綜合療法治療大齡兒童弱視的效果分析_《華西醫學》

作者：

陳冰潔 ,  劉隴黔

四川大學華西醫院眼科（成都，610041）;

關鍵詞：

弱視大齡兒童綜合療法對比敏感度立體視銳度

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【摘要】　目的　觀察綜合療法治療大齡兒童弱視的療效。　方法　回顧分析2008年1月-2010年10月在我院初診并經綜合治療的8～13歲弱視兒童62例85只眼的臨床資料。治療前最佳矯正視力0.1~0.7，平均0.46±0.17。觀察患者經弱視綜合治療后視力、空間對比敏感度及立體視提升效果。　結果　治療后視力正常22例31只眼（36.5%），進步29例39只眼（45.9%），無效11例15只眼（17.6%）；總有效率82.4%，與治療前相比，差異有統計學意義（P lt;0.001）。空間對比敏感度基本正常11例16只眼（18.8%），進步43例58只眼（68.2%），無效8例11只眼（12.9%）。弱視眼在1.5、3、6三個低空間頻率的對比敏感度值與治療前相比提升有統計學意義（P lt;0.001）；在12和18兩個高空間頻率，對比敏感度值與治療前相比提升無統計學意義（P gt;0.05）。立體視銳度正常12例（19.4%），進步26例（41.9%），無效24例（38.7%），立體視銳度與治療前相比提升具有統計學意義（P lt;0.001）。　結論　綜合療法治療大齡兒童弱視能取得令人較為滿意的療效，患兒視力顯著提升，低到中等頻率空間對比敏感度及立體視銳度也有較大提升。
【Abstract】　Objective　 To explore the therapeutic effect of comprehensive therapy on elder children with amblyopia. 　Methods　 The clinical data of 62 patients (85 eyes) with amblyopia who underwent the comprehensive therapy between January 2008 and October 2010 were retrospectively analyzed. The best-corrected visual acuity was 0.1-0.7 (mean 0.46±0.17) before the treatment. The visual acuity, spatial contrast sensitivity and stereoacuity of the patients after the treatment were observed.　Results　 After the comprehensive therapy, the visual acuity was normal in 22 patients (31 eyes, 36.5%), improved in 29 patients (39 eyes, 45.9%), invalid in 11 patients (15 eyes, 17.6%). The total effective rate was 82.4% which was differed significantly from that before the treatment (P lt;0.001). The spatial contrast sensitivity was almost normal in 11 patients (16 eyes, 18.8%), improved in 43 patients (58 eyes, 68.2%), and invalid in 8 patients (11 eyes, 12.9%). The examination of spatial contrast sensitivity showed that the improvement was only statistically significant when frequency equates 1.5, 3, or 6 (P lt;0.001) compared with those before the treatment; while no statistically significant improvement was observed in higher frequencies of 12, 18 (P gt;0.05). The stereoacuity was normal in 12 patients (19.4%), improved in 26 (41.9%), and invalid in 24 (38.7%); the difference in stereoacuity before and after the treatment was significant (P lt;0.001).　Conclusion　 The therapeutic effect of comprehensive therapy is good: the visual acuity of the patients improves obviously, and the low to middle spatial contrast sensitivity and stereoacuity improve apparently.

