The research progress of partially accommodative esotropia

doi:10.3877/cma.j.issn.2095-2007.2024.03.009

Abstract

Abstract:

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

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.

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References 51

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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)≥20^Δ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

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)≥20^Δ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

作者	年份	例数	手术设计	随访时间	手术效果	双眼视功能
作者	年份	例数	手术设计	随访时间	手术效果	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

作者	年份	例数	手术设计	随访时间	手术效果	双眼视功能
作者	年份	例数	手术设计	随访时间	手术效果	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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