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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) ›› 2024, Vol. 14 ›› Issue (01) : 6 -13. doi: 10.3877/cma.j.issn.2095-2007.2024.01.002

论著

基本型间歇性外斜视眼位控制力相关因素的临床研究
洪洁1, 张琼月2, 刘祥祥1, 赵逸阳3, 李晶欣4, 李慧馨5, 付晶1,†()   
  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　北京市眼科学与视觉科学重点实验
    2. 100730　首都医科大学附属北京同仁医院眼科2021级硕士研究生
    3. 100730　首都医科大学附属北京同仁医院眼科2022级硕士研究生
    4. 100730　首都医科大学附属北京同仁医院眼科2022级博士研究生
    5. 100730　首都医科大学附属北京同仁医院眼科2023级博士研究生
  • 收稿日期:2024-02-03 出版日期:2024-02-28
  • 通信作者: 付晶
  • 基金资助:
    国家自然科学基金项目(82070998); 首都临床诊疗技术研究及转化应用项目(Z201100005520044); 高层次公共卫生技术人才建设项目培养计划(学科带头人-02-10)

The factors related to eye position control in basic intermittent exotropia

Jie Hong1, Qiongyue Zhang2, Xiangxiang Liu1, Yiyang Zhao3, Jingxin Li4, Huixin Li5, Jing Fu1,†()   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
    2. Master′s degree 2021 (majoring in ophthalmology), Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
    3. Master′s degree 2022 (majoring in ophthalmology), Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
    4. Doctor′s degree 2022 (majoring in ophthalmology), Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
    5. Doctor′s degree 2023 (majoring in ophthalmology), Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2024-02-03 Published:2024-02-28
  • Corresponding author: Jing Fu
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引用本文：

洪洁, 张琼月, 刘祥祥, 赵逸阳, 李晶欣, 李慧馨, 付晶. 基本型间歇性外斜视眼位控制力相关因素的临床研究[J]. 中华眼科医学杂志(电子版), 2024, 14(01): 6-13.

Jie Hong, Qiongyue Zhang, Xiangxiang Liu, Yiyang Zhao, Jingxin Li, Huixin Li, Jing Fu. The factors related to eye position control in basic intermittent exotropia[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(01): 6-13.

目的

探讨基本型间歇性外斜视(IXT)患者控制力的影响因素。

方法

收集2021年3月至2023年9月首都医科大学附属北京同仁医院眼科中心的434例(868只眼)基本型IXT患者的病例资料。其中，男性215例(430只眼)，女性219例(438只眼)；年龄4～20岁，年龄中位数为9.83(8.23，11.63)岁。使用纽卡斯尔(NCS)控制力评分法评估患者眼位控制力。根据NCS评分结果分为控制力良好组和控制力不佳组。检查所有患者的屈光状态、斜视度、立体视觉、调节功能及集合功能。年龄、屈光状态、斜视度、近立体视、调节功能及集合功能等经正态性检验不服从正态分布，以中位数(下四分位数，上四分位数)表示，组间比较采用秩和检验。远立体视保存率以百分比表示，组间比较采用χ2检验。采用Logistic回归分析IXT控制力的影响因素。

