52例III型急性共同性内斜视术后视功能分析

Analysis of Binocular Visual Function in 52 Cases of Acute Acquired Concomitant Esotropia Type III

摘要: 目的：分析III型急性共同性内斜视术前与术后双眼视功能的变化。方法：回顾性分析2017年1月至2018年12月就诊于厦门眼科中心并行手术治疗的AACE (III)型患者52例，发病年龄15~41岁，性别男30例，女22例，屈光度−2.25 D~−6.50 D，最佳矫正视力0.8~1.0。33 cm斜视度+15~+25 PD，6 m斜视度+18~+40 PD，病程6月~3年，其中病程6月~1年组27例，>1年组25例，术前23例配戴压贴三棱镜，配戴时间>6月。评估术前及术后3个月双眼视的变化，近立体视和远立体视分别采用Titmus、同视机检查。结果：52例患者术后复视消失。病程6月~1年组术后分别有24例和21例获得了远立体视和近立体视；病程>1年组术后分别有15例和13例获得了远立体视和近立体视，同视机检查结果组间比较，无显著性差异(p > 0.05)，Titmus检查结果组间比较，差异有显著性(p < 0.05)。术前和术后组间比较，远立体视和近立体视差异均有显著性(p < 0.05)。配戴压贴三棱镜组术后分别有23例和21例获得了远立体视和近立体视；未配戴压贴三棱镜组分别有18例和15例获得了远立体视和近立体视，两组比较同视机检查结果，无显著性差异(p > 0.05)，Titmus检查结果组间比较，差异有显著性(p < 0.05)。结论：III型急性共同性内斜视病程超过1年，近立体视丢失几率增加。及时配戴三棱镜能够有效的保留近立体视。近立体视的丢失要早于远立体视，术后恢复亦较远立体视难度大。建议发病6个月后手术治疗，消除复视，改善外观，重新建立双眼视功能。

Abstract: Objective: To investigate the changes of binocular visual function in acute acquired concomitant esotropia (ACCE) type III after surgery. Methods: This was a retrospective study. 52 cases of AACE (III) aged 15 - 41 years (30 males and 22 females) were treated in the Strabismus and Pe-diatric Ophthalmology Service of Xiamen eye center from January 2017 to December 2018. The range of Diopter was from −2.25 D to −6.50 D. The best corrected visual acuity was 0.8 - 1.0. The degree of strabismus in 33 cm and 6 m distance was +15 - +25 PD and +18 - +40 PD. The degree of distance strabismus and near strabismus was consistent in 10 cases, and the degree of dis-tance strabismus was larger in 40 cases. The course of disease was between 6 months and 3 years (6 months to 1 year in 27 cases and over 1 year in 25 cases). The press-on prism was worn in 23 cases over 6 months before surgery. The biocular vision function before and after surgery was evaluated. Near stereoacuity and distance stereoacuity were investigated by Titmus and synoptophore at postoperative 3 months. Results: 52 cases of ACCE were completely orthotopic after surgery and their diplopias disappeared. In group with course of 6 months to 1 year, 24 cases and 21 cases achieved distance stereoacuity and near stereoacuity. In group with course over 1 year, 15 cases and 13 cases achieved distance stereoacuity and near stereoacuity. The differences in data by synoptophore between groups were not significant (p > 0.05), but data by Titmus were statistically different (p < 0.05). The distance and near stereoacuity before and af-ter surgery were significantly different (p < 0.05). In group with press-on prism, 23 cases and 21 cases achieved distance stereoacuity and near stereoacuity. In group without press-on prism, 18 cases and 15 cases achieved distance stereoacuity and near stereoacuity. The differences in data by synoptophore between groups were not significant (p > 0.05), but data by Titmus were sta-tistically different (p < 0.05). Conclusion: The odds ratio of stereoacuity loss was increased with course over 1 year in ACCE type III. Prism may effectively preserve binocular visual function. Surgical therapy can eliminate diplopia, improve appearance and regain binocular visual func-tion.