分开不足患者治疗前后水平扫视速度特点的研究
发布时间：2019-06-05 03:31
【摘要】：目的:结合分开不足的临床特点,通过对患者组与正常健康组水平扫视速度特点对比结果的分析,对本病的治疗效果进行评价,从而提高对本病的认识。方法:本研究为回顾性研究,研究对象为连续收集的2014年10月至2016年3月在天津市眼科医院确诊并接受治疗的15例“分开不足”患者做为患者组(P组),共30只眼;将随机选取的16例正常人,共32只眼作为对照组(N组)。使用红外眼动仪对两眼先后进行测量并记录各组外转、内转10°、20°时水平扫视速度的数据,将收集的红外眼动数据进行数据格式转换后导入Metlab数据处理软件继而进行数据的离线筛选和处理。结合治疗前后详细的临床资料,观察项目包括发病年龄、头颅MRI、CT检查,治疗前后的临床表现及不同注视角度时水平扫视平均峰值速度,通过分别比较两组(N组、P组)不同水平运动注视角度条件下平均峰值速度,以及比较患者组治疗前(P1组)后(P2组)平均峰值速度,对本病的治疗效果进行评价。所有患者随访时间为3个月~2年,平均为7.3个月。所有统计学分析均使用SPSS 11.5统计软件分析处理。峰值速度组间进行两独立样本t检验,组内峰值速度进行配对t检验,均以P0.05为差异有统计学意义。结果:1.15例患者术前均仅于视远时出现同侧复视,且各方向复视像距离无明显差异。6例患者缓慢起病,9例患者急性起病且症状较为稳定。1例患者有Miller-Fisher综合征病史,2例患者有高血压病史,1例患者有安眠类药物摄入3个月史,行神经科会诊及头颅MRI、CT检查均回报未见明显异常。术前内斜度5m:+14PD~+40PD,33cm:+6PD~+25PD。分开性融合范围为:-1°~-4°,平均-2.5°;集合性融合范围为:+6°~+21°,平均+11.9°。近立体视范围为:60"~3000",平均733.3"。AC/A值范围为0.7-4.0,平均2.5。行手术治疗患者14例(共15只眼),外直肌手术缩短量为4.0~7.5mm;在屈光矫正基础上加配三棱镜矫正患者1例。治疗后2例患者在术后第6周裸眼时出现短暂的视远复视,但戴镜后复视症状消失;3例视近时出现视物疲劳症状,其余患者复视症状均消失且未见明显眼部不适症状;术后末次随访结果为:斜视度数5m:-4PD~+8PD,33cm:-8PD~+6PD。分开性融合范围为:-2°~-5°,平均-3.0°;集合性融合范围为:+10°~+24°,平均+16.8°。近立体视范围为:40"~800",平均243.3"。AC/A值范围为1.3-5.0,平均3.1。2.患者组治疗前(P1组)与对照组(N组)相比,相同眼球运动注视角度条件下,内、外转时P1组平均峰值速度均较N组低,但P0.05,差异无统计学意义。治疗前患者组(P1组)与末次随访患者组(P2组)相比,外转、内转10°时的平均峰值速度P2组较P1组有改善,但P0.05差异无统计学差异;外转、内转20°时的平均峰值速度P2组较P1组有改善且P0.05,差异有统计学意义。结论:1.分开不足患者组水平扫视外转10°、20°时的平均峰值速度与正常健康人组相比有差异,但差异无统计学意义,支持分开不足是不同于展神经麻痹的一种独立疾病。2.手术量为4.0~7.5mm的外直肌加强手术对消除复视,矫正14PD~40PD视远性内斜视,改善双眼视功能具有较好的疗效。3.手术治疗可以提高患者双眼眼球水平扫视速度且外转20°注视角度时扫视速度提高更显著。
[Abstract]:Objective: To evaluate the treatment effect of the disease by analyzing the characteristics of the horizontal saccade velocity of the patient group and the normal healthy group, and to improve the understanding of the disease. Methods: This study was a retrospective study. The subjects of the study were continuously collected from October 2014 to March 2016, and 15 patients with "to be separated from each other" who were diagnosed and treated in the Eye Hospital of Tianjin were treated as the patient group (P group) in 30 eyes, and the randomly selected 16 normal persons were randomly selected. A total of 32 eyes were treated as control group (N group). And the data of the horizontal glance speed at the time of the external rotation, the internal rotation of 10 degrees and the 20 degrees of each group are recorded by using an infrared eye movement instrument, and the collected infrared eye movement data is converted into a Metlab data processing software and then subjected to offline screening and processing of the data. Combined with the detailed clinical data before and after treatment, the observation items included the age of the onset, the MRI of the head, the CT examination, the clinical manifestation before and after the treatment and the average peak velocity of the horizontal saccade at different fixation angles, and by comparing the two groups (N groups, The mean peak velocity of P (P group) at different levels was observed, and the mean peak velocity of the (P2) group was compared with that of the patients before and after treatment (group P1), and the treatment effect of the disease was evaluated. The follow-up time of all patients was 3 months to 2 years, with an average of 7.3 months. All statistical analyses were processed using the SPSS 11.5 statistical software. The peak velocity of the group was tested by t-test and the peak velocity in the group was paired t-test, which was statistically significant with the difference of P0.05. Results:1.15 patients had the same ipsilateral diplopia before operation. in 1 case, there were a history of Miller-Fisher's syndrome,2 had a medical history of hypertension,1 patient had a history of 3-month intake of sleep-type drugs, a neurology consultation and a head MRI, There was no obvious abnormality in the return of CT examination. The preoperative slope was 5 m: + 14PD + 40PD, 33cm: + 6PD + 25PD. The range of the separation fusion is: -1 掳 ~ -4 掳, mean-2.5 掳; the range of the combined fusion is + 6 掳 ~ + 21 掳, and the mean + 11.9 掳. The near-stereoscopic range is:60 "~ 3000", with an average of 733.3 ". The AC/ A value ranges from 0.7 to 4.0, averaging 2.5. 