结果

控制力良好组患者主视眼的等效球镜屈光度(SE)、非主视眼SE、看近斜视度、看远斜视度及近立体视分别为－1.25(－2.75，0.50)D、－1.38(－2.78，0.75)D、－30(－40，－25)PD、－25(－35，－20)PD及2.30(2.15，2.90)Log弧秒；控制力不佳组患者分别为－0.00(－1.75，0.88)D、－0.25(－1.88，1.00)D、－50(－60，－40)PD、－50(－60，－35)PD及2.60(2.15，3.20)Log弧秒。两组比较，控制力良好组患者主视眼和非主视眼的近视屈光度均更大、看近和看远斜视度均更小而近立体视更好，其差异均有统计学意义(Z＝－3.314，－3.047，－11.803，－12.328, －2.785；P<0.05)。控制力良好组和控制力不佳组患者的远立体视保存率分别为65.58%和36.79%。两组比较，控制力良好组患者远立体视保存率更高，差异具有统计学意义(χ2＝33.079；P<0.05)。控制力良好组患者主视眼、非主视眼及双眼调节灵活度分别为9.00(6.63，11.00)cpm、8.50(6.50，11.00)cpm及7.75(6.00，10.00)cpm；控制力不佳组患者分别为7.50(6.00，10.00)cpm、7.50(6.00，9.25)cpm及7.00(5.00，9.00)cpm。控制力良好组患者主视眼、非主视眼及双眼调节灵活度均优于控制力不佳组，其差异具有统计学意义(Z＝－4.065，－3.666，－2.690；P<0.05)。控制力良好组患者看远总集合幅度、看近总集合幅度、看远融像储备率、看近融像储备率、AC/A、看远集合储备及看近集合储备分别为50.50(35.75，59.00)、55.00(47.50，65.00)、0.76(0.51，1.16)、0.77(0.51，1.11)、2.00(1.00，4.00)、22.00(16.00，27.00)及24.00(18.00，30.00)；控制力不佳组患者分别为65.00(55.25，77.00)、70.00(58.50，84.00)、0.50(0.31，0.72)、0.51(0.34，0.65)、2.33(1.00，4.00)、22.00(16.00，28.00)及24.00(18.00，30.00)。两组比较，控制力良好组患者看远总集合幅度和看近总集合幅度均更小、看远融像储备率和看近融像储备率均更大，其差异具有统计学意义(Z＝－7.439，－6.435，－5.709，－6.254；P<0.05)；而AC/A、看远集合储备及看近集合储备的差异无统计学意义(Z＝－0.845，－0.469，－0.798；P>0.05)。多因素Logistic回归分析发现影响IXT患者眼位控制力的因素中，非主视眼SE、远立体视、看近集合幅度及看近融像储备率具有统计学意义(OR＝1.220，95%CI：1.044～1.427，P<0.05)、(OR＝0.399，95%CI：0.203～0.785，P<0.05)、(OR＝1.050，95%CI：1.027～1.074，P<0.05)及(OR＝0.149，95%CI：0.054～0.412，P<0.05)。

结论

基本型IXT的控制力主要由集合功能而非调节功能影响；基本型IXT的控制力可能主要通过看近的集合功能来驱动。

关键词: 间歇性外斜视, 控制力, 集合幅度, 融像储备率
Objective

To explore the factors related to eye position control in basic intermittent exotropia (IXT).

Methods

A total of 434 patients (868 eyes) with basic type IXT from the Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from March 2021 to September 2023 were collected. Among them, there were 215 males (430 eyes) and 219 females (438 eyes) with a median age of 9.83 (8.23, 11.63) years (ranging from 4 to 20 years old). The eye position control was performed by Newcastle control scale (NCS). According to the NCS results, they were divided into good control group and poor control group. The refractive status, strabismus, stereoscopic vision, adjustment function, and convergence function of all patients were performed. Age, refractive status, strabismus, near stereoscopic vision, adjustment function, and collection function did not follow a normal distribution after normality testing, and were expressed as M (Q1, Q3) and compared by rank sum test for inter group. Far stereoscopic vision was expressed by percentages, and compared by χ2 for inter group. The factors of IXT control force was to analyze by logistic regression.

Results

The equivalent spherical refractive index (SE) of the main eye, non main eye SE, near and far strabismus, and near stereopsis of patients with good control were -1.25 (-2.75, 0.50) D, -1.38 (-2.78, 0.75) D, -30 (-40, -25) PD, -25 (-35, -20) PD, and 2.30 (2.15, 2.90) Log arc seconds, respectively. The patients in the group with poor control were -0.00 (-1.75, 0.88) D, -0.25 (-1.88, 1.00) D, -50 (-60, -40) PD, -50 (-60, -35) PD, and 2.60 (2.15, 3.20) Log arc seconds, respectively. The group with good control had higher myopia diopter in both the primary and non primary eyes, smaller near and far strabismus, and better near stereoscopic vision, and the differences were statistically significant (Z=-3.314, -3.047, -11.803, -12.328, -2.785; P<0.05). The far standing stereoscopic preservation rates of patients with good control and poor control were 65.58% and 36.79%, respectively. The patients with good control had a higher preservation rate of distant stereoscopic vision, and the difference was statistically significant (χ 2=33.079, P<0.05). The adjustment flexibility of the dominant eye, non dominant eye, and binocular vision in patients with good control were 9.00 (6.63, 11.00) cpm, 8.50 (6.50, 11.00) cpm, and 7.75 (6.00, 10.00) cpm, respectively. The patients in the poor control group had 7.50 (6.00, 10.00) cpm, 7.50 (6.00, 9.25) cpm, and 7.00 (5.00, 9.00) cpm, respectively. The patients with good control had better primary vision, non primary vision, and binocular adjustment flexibility than those in the group with poor control, and the differences were statistically significant (Z=-4.065, -3.666, -2.690; P<0.05). The patients with good control had a total range of far and near images, a reserve rate for far and near images, an accommodative convergence/accommodation (AC/A) ratio, a reserve rate for far and near images, and a reserve rate for far and near images, which were 50.50 (35.75, 59.00), 55.00 (47.50, 65.00), 0.76 (0.51, 1.16), 0.77 (0.51, 1.11), 2.00 (1.00, 4.00), 22.00 (16.00, 27.00), and 24.00 (18.00, 30.00), respectively; The patients with poor control were 65.00 (55.25, 77.00), 70.00 (58.50, 84.00), 0.50 (0.31, 0.72), 0.51 (0.34, 0.65), 2.33 (1.00, 4.00), 22.00 (16.00, 28.00), and 24.00 (18.00, 30.00), respectively. The patients with good control had smaller total collection amplitude at far and near distances, and larger reserve rates for far and near distance fusion images, with statistically significant differences (Z=-7.439, -6.435, -5.709, -6.254; P<0.05); However, there was no statistically significant difference in AC/A, far set reserve, and near set reserve (Z=-0.845, -0.469, -0.798; P>0.05). After multivariate logistic regression analysis, the factors that affect the control of eye position in IXT patients, non dominant eye SE, distant stereo vision, near range collection amplitude, and near fusion image reserve rate were statistically significant (OR=1.220, 95%CI: 1.044 to 1.427, P<0.05), (OR=0.399, 95%CI: 0.203 to 0.785, P<0.05), (OR=1.050, 95%CI: 1.027 to 1.074, P<0.05), and (OR=0.149, 95%CI: 0.054 to 0.412, P<0.05).

