training group were 12.0(18.75)° and 6.5(17.25)°; after training for 2 months, those were 13.0(20.75)° and 18.0(12.25)°, respectively. The training group was significantly enlarged between before and after training using non-parametric rank sum test (Z=-4.54, P<0.05); there was statistically significant difference between groups (Z=-2.49, P<0.05). After training for 2 months, the number of the distance stereo vision function of patients in the training group was 22 cases (57.9%) with the significant difference between after and before training (χ²=-4.46, P<0.05); there was statistically significant difference between groups (χ²=-2.08, P<0.05). After training for 2 months, the number of the near-stereoscopic vision function of patients in the control group and the training group was 20 cases (62.5%) and 30 cases (78.9%) with significant difference between before and after training using Chi-square test (χ²=-2.65, -3.26; P<0.05). Before training, the degree of horizontal perceptual eye position of control group and training group were 148.5 (232.25) pixels and 78.5(234.25) pixels, respectively; the degree of vertical perceptual eye position were 14.0 (23.75) pixels and 10.0 (28.00) pixels, respectively. After training for 2 months, the degree of horizontal perceptual eye position were 43.0 (155.25) pixels and 13.0 (27.25) pixels; the degree of vertical perceptual eye position were 9.0 (14.25) pixels and 4.0 (6.00) pixels. There were statistically significant difference in the degree of perceptual eye between after and before training (Z=-4.50, -3.43; P<0.05); there were statistically significant difference between groups after training using non-parametric rank sum test (Z=-3.34, -3.28; P<0.05).

The perceptual eye position could more accurately and quantitatively reflect the damage degree of central visual perception function. Visual perception training could be helpful to repair central visual perception function and reconstruct binocular vision function.