【作者】 刘艳丽；

【导师】 赵堪兴；

【作者基本信息】 天津医科大学 ， 眼科学， 2010， 硕士

【摘要】 目的：研究间歇性外斜视手术前立体视功能损害程度、术后立体视功能重建及其影响因素。探讨间歇性外斜视的最佳手术时机。方法：病例对照研究,非匹配型。2009年10月～2010年1月在天津市眼科医院筛选间歇性外斜视患者。按年龄分为3组,组1：4岁≤年龄<8岁,组2：8岁≤年龄<18岁,组3：年龄≥18岁,每组30例,其中男55例,女35例。基本型66例,集合不足型24例,假性分开过强型并入基本型。每位患者术前、术后6周及以上复诊时检查斜视度、眼球运动,用Worth四点灯检查视远的中心凹融合功能,同视机猫捉蝴蝶画片检查视远的周边融合功能；用Titmus、Frisby、颜少明编著《数字化立体视觉检查图》(Digital Stereoscopic Test Charts, DSTC)检查近立体视觉；用同视机随机点立体视画片(random-dot stereograms, RDS)、OPTEC6500、FD2 (Frisby Davis Distance Stereotest)检查远立体视觉。比较各年龄组术前立体视觉损害情况、术后立体视觉重建情况及影响其恢复的相关因素。结果：(1)、术前Frisby、Titmus:各年龄组间无差别(P>0.05)。DSTC：组2立体视视锐度小于其它两组,后二者无差别。术前OPTEC6500、同视机RDS：组2立体视视锐度小于其它两组,后两组无差别。术前FD2：组2、组1、组3立体视视锐度依次增大。发现年龄：组1最小,其余两组无差别。病程随年龄组别依次增长,斜视度依次增大。(2)、术后Frisby、Titmus:各年龄组间无差别(P>0.05)。术后DSTC：组1立体视视锐度大于其它两组,后两组无差别。术后OPTEC6500、FD2：各年龄组间无差别。同视机RDS：组2立体视视锐度小于其它两组,后二者无差别。(3)、手术前后立体视视锐度Titmus无变化,Frisby、DSTC、OPTEC6500、同视机RDS、FD2明显改善。(4)术后视近眼位过矫、欠矫均会影响术后近立体视的重建,以过矫影响最大,欠矫影响相对较小；术后视远眼位过矫、欠矫对术后远立体视重建的影响,不同检查方法得出结论不同：同视机RDS结果是均没有影响；OPTEC6500结果是均有影响；FD2结果是欠矫没有影响,过矫有影响。术后远立体视视锐度同视机RDS结果与病程呈正相关关系,OPTEC6500、FD2结果均与发现年龄呈负相关关系,三者均与轻度眼球运动异常、近斜视度、远斜视度无相关关系,同视机RDS、FD2结果均与术前远周边融合范围呈负相关关系,OPTEC6500结果与术前远中心凹融合功能呈负相关关系。结论：(1)、术前间歇性外斜视近立体视损坏轻,远立体视损坏严重,发现年龄越早,病程越长损坏越重。(2)、术后远近立体视觉均有改善,但以远立体视改善明显。(3)、远立体视和融合功能减退可作为病情进展的参考指标,对其预后估计和疗效评价有重要意义。(4)、不同立体视觉检查仪器侧重于检查双眼视功能的不同方面,各有优缺点,应通过不同方面的检查给予综合评估。(5)、发现年龄越大、病程越短的术后立体视重建得越好。(6)、成功的矫正手术可明显改善立体视觉,过矫可阻碍立体视的重建。更多还原

【Abstract】 Objective:To investigate the damage of the stereopsis in intermittent exotropia pre-operation, the reconstruction of stereopsis post-operation and effect factors.To opproach the optimal timing of surgery.Methods:Case control study, non-match type.To collect the patients with intermittent exotropia in Tianjin Eye Hospital from Oct.2009 to Jan.2010.All the cases (female 35 cases and male 55 cases) were classified 3 groups, in which had 30 cases in each group, age between 4 to 8 years old in group 1, age between 8 to 18 years old in group 2 and age beyond 18 years old in group 3.There were 66 cases with basic type and 24 cases with convergence insufficient type. Pseudo-divergence excess was combined with basic intermittent exotropia. Pre- and Post- operation examinations to each patient include the tests of ocular alignment, assessment of eye movements, Worth four-dot test at 6 meters for central fusion, synoptophore with the picture of cat and butterfly for peripheral fusion, Titmus, Frisby, Digital Stereoscopic Test Charts (DSTC) composed by Yan Shaoming, synoptophore with the Picture of RDS triburated by Tianjin Eye Hospital. To compare the damage of stereopsis, the reconstruction of stereopsis and its influencing factors among three groups.Results:(1).There was no statistically significant difference between the stereoacuity tested by Frisby arid Titmus before surgery (P>0.05). The average stereoacuity tested by DSTC, OPTEC6500 and synoptophore with RDS in group 2 was respectively less than that in other groups, however, there was no statistically significant difference between the group 1 and group 3. Stereoacuity tested by FD2 increased gradually in turn of group2, group 1 and group 3. Onsetting age in group 1 was the mimimus, and there was no statistically significant difference between the other groups.The course of disease became longer gradually with increasing average age of every group, and the deviation became larger gradually at the same time. (2). There was no statistically significant difference among the Post-operation stereoacuity of three goups tested by Frisby, Titmus, OPTEC6500, and FD2 respectively (P>0.05). Stereoacuity tested by DSTC in group 1 was more than the other groups. However, there was no statistically significant difference between the other groups. Stereoacuity tested by synoptophore with RDS in grouP 2 was less than the other groups. However, there was no statistically significant difference between the other groups. (3). There is no chang Post-operation in Titmus, but there were significantly differeces in Frisby, DSTC, OPTEC6500, synoptophore with RDS and FD2 between pre- and post -operation. (4).Both surgical overcorrection and undercorrection hindered stereopsis reconstruction. Overcorrection did the more, while undercorrection did the less. Postoperative distant stereoacuity tested by synoptophore with RDS was positive correlative to course of disease and distant stereoacuity tested by OPTEC6500 and FD2 was negative correlative to onset age. All tests were not correlative to ocular movement mild disorder and amplitude of diviation. Stereoacuity tested by synoptophore with RDS and FD2 was negative correlative to pre-operative peripheral fusion range, and stereoacuity tested by OPTEC6500 was negative correlative to preoperative central fusion.Conclusion:(1).Distant stereopsis is damaged severely, while near stereopsis is damaged lightly. Stereopsis is damaged more severely with earlier age of onset and longer course of disease. (2).Both near and distant stereopsis improve after surgery, especially distant stereopsis. (3).Reduction of distance stereopsis can labell the progression of intermittent exotropia, so stereopsis is important to estimate prognosis and treatment effect of surgery. (4).Different stereoscopic tests have particular emphasis on different aspects of binocular vision. Therefore we should assess synthetically binocular vision by different tests. (5). Postoperative stereopsis is better when age of onset is older, and course of disease is shorter. (6). A successful surgery can improve significantly stereopsis, but overcorrection hinders the postoperative stereopsis reconstruction.更多还原