Conclusions

The control in basic IXT is primarily influenced by convergence rather than accommodation. The control in basic IXT may be primarily driven by the near convergence.

Key words: Intermittent extropia, Control, Convergence amplitude, Fusional reserve ratio
表1 近立体视数值转换为对数值(弧秒)
近距离立体视 近距离立体视Log对数
40 1.60
60 1.78
100 2.00
200 2.30
400 2.60
800 2.90
无立体视 3.20
表2 纽卡斯尔控制力评分表
评分项目 得分
家庭控制能力评估  
出现间歇性外斜视或单眼闭合的时间：  
从不 0
在看远时出现外斜视时间<50% 1
在看远时出现外斜视时间>50% 2
在看远及看近时均出现外斜视时间>50% 3
诊室控制能力评估  
看远：  
遮盖试验后，立即恢复正位 0
遮盖试验后，眨眼或再注视才能恢复正位 1
遮盖试验后，不能恢复正位或自发性出现外斜视 2
自然状态下看远就是外斜 3
看近：  
遮盖试验后，立即恢复正位 0
遮盖试验后，眨眼或再注视才能恢复正位 1
遮盖试验后，不能恢复正位或自发性出现外斜视 2
自然状态下看近就是外斜 3
总分＝家庭观察＋诊室观察(看近)＋诊室观察(看远)  
表3 不同控制力的基本型间歇性外斜视患者的临床特征的比较[M(Q1，Q3)]
组别 例数 年龄(岁) 主视眼SE(D) 非主视眼SE(D) 看近斜视度(PD) 看远斜视度(PD) 近立体视觉(Log弧秒)
控制力良好 154 10.37(9.13，12.69) －1.25(－2.75，0.50) －1.38(－2.78，0.75) －30(－40，－25) －25(－35，－20) 2.30(2.15，2.90)
控制力不佳 280 9.53(7.76，11.36) －0.00(－1.75，0.88) －0.25(－1.88，1.00) －50(－60，－40) －50(－60，－35) 2.60(2.15，3.20)
Z值   －3.856 －3.314 －3.047 －11.803 －12.328 －2.785
P值   <0.05 <0.05 <0.05 <0.05 <0.05 <0.05
表4 不同控制力基本型间歇性外斜视患者远立体视的比较
组别 例数 远立体视保存[例(%)] 远立体视丧失[例(%)]
控制力良好 154 101(65.58%) 53(34.42%)
控制力不佳 280 103(36.79%) 177(63.21%)
χ2值   33.079
P值   <0.05
表5 不同控制力基本型间歇性外斜视患者的调节参数的比较[M(Q1，Q3)]
组别 例数 主视眼NRA 非主视眼NRA 双眼NRA 主视眼PRA 非主视眼PRA
控制力良好 154 2.25(1.94，2.50) 2.25(2.00，2.50) 2.25(1.75，2.50) －2.25(－3.00，－1.50) －2.25(－3.00，－1.50)
控制力不佳 280 2.25(1.75，2.50) 2.25(1.75，2.50) 2.25(1.75，2.50) －2.25(－3.00，－1.50) －2.25(－3.00，－1.50)
Z值   －0.378 －0.125 －0.347 －0.686 －0.109
P值   >0.05 >0.05 >0.05 >0.05 >0.05
组别 例数 双眼PRA 主视眼AMP 非主视眼AMP 双眼AMP 主视眼调节灵活度(cpm)
控制力良好 154 －2.25(－3.00，－1.50) 7.88(6.50, 9.75) 7.75(6.00，10.00) 7.25(6.25，8.50) 9.00(6.63，11.00)
控制力不佳 280 －2.25(－3.00，－1.50) 7.50 (5.75，9.50) 7.50(6.00，9.25) 6.75 (5.75，8.25) 7.50 (6.00，10.00)
Z值   －1.092 －1.583 －1.574 －1.705 －4.065
P值   >0.05 >0.05 >0.05 >0.05 <0.05
组别 例数 非主视眼调节灵活度(cpm) 双眼调节灵活度(cpm) 主视眼MEM 非主视眼MEM 双眼BCC