14 patients (15 eyes) were treated with operation, and the reduction of the external rectus muscle was 4.0-7.5 mm, and one case was treated with three-prism correction on the basis of refractive correction. After the treatment, two patients had a short visual and diplopia at the 6-week open-hole, but the symptoms of diplopia disappeared after the wearing of the lens; the symptoms of visual fatigue appeared in 3 cases, and the symptoms of the rest of the patients disappeared without obvious ocular discomfort; the result of the last follow-up was as follows: the degree of strabismus was 5 m: -4PD ~ + 8PD, 33cm:-8PD ~ + 6PD. The range of the separation fusion is: -2 掳 ~ -5 掳, average-3.0 掳; the range of the combined fusion is + 10 掳 ~ + 24 掳, and the mean + 16.8 掳. The near-stereoscopic range is:40" to 800 ", average 243.3". The AC/ A value range is 1.3-5.0, average 3.1.2. Compared with the control group (group N), the average peak velocity of P1 group was lower in the first group (group P1) than in the control group (group N), but the mean peak velocity of P1 group was lower than that of the control group (P <0.05). The mean peak velocity in the first group (P1 group) and the last follow-up group (group P2) was improved in the first group (group P1) compared with that of the last follow-up group (group P2). The difference is of statistical significance. Conclusion:1. The average peak velocity at 20 掳 was different from that of the normal control group, but the difference was not statistically significant, and the support of the separation was different from that of the normal control group. The operation amount was 4.0 ~ 7.5mm, the external rectus muscle strengthening operation was effective in eliminating diplopia, correcting 14PD-40PD, and improving the binocular vision function. The operation treatment can improve the glance speed of the eyes of the patients and the glance speed is improved more remarkably when the eyes of the two eyes are rotated by 20 degrees.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R777.41
本文编号：2493224
[Abstract]:Objective: To evaluate the treatment effect of the disease by analyzing the characteristics of the horizontal saccade velocity of the patient group and the normal healthy group, and to improve the understanding of the disease. Methods: This study was a retrospective study. The subjects of the study were continuously collected from October 2014 to March 2016, and 15 patients with "to be separated from each other" who were diagnosed and treated in the Eye Hospital of Tianjin were treated as the patient group (P group) in 30 eyes, and the randomly selected 16 normal persons were randomly selected. A total of 32 eyes were treated as control group (N group). And the data of the horizontal glance speed at the time of the external rotation, the internal rotation of 10 degrees and the 20 degrees of each group are recorded by using an infrared eye movement instrument, and the collected infrared eye movement data is converted into a Metlab data processing software and then subjected to offline screening and processing of the data. Combined with the detailed clinical data before and after