共同性斜视手术前后双眼视觉变化的临床研究

发布时间：2018-08-06 20:41

【摘要】：目的：观察共同性斜视患者手术前后双眼视觉的变化，探讨不同斜视类型对术后双眼视觉恢复的影响以及术后双眼视觉恢复的规律。方法：选取2010年10月至2011年12月间在我科住院行斜视矫正术的72例共同性斜视患者，其中男41例，女31例，年龄在3～36岁之间，按斜视类型分为四组：组1，共同性内斜视13例；组2，间歇性外斜视27例；组3，恒定性外斜视21例；组4，恒定性外斜视伴下斜肌亢进11例。手术前后分别进行眼部常规检查，屈光检查，三棱镜加交替遮盖法测量斜视度，应用同视机检查双眼视觉三级功能，应用颜少明编绘的《立体视觉检查图》测定近立体视锐度。记录术前、术后第1天、第7天、1个月及3个月的各项检查数据，并对数据资料进行统计学分析。结果： 1.不同斜视类型患者双眼视觉的比较： ⑴术前的一般情况：四组间手术年龄、发病年龄及术前斜视度的差异均无统计学意义（P0.05）。四组间术前同时视、融合功能、远立体视及近立体视的差异均无统计学意义（P0.05）。 ⑵术后Ⅰ级同时视功能：组2（23例，85.2%）术后同时视的恢复明显优于组1（7例，53.8%）、组3（12例，57.1%）及组4（6例，54.5%），其差异有统计学意义（P0.05）。 ⑶术后II级融合功能：组2（19例，70.4%，19.3°±3.1°）术后融合功能及融合范围的恢复明显优于组1（5例，38.5%，6.3°±4.8°）、组3（9例，42.9%，14.1°±3.7°）及组4（3例，，27.3%，12.4°±7.5°），其差异有统计学意义（P0.05）。 ⑷术后III级远立体视：组2（8例，29.6%）术后远立体视的恢复明显优于组1（0例），其差异有统计学意义（P0.05）。 ⑸术后近立体视：组2（24例，88.9%）术后近立体视的恢复明显优于组1（5例，38.5%）、组3（11例，52.4%）及组4（8例，72.7%），其差异有统计学意义（P0.05）。 2.手术前后双眼视觉的比较：共同性斜视患者术后双眼视觉三级功能及近立体视的恢复明显优于术前，其差异有统计学意义（P0.05）。术后第1天与第7天之间比较；术后1个月与3个月之间比较双眼视觉三级功能及近立体视恢复的差异无统计学意义（P0.05）。结论： 1.共同性斜视患者均有不同程度的双眼视觉损害。 2.共同性斜视术后双眼视觉三级功能及近立体视较术前均有明显改善，手术是恢复和重建双眼视觉的有效方法。 3.间歇性外斜视双眼视觉的恢复优于非调节性内斜视、恒定性外斜视以及恒定性外斜视伴下斜肌亢进，而非调节性内斜视、恒定性外斜视以及恒定性外斜视伴下斜肌亢进对双眼视觉的影响一致。 4.共同性斜视术后1个月与3个月双眼视觉的恢复无显著差异，双眼视觉的恢复在术后1个月左右基本稳定。
[Abstract]:Objective: to observe the changes of binocular vision in concomitant strabismus patients before and after operation, and to explore the effect of different strabismus types on postoperative binocular visual recovery and the regularity of binocular visual recovery. Methods: from October 2010 to December 2011, 72 concomitant strabismus patients were selected, including 41 males and 31 females, aged between 3 and 36 years. According to the type of strabismus, they were divided into four groups: group 1, concomitant esotropia (n = 13), group 2, intermittent exotropia (n = 27), group 3, constant exotropia (n = 21), group 4, constant exotropia (n = 11) with hypertropism. Eye routine examination, refractive examination, prism and alternate shading method were performed before and after operation respectively. The third degree of binocular vision was examined by the same vision machine, and the near stereopsis acuity was measured by the stereopsis chart drawn by Yan Shaoming. The data of pre-operation, 1st day, 7th day, 1st month and 3rd month were recorded, and the data were analyzed statistically. Results: 1. Comparison of binocular vision in patients with different strabismus types: 1General situation before operation: the age of operation, the age of onset and the degree of strabismus were not significantly different among the four groups (P0.05). Preoperative simultaneous vision and fusion function among the four groups, There was no significant difference between distant stereopsis and proximal stereopsis (P0.05). 2 after operation, the recovery of simultaneous vision in group 2 (23 cases, 85.2%) was significantly better than that in group 1 (7 cases, 53.8%), group 3 (12 cases, 57.1%) and group 4 (group 4, 54.5%), the difference was statistically significant. 3 postoperative grade II fusion function in group 2 (19 cases, 19.3 掳卤3.1 掳) was significantly better than that in group 1 (5 cases, 38.5 掳卤4.8 掳), group 3 (9 cases, 42.9 掳卤3.7 掳) and group 4 (3 cases, 27.312.4 掳卤7.5 掳), the difference was statistically significant (P0.05). The recovery of distant stereopsis in group 2 (8 cases, 29.6%) was significantly better than that in group 1 (0 cases), the difference was statistically significant (P0.05). 5 the recovery of near stereopsis in group 2 (24 cases, 88.9%) was significantly better than that in group 1 (5 cases, P0.05). 38.5%, group 3 (11 cases, 52.4%) and group 4 (8 cases, 72.7%), the difference was statistically significant (P0.05). Comparison of binocular vision before and after operation: postoperative concomitant strabismus patients had significantly better recovery of binocular visual function and near stereopsis than before operation (P0.05). There was no significant difference in visual function and near stereopsis between 1 month and 3 months after operation (P0.05). Conclusion: 1. Concomitant strabismus patients have different degrees of binocular visual impairment. 2. 2. After concomitant strabismus, the third degree function of binocular vision and the near stereopsis were improved obviously. Surgery is an effective method to restore and reconstruct binocular vision. 3. The recovery of binocular vision of intermittent exotropia was superior to that of non-adjustable esotropia, constant exotropia and constant exotropia with hyper inferior oblique muscle, but not accommodative esotropia. The effects of constant exotropia and constant exotropia with inferior oblique hyperactivity on binocular vision were consistent. 4. There was no significant difference in the recovery of binocular vision between 1 month and 3 months after concomitant strabismus. The recovery of binocular vision was basically stable at about 1 month after operation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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