引用本文： 陳冰潔,劉隴黔. 綜合療法治療大齡兒童弱視的效果分析. 華西醫學, 2011, 26(4): 568-571. doi: 復制

1.	中華醫學會全國兒童弱視斜視防治學組. 弱視的定義、分類及療效評價標準[J]. 中國斜視與小兒眼科雜志, 1996, 4(3): 97- 99.
2.	劉家琦, 郭靜秋. 弱視斜視臨床與發病機理的研究[J]. 北京醫科大學學報, 1992, 24(4): 289.
3.	陰正勤. 弱視發病機制研究進展[J]. 中國斜視與小兒眼科雜志, 2004, 12(1): 45.
4.	Park KH, Hwang JM, Ahn JK. Efficacy of amblyopia therapy initiated after 9 years of age[J]. Eye (Lond), 2004, 18(6): 571-574.
5.	Hwang DJ, Kim YJ, Lee JY. Effect and sustainability of part-time occlusion therapy for patients with anisometropic amblyopia aged>or =8 years[J]. Br J Ophthalmol, 2010, 94(9): 1160-1164.
6.	Vereecken EP, Brabant P. Prognosis for vision in the amblyopic eye after loss of the good eye[J]. Arch Ophthalmol, 1984, 102(2): 220-224.
7.	Moseley M, Fielder A. Improvement in amblyopic eye function and contralateral eye disease: evidence of residual plasticity[J]. Lancet, 2001, 357(9260): 902-904.
8.	Klaeger-Manzanell C, Hoyt CS, Good WV. Two-step recovery of vision in amblyopic eye after visual loss and enucleation of the fixing eye[J]. Br J Ophthalmol, 1994, 78(6): 506-507.
9.	陰正勤, 余濤, 陳莉. 斜視性弱視貓發育過程視皮層神經元NMDA2R1表達的免疫組織化學電鏡觀察[J]. 中華眼科雜志, 2000, 36(1): 208-211.
10.	Levi DM, Li RW. Improving the performance of the amblyopic visual system[J]. Philos Trans R Soc Lond B Biol Sci, 2009, 364(1515): 399-407.
11.	McKee SP, Levi DM, Movshon JA. The pattern of visual deficits in amblyopia[J]. J Vis, 2003, 3(5): 380-405.
12.	黃佳, 瞿小妹, 薛楓. 視覺敏感期后弱視的可塑性研究進展[J]. 眼視光學雜志, 2006, 8(5): 338.
13.	Scheiman MM, Hertle RW, Kraker RT, et al. Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial[J]. Arch Ophthalmol, 2008, 126(12): 1634-1642.
14.	Pediatric Eye Disease Investigator Group, Repka MX, Kraker RT, et al. A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years[J]. Arch Ophthalmol, 2008, 126(8): 1039-1044.

1. 　中華醫學會全國兒童弱視斜視防治學組. 弱視的定義、分類及療效評價標準[J]. 中國斜視與小兒眼科雜志, 1996, 4(3): 97- 99.
2. 　劉家琦, 郭靜秋. 弱視斜視臨床與發病機理的研究[J]. 北京醫科大學學報, 1992, 24(4): 289.
3. 　陰正勤. 弱視發病機制研究進展[J]. 中國斜視與小兒眼科雜志, 2004, 12(1): 45.
4. 　Park KH, Hwang JM, Ahn JK. Efficacy of amblyopia therapy initiated after 9 years of age[J]. Eye (Lond), 2004, 18(6): 571-574.
5. 　Hwang DJ, Kim YJ, Lee JY. Effect and sustainability of part-time occlusion therapy for patients with anisometropic amblyopia aged>or =8 years[J]. Br J Ophthalmol, 2010, 94(9): 1160-1164.
6. 　Vereecken EP, Brabant P. Prognosis for vision in the amblyopic eye after loss of the good eye[J]. Arch Ophthalmol, 1984, 102(2): 220-224.
7. 　Moseley M, Fielder A. Improvement in amblyopic eye function and contralateral eye disease: evidence of residual plasticity[J]. Lancet, 2001, 357(9260): 902-904.
8. 　Klaeger-Manzanell C, Hoyt CS, Good WV. Two-step recovery of vision in amblyopic eye after visual loss and enucleation of the fixing eye[J]. Br J Ophthalmol, 1994, 78(6): 506-507.
9. 　陰正勤, 余濤, 陳莉. 斜視性弱視貓發育過程視皮層神經元NMDA2R1表達的免疫組織化學電鏡觀察[J]. 中華眼科雜志, 2000, 36(1): 208-211.
10. 　Levi DM, Li RW. Improving the performance of the amblyopic visual system[J]. Philos Trans R Soc Lond B Biol Sci, 2009, 364(1515): 399-407.
11. 　McKee SP, Levi DM, Movshon JA. The pattern of visual deficits in amblyopia[J]. J Vis, 2003, 3(5): 380-405.
12. 　黃佳, 瞿小妹, 薛楓. 視覺敏感期后弱視的可塑性研究進展[J]. 眼視光學雜志, 2006, 8(5): 338.
13. 　Scheiman MM, Hertle RW, Kraker RT, et al. Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial[J]. Arch Ophthalmol, 2008, 126(12): 1634-1642.
14. 　Pediatric Eye Disease Investigator Group, Repka MX, Kraker RT, et al. A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years[J]. Arch Ophthalmol, 2008, 126(8): 1039-1044.

《華西醫學》

綜合療法治療大齡兒童弱視的效果分析

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《華西醫學》

綜合療法治療大齡兒童弱視的效果分析

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