treatment, the observation items included the age of the onset, the MRI of the head, the CT examination, the clinical manifestation before and after the treatment and the average peak velocity of the horizontal saccade at different fixation angles, and by comparing the two groups (N groups, The mean peak velocity of P (P group) at different levels was observed, and the mean peak velocity of the (P2) group was compared with that of the patients before and after treatment (group P1), and the treatment effect of the disease was evaluated. The follow-up time of all patients was 3 months to 2 years, with an average of 7.3 months. All statistical analyses were processed using the SPSS 11.5 statistical software. The peak velocity of the group was tested by t-test and the peak velocity in the group was paired t-test, which was statistically significant with the difference of P0.05. Results:1.15 patients had the same ipsilateral diplopia before operation. in 1 case, there were a history of Miller-Fisher's syndrome,2 had a medical history of hypertension,1 patient had a history of 3-month intake of sleep-type drugs, a neurology consultation and a head MRI, There was no obvious abnormality in the return of CT examination. The preoperative slope was 5 m: + 14PD + 40PD, 33cm: + 6PD + 25PD. The range of the separation fusion is: -1 掳 ~ -4 掳, mean-2.5 掳; the range of the combined fusion is + 6 掳 ~ + 21 掳, and the mean + 11.9 掳. The near-stereoscopic range is:60 "~ 3000", with an average of 733.3 ". The AC/ A value ranges from 0.7 to 4.0, averaging 2.5. 14 patients (15 eyes) were treated with operation, and the reduction of the external rectus muscle was 4.0-7.5 mm, and one case was treated with three-prism correction on the basis of refractive correction. After the treatment, two patients had a short visual and diplopia at the 6-week open-hole, but the symptoms of diplopia disappeared after the wearing of the lens; the symptoms of visual fatigue appeared in 3 cases, and the symptoms of the rest of the patients disappeared without obvious ocular discomfort; the result of the last follow-up was as follows: the degree of strabismus was 5 m: -4PD ~ + 8PD, 33cm:-8PD ~ + 6PD. The range of the separation fusion is: -2 掳 ~ -5 掳, average-3.0 掳; the range of the combined fusion is + 10 掳 ~ + 24 掳, and the mean + 16.8 掳. The near-stereoscopic range is:40" to 800 ", average 243.3". The AC/ A value range is 1.3-5.0, average 3.1.2. Compared with the control group (group N), the average peak velocity of P1 group was lower in the first group (group P1) than in the control group (group N), but the mean peak velocity of P1 group was lower than that of the control group (P <0.05). The mean peak velocity in the first group (P1 group) and the last follow-up group (group P2) was improved in the first group (group P1) compared with that of the last follow-up group (group P2). The difference is of statistical significance. Conclusion:1. The average peak velocity at 20 掳 was different from that of the normal control group, but the difference was not statistically significant, and the support of the separation was different from that of the normal control group. The operation amount was 4.0 ~ 7.5mm, the external rectus muscle strengthening operation was effective in eliminating diplopia, correcting 14PD-40PD, and improving the binocular vision function. The operation treatment can improve the glance speed of the eyes of the patients and the glance speed is improved more remarkably when the eyes of the two eyes are rotated by 20 degrees.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R777.41
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