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中华眼科医学杂志(电子版) ›› 2024, Vol. 14 ›› Issue (03) : 177 -181. doi: 10.3877/cma.j.issn.2095-2007.2024.03.009

综述

部分调节性内斜视的临床研究进展
李广林1, 唐凯2, 卢秀珍2,†()   
  1. 1. 250355　济南，山东中医药大学眼科与视光医学院2022级硕士研究生；252600　山东省聊城市第二人民医院眼科
    2. 250002　济南，山东中医药大学附属眼科医院眼科　山东省眼病防治研究院
  • 收稿日期:2024-06-08 出版日期:2024-06-28
  • 通信作者: 卢秀珍
  • 基金资助:
    山东省医药卫生科技项目(202307020987，202107020953)

The research progress of partially accommodative esotropia

Guanglin Li1, Kai Tang2, Xiuzhen Lu2,†()   

  1. 1. Master′s degree 2022, Ophthalmology & Optometry Medical School, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Department of Ophthalmology, The Second People′s Hospital of Liaocheng, Liaocheng 252600, China
    2. Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Shandong Academy of Eye Disease Prevention and Therapy, Jinan 250002, China
  • Received:2024-06-08 Published:2024-06-28
  • Corresponding author: Xiuzhen Lu
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引用本文：

李广林, 唐凯, 卢秀珍. 部分调节性内斜视的临床研究进展[J]. 中华眼科医学杂志(电子版), 2024, 14(03): 177-181.

Guanglin Li, Kai Tang, Xiuzhen Lu. The research progress of partially accommodative esotropia[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(03): 177-181.

部分调节性斜视(PAET)是指不完全由调节因素引起的内斜视，当远视性屈光不正戴镜充分矫正后内斜视度减少但不能完全矫正，是内斜视中的常见类型。屈光矫正和弱视治疗是PAET治疗的首要步骤。目前，针对残余内斜视的矫正方法和如何促进双眼视功能的恢复尚存在争议。近年来，有关PAET的研究主要围绕其临床特征、戴镜后残余内斜视的矫正及双眼视功能的恢复等问题展开。本文中笔者就该领域的最新研究进展进行综述。

关键词: 部分调节性内斜视, 临床特征, 治疗, 视功能

Partial accommodative strabismus (PAET) is a kind of esotropia that is not completely caused by accommodative factors. When hyperopic ametropia is fully corrected with glasses, the degree of esotropia decreases but cannot be completely corrected. PAET is a common type of esotropia. Refractive correction and amblyopia treatment are the first steps of PAET treatment. At present, there are still controversies about the correction method of residual esotropia and how to promote the recovery of binocular visual function. In recent years, the research on PAET mainly focuses on its clinical characteristics, the correction of residual esotropia after wearing glasses and the recovery of binocular visual function. The latest research progress in this field was summarized in this paper.

Key words: Partially accommodative esotropia, Clinical features, Treatment, Visual function
表1 部分调节性内斜视戴镜后残余内斜视不同矫正措施的优势与不足汇总
矫正措施 优势 不足
棱镜矫正 配戴三棱镜矫正(残余斜视度≤20△)的成功率可达44%，尤其是对于基线知觉状态良好、Worth四点灯检查融合功能良好且无弱视患者的成功率较高 配戴较大屈光度三棱镜，视力会有所下降，虽眼位矫正理想，但双眼视功能未能明显改善；去三棱镜率低
双眼鼻侧遮盖 可能是由于双眼鼻侧遮盖后，鼻侧视网膜敏感度提高，减少了周边异常视知觉，双颞侧视野得以融合，促进双眼发散，阻止视网膜异常对应进一步发展，残余斜视角得以减少 对视功能提升的作用较弱
A型肉毒毒素注射 具有安全有效、损伤微小、操作简单、节约医疗成本以及患者接纳度好等优势；单次注射对小角度部分调节性内斜视的疗效较好；发病较早的部分调节性内斜视患者(≤2.5岁)，可能比手术更可取 目前尚无公认的矫正斜视相关的剂量标准；对大角度斜视的疗效较差，可能需要反复注射以达到最佳眼位矫正效果
标准手术 根据患者戴镜远距斜视角行双眼内直肌后徙术治疗非调节部分的内斜视，术后过矫率较低 术后欠矫率可达30%～75%，术前高度远视和大角度内斜视是术后欠矫的高危因素
增量手术 可最大限度降低欠矫率 增加了戴镜过矫的风险
三棱镜适应试验后斜视手术 根据三棱镜适应试验后测量的最大斜视度设计手术，手术成功率显著提高、欠矫率降低；可作为术前目标斜视角的有效检查方法 棱镜眼镜可能较厚、较重，可致视物变形，影响患者视觉体验，患者不易接受
双眼内直肌后徙联合后固定术 术前斜视角差异(戴镜远距斜视角与裸眼近距斜视角之间的差异)≥20Δ者中，联合术式的术后成功率显著高于增量手术 该联合术式的操作较为复杂，增加了眼球穿孔风险
表2 部分调节性内斜视治疗效果和双眼视功能恢复情况的部分文献汇总
作者 年份 例数 手术设计 随访时间 手术效果 双眼视功能
治疗前 治疗后
Iordanous等[1] 2015 57 标准手术 6个月 仅纳入57例术后眼位正位者 无 42%最终恢复为良好立体视功能(≤100″)
Mohan等[22] 2018 47 标准手术 12年 手术成功率48.9%，欠矫率21.3%，过矫率14.9%，14.9%为高AC/A性内斜视 31.8%具有周边双眼单视功能(Worth 4点测试)，0%具有立体视功能 52%具有周边双眼单视功能，18%具有良好立体视功能(60″～120″)
Wang等[39] 2024 60 标准手术 12个月 术后成功率62%，欠矫率26%，过矫率12% 15%具有不同程度双眼视功能，32%具有近立体视功能 78%具有不同程度双眼视功能，74%具有近立体视功能，21%具有精细立体视功能(≤100″)
    28 BTXA注射 12个月 术后成功率43%，欠矫率57%，过矫率0% 22%具有不同程度双眼视功能，22%具有近立体视功能 67%具有不同程度双眼视功能，75%具有近立体视功能，20%具有精细立体视功能(≤100″)
Jotterand和Isenberg[44] 1988 18 增量手术 26个月 手术成功率61.1%，欠矫率22.2%，过矫率16.7% 无 88.2%具有不同程度双眼视功能，23.5%具有良好立体视功能(≤40″)，11.8%无双眼视功能
Jang等[45] 2021 33 增量手术 12月 手术成功率63.6%，欠矫率21.2%，过矫率15.2% 54.5%具有一定立体视功能(≤3000″)，36.3%具有良好立体视功能(≤400″) 立体视为(2.55±0.62)Log弧秒
    18 PAT后斜视手术 12月 手术成功率66.7%，欠矫率33.3%，过矫率0% 69.2%具有一定立体视功能(≤3000″)，23.1%具有良好立体视功能(≤400″) 立体视为(2.86±0.58)Log弧秒
Kim等[43] 2021 102 PAT后斜视手术 6年 术后成功率63.7%，欠矫率27.5%，过矫率8.8% PAT应答者的立体视为(2.4±0.6)Log弧秒，PAT无应答者立体视为(2.8±0.5)Log弧秒 无
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