【摘要】 目的总结、评估全遮盖法治疗年长儿童屈光参差性弱视的疗效。方法收集2009年1月至2012年12月广东省江门市妇幼保健院眼科56例(56只眼)屈光参差性弱视患者的临床资料,患者均在10~16岁。所有患者经眼科常规检查和散瞳验光后确诊,并给予有视觉意义的屈光矫正治疗,全天连续遮盖非弱视眼。同时配合光栅及精细作业,每个月复查1次,随访2~4年。治疗前、后患者的视力以均数±标准差(x珋±s)的形式表示,并采用配对t检验的方法进行比较。不同年龄、不同弱视程度及不同注视性质的患者治疗后6、12个月视力提高的幅度以均数±标准差(x珋±s)的形式表示,并采用独立样本t检验的方法进行组间比较,采用配对t检验的方法进行组内比较。结果治疗后3个月弱视眼矫正视力提高1行及以上者50例(50只眼),占87.50%;提高2行及以上者31例(31只眼),占55.36%。治疗后6个月弱视眼矫正视力提高1行及以上者55例(55只眼),占98.21%;提高2行及以上者44例(44只眼),占78.57%。治疗后12个月弱视眼矫正视力提高1行及以上者56例(56只眼),占100.00%;提高2行及以上者48例(48只眼),占85.71%。治疗前患者弱视眼的平均矫正视力为(0.22±0.18),治疗后6个月患者弱视眼的平均矫正视力为(0.64±0.21),平均提高4.2行;治疗后12个月患者弱视眼的平均矫正视力为(0.66±0.23),平均提高视力4.4行,治疗后6、12个月患者弱视眼的平均矫正视力较治疗前明显提高,差异有统计学意义(t=11.09,11.87;P<0.05)。10~13岁组患者治疗后6个月视力提高幅度为(0.53±0.23),治疗后12个月视力提高幅度为(0.56±0.20);14~16岁组患者治疗后6个月视力提高幅度为(0.31±0.18),治疗后12个月视力提高幅度为(0.56±0.20),治疗后6、12个月两组患者视力提高幅度比较,差异有统计学意义(t1=3.98,4.29;P1<0.05)。治疗后6、12个月10~13岁组患者视力提高幅度比较,差异无统计学意义(t2=0.58,P2>0.05)。治疗后6、12个月14~16岁组患者视力提高幅度比较,差异无统计学意义(t3=0.35,P>0.05)。中度弱视组患者治疗后6个月视力提高幅度为(0.45±0.13),治疗后12个月视力提高幅度为(0.52±0.11);重度弱视组患者治疗后6个月视力提高幅度为(0.37±0.16),治疗后12个月视力提高幅度为(0.39±0.13),治疗后6个月两组患者视力提高幅度比较,差异无统计学意义(t1=1.53,P1>0.05);治疗后12个月,两组患者视力提高幅度比较,差异有统计学意义(t1=2.52,P1<0.05)。治疗后6、12个月中度弱视组患者视力提高幅度比较,差异有统计学意义(t2=2.87,P2<0.05)。治疗后6、12个月重度弱视组患者视力提高幅度比较,差异无统计学意义(t3=0.82,P3>0.05)。中心注视性弱视组患者治疗后6个月视力提高幅度为(0.45±0.13),治疗后12个月视力提高幅度为(0.52±0.11);旁中心注视性弱视组患者治疗后6个月视力提高幅度为(0.37±0.16),治疗后12个月视力提高幅度为(0.39±0.13),治疗后6、12个月两组患者视力提高幅度比较,差异有统计学意义(t1=2.42,2.87;P1<0.05)。治疗后6、12个月中心注视性弱视组患者视力提高幅度比较,差异有统计学意义(t2=2.64,P2<0.05)。治疗后6、12个月旁中心注视性弱视组患者视力提高幅度比较,差异无统计学意义(t3=0.85,P3>0.05)。本研究治疗过程中,有3例(3只眼)患者被遮盖眼矫正视力曾略有下降,去除遮盖后数小时,视力恢复至原有水平,第2天继续遮盖,此3例(3只眼)患者在之后的遮盖治疗中,每月停止遮盖1 d,治疗结束时未发生遮盖性弱视。有6例(6只眼)患者在停止遮盖治疗后2~4个月后视力回退2~3行,再次给予健眼遮盖治疗3个月,弱视眼矫正视力恢复至原有水平,随访2~4年患者视力未下降。结论全遮盖法治疗年长儿童屈光参差性弱视的疗效较好。更多还原

【Abstract】 Objective To evaluate the effectiveness of full-time patching or occlusion in treating anisometropic amblyopia in older children. Methods A total of 56 children(56 eyes) aged 10-16 years who presented to the Department of Ophthalmology,Jiangmen Maternal and Children’ s Health Hospital with anisometropic amblyopia between January,2009 and December,2012 were enrolled in this study. After diagnosis of anisometropic amblyopia through routine ophthalmologic examinations pupil dilated optometry,all patients underwent refraction correction and continuous full-time patching. After treatment,patients were followed up for 24 to 48 months during which monthly assessments were performed. Changes in visual acuity before and after treatment were analyzed. Results At three months after treatment,the corrected visual acuity of 50 patients(50 eyes) was improved 1 line or more with an overall effectiveness rate of 87. 50%,and that of 31 patients(31 eyes) was improved 2 lines or more with an overall effectiveness rate of 55. 36%.At 6 months after treatment,the corrected visual acuity of 55 patients(55 eyes) was improved 1 line or more with an overall effectiveness rate of 98. 21%,and that of 44 patients( 44 eyes) was improved 2 lines ore more with an average overall effectiveness rate of 78. 57%. At 12 months after treatment,the corrected visual acuity of 56 patients(56 eyes) was improved 1 line ore more with an overall effectiveness rate of 100%,and that of 48 patients(48 eyes) was improved 2 lines or more with an overall effectiveness rate of 85. 71%.Before treatment,the average corrected visual acuity of patients’ amblyopia was( 0. 22 ± 0. 18),while at 6months after treatment,the average corrected visual acuity reached( 0. 64 ± 0. 21) with an average improvement of 4. 2 lines. At 12 months after treatment,the average corrected visual acuity reached(0. 66 ±0. 23) with an average improvement of visual acuity of 4. 