控制力良好 154 8.50(6.50，11.00) 7.75(6.00，10.00) 0.75(0.50，0.75) 0.75(0.50，0.75) 0.00(0.00，0.25)
控制力不佳 280 7.50(5.63，10.00) 7.00(5.00, 9.00) 0.50(0.50，0.75) 0.50(0.50，0.75) 0.00(0.00，0.50)
Z值   －3.666 －2.690 －0.607 －1.104 －0.753
P值   <0.05 <0.05 >0.05 >0.05 >0.05
表6 不同控制力的基本型间歇性外斜视患者集合参数的比较[M(Q1，Q3)]
组别 例数 AC/A 看远集合储备 看远总集合幅度 看远融像储备率 看近集合储备 看近总集合幅度 看近融像储备率
控制力良好 154 2.00(1.00，4.00) 22.00(16.00，27.00) 50.50(35.75，59.00) 0.76(0.51，1.16) 24.00(18.00，30.00) 55.00(47.50，65.00) 0.77(0.51，1.11)
控制力不佳 280 2.33(1.00，4.00) 22.00(16.00，28.00) 65.00(55.25，77.00)) 0.50(0.31，0.72) 24.00(18.00，30.00) 70.00(58.50，84.00) 0.51(0.34，0.65)
Z值   －0.845 －0.496 －7.439 －5.709 －0.798 －6.435 －6.254
P值   >0.05 >0.05 <0.05 <0.05 >0.05 <0.05 <0.05
表7 基本型间歇性外斜视患者控制力的影响因素分析
影响因素 单因素Logistic回归分析 多因素Logistic回归分析
OR(95%CI) P值 OR(95%CI) P值
年龄 0.880(0.819，0.947) <0.05    
主视眼SE 1.175(1.062，1.300 ) <0.05    
非主视眼SE 1.169(1.061，1.288) <0.05 1.220(1.044，1.427) <0.05
看近斜视度 0.903(0.885，0.922) <0.05    
看远斜视度 0.899(0.880，0.919) <0.05    
远立体视觉 0.305(0.202，0.461) <0.05 0.399(0.203，0.785) <0.05
近立体视觉 1.964(1.241，3.109) <0.05    
主视眼NRA 0.877(0.613，1.255) >0.05    
非主视眼NRA 0.869(0.604，1.250) >0.05    
双眼NRA 1.038(0.718，1.501) >0.05    
主视眼PRA 1.105(0.860，1.420) >0.05    
非主视眼PRA 1.019(0.799，1.300) >0.05    
双眼PRA 1.146(0.894，1.469) >0.05    
主视眼AMP 0.946(0.879，1.018) >0.05    
非主视眼AMP 0.937(0.870，1.009) >0.05    
双眼AMP 0.948(0.860，1.046) >0.05    
主视眼调节灵活度 0.870(0.813，0.932) <0.05    
非主视眼调节灵活度 0.874(0.814，0.939) <0.05    
双眼调节灵活度 0.900(0.838，0.968) <0.05    
主视眼MEM 0.995(0.595，1.666) >0.05    
非主视眼MEM 0.771(0.447，1.330) >0.05    
双眼BCC 1.210(0.781，1.875) >0.05    
AC/A 0.989(0.912，1.095) >0.05    
看远集合储备 1.009(0.979，1.040) >0.05    
看远总集合幅度 1.066(1.046，1.086) <0.05    
看远融像储备率 0.118(0.053，0.262) <0.05    
看近集合储备 0.990(0.962，1.018) >0.05    
看近总集合幅度 1.053(1.035，1.071) <0.05 1.050(1.027，1.074) <0.05
看近融像储备率 0.080(0.034，0.187) <0.05 0.149(0.054，0.412) <0.05
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