修改稿-间歇性外斜视术后眼位回退影响因素概要

间歇性外斜视术后双眼视功能训练邱辉，李心瑶，李洪阳，王欣玲，张劲松【摘要】目的：观看双眼视功能训练对间歇性外斜视患者术后重建三级视功能的作用。

方式：间歇性外斜视术后患者121例,随机分为训练组与对照组。

斜视术后训练组采纳双眼视功能训练软件进行三级视功能训练,对照组不进行训练。

对所有患者术前、术后1wk及术后12mo 进行三级视功能检查。

所得结果进行分析比较。

比较两组术后12mo 的眼位回退率。

结果：训练组与对照组进行比较,术后12mo训练组三级视功能形成者的比例明显高于对照组,不同有统计学意义(P<。

术后12mo训练组眼位回退率低于对照组,不同有统计学意义(P<。

结论：双眼视功能训练有助于间歇性外斜视患者术后恢复与重建三级视功能，三级视功能的恢复有利于降低间歇性外斜视患者术后眼位回退率。

【关键词】双眼视功能;间歇性外斜视AbstractAIM: To observe the clinical effect of binocular vision train ing for patients with intermittent exotropia after : Totally 121 patients with intermittent exotropia were divided into training group and control group randomly. After surgery, patients in training group were treated by usingbinocular vision training software, no training for patients in control group. Binocular vision function was examined before surgery, 1 week and 12 months after surgery.RESULTS: Twelve months after surgery，recovery rate of binocular vision of patients in training group was higher than that of patients in control group. Recession rate of eye position of patients in training group was lower than that of patients in control : Binocular vision training for patients with intermittent exotropia after surgery is helpful for recovery of binocular vision. Reconstruction of binocular vision is useful in keeping eye position.KEYWORDS: binocular vision; intermittent exotropia0引言间歇性外斜视是斜视中较常见类型，会阻碍双眼视功能的发