儿童内斜视矫正术后双眼单视建立的相关性

发布时间：2018-05-13 04:03

  本文选题：内斜视 + 儿童　； 参考：《山东大学》2012年硕士论文

【摘要】：研究背景和目的：双眼单视是大脑视皮层将外界物体投射到两眼视网膜上独立的物像合而为一的皮质现象,是认识环境的一种高级的、完善的适应表现,双眼单视的形成必须满足在3岁之前有良好的双眼正位和相似的视网膜成像。斜视患儿随着年龄增长、时间延长、斜视度增加,双眼单视破坏严重,这就要求对恒定性斜视,尤其是对伴有单眼弱视、屈光参差等因素的恒定性斜视进行早期治疗,而内斜视是最常见的斜视类型,尤其在儿童中更为常见。本文旨在观察和分析内斜视儿童眼位矫正后双眼单视功能的建立情况及其影响因素。 方法：回顾性病例系列研究。收集2008年11月至2011年9月期间,在我院行单眼内直肌后徙术或双眼内直肌后徙术(伴下斜肌亢进者行下斜肌后徙术)并且术后随访眼位正位(≤±8PD)的连续性内斜视儿童病例111例。所有病例术前均进行裸眼及矫正视力、屈光状态及眼球运动检查,并常规行眼前节和眼底检查。大于2D的远视性屈光不正者均经戴镜治疗至少3个月以上。合并斜视性弱视者先行遮盖治疗,待两眼视力相差≤2行后再行手术。术后随访检查均采用三棱镜加交替遮盖法,测量患儿戴镜注视6m及33cm调节性视标时第一眼位的斜视度；患儿的中心窝知觉融合(距离患儿2m)和周边知觉融合功能(距离患儿33cm)采用手电筒式Worth四点灯检查,患儿的立体视锐度功能采用Titmus立体视图测定。所有手术均由同一医生完成,术后随访时间为术后1周、6-8周、6月,以后随访每半年1次,记录眼位及双眼单视功能建立情况,以末次随访结果纳入本资料进行统计。 结果：(1)111例内斜视矫正正位儿童中,术后获得周边融合者68例(61.3%),其中获得中心融合者6例(5.4%)；56例(50.5%)建立了不同程度的立体视。(2)手术年龄(P0.001)、弱视治疗时间(P0.05)、最终随访的斜视度(P0.05)与术后周边融合的建立呈负相关；两眼屈光参差差值与术后周边融合的建立无相关性(P0.05)。(3)四种内斜视类型之间术后周边融合建立的差异有统计学意义(x2=15.977,P=0.001),周边融合建立的难易顺序依次为先天性内斜视(OR=1.0)、非调节性内斜视(OR=3.008)、部分调节性内斜视(OR=4.475)、高AC/A型内斜视(OR=82.217) 结论：(1)内斜视儿童进行手术年龄愈早,术后愈易建立周边融合；患儿术前弱视治疗时间愈短,术后愈易建立周边融合；内斜视患儿矫正术后斜视度愈小术后愈易建立周边融合；(2)四种内斜视类型中,最难建立周边融合的是先天性内斜视,依次为非调节性内斜视、部分调节性内斜视,高AC/A型内斜视则最易建立周边融合。
[Abstract]:Background and objective: binocular monopia is a cortical phenomenon in which the visual cortex of the brain projects an external object onto an independent image of the retina, and it is a high-level and perfect adaptation to the cognitive environment. The formation of binocular monopia must be satisfied with good binocular alignment and similar retinal imaging before the age of 3. With the increase of age, time, degree of strabismus and serious damage of binocular monotropia, children with strabismus need early treatment for constant strabismus, especially for constant strabismus with monocular amblyopia, anisometropia, and other factors, such as monocular amblyopia, anisometropia, etc. Esotropia is the most common type of strabismus, especially in children. The purpose of this study was to observe and analyze the establishment of binocular monocular function and its influencing factors after orthopedics correction in children with esotropia. Methods: retrospective case series study. For the period from November 2008 to September 2011, 111 cases of continuous esotropia were performed in our hospital with unilateral medial rectus recession or bilateral medial rectus recession (with inferior oblique muscle recession). The postoperative follow-up was performed in 111 cases of consecutive esotropia children with positive position (鈮，

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