4 lines. At 6 and 12 months after treatment,the average corrected visual acuity of patients’ amblyopia was improved significantly,compared to that before treatment,whose difference has statistical significance( t = 11. 09,11. 87; P < 0. 05). After patients were stratified into two(10-13 years old and 14-16 years old) age groups,the improved magnitude of visual acuity for the 10-13 year-old group was( 0. 53 ± 0. 23) at 6 months after treatment and( 0. 56 ± 0. 20) at 12 months after treatment,while that for 14-16 year-old group was(0. 31 ± 0. 18) at 6 months after treatment and(0. 56 ± 0. 20) at 12 months after treatment. Therefore,after the comparison of the improved magnitude of visual acuity,the difference is of statistical significance( t1= 3. 98,4. 29;P1< 0. 05). At 6 and 12 months after treatment,the comparison of improved magnitude of visual acuity in the 10-13 year-old group doesn’ t have statistical significance in terms of their difference( t2= 0. 58,P2> 0. 05). At 6 and 12 months after treatment,the comparison of improved magnitude of visual acuity in the 14-16 year-old group doesn’ t have statistical significance in terms of their difference either( t3= 0. 35,P3> 0. 05). At 6 months after treatment,the comparison of improvement magnitude of visual acuity doesn’ t have statistical significance in terms of their difference( t1= 1. 53,P1> 0. 05),while 12 months after treatment,the comparison of the improvement magnitude of visual acuity among these two groups has statistical significance in terms of their difference(t1= 2. 52,P1< 0. 05). At 6 and 12 months after treatment,the comparison of the improvement magnitude of visual acuity in moderate amblyopia has statistical significance in terms of their difference( t2= 2. 87,P2<0. 05). At 6 and 12 months after treatment,the comparison of the improvement magnitude of visual acuity in severe amblyopia doesn’ t have statistical significance( t3= 0. 82,P3> 0. 05). For amblyopia with central fixation,the improvement magnitude of visual acuity is( 0. 45 ± 0. 13) at 6 months after treatment and(0. 52 ± 0. 11) at 12 months after treatment. For amblyopia with side-central fixation,the improvement magnitude of visual acuity is(0. 37 ± 0. 16) at 6 months after treatment and( 0. 39 ± 0. 13),At 6 and 12 months after treatment,the comparison of the improvement magnitude of visual acuity among these two groups has statistical significance in terms of their difference( t1= 2. 42,2. 87;P1< 0. 05). The comparison of the improvement magnitude of visual acuity in amblyopia with central fixation is of statistical significance in terms of the difference( t2= 2. 64,P2< 0. 05). At 6 and 12 months after treatment,the comparison of the improvement magnitude of visual acuity in amblyopia with side-central fixation doesn’ t have statistical significance( t3= 0. 85,P3> 0. 05). In the treatment of this research,the corrected visual acuity of the covered eye of 3 patients( 3 eyes) decreased. After the eye cover was removed fore few hours,the acuity recovered to its original level. The next day,the eye was covered continuously. In the covered treatment of these three patients(3 eyes) after that,the covered treatment stopped one day per month. When the treatment is over,no covered amblyopia was found. At 2-4 months after the covered treatment,the visual acuity of 6patients(6 eyes) fell back 2-3 lines,then they wre treated with covered treatment of eye health 3 months,and it corrected visual acuity recovered to its original level. After 2-4 years,the visual acuity of these patients didn’t decrease. Conclusion Full-time patching therapy proves effective for anisometropic amblyopia in older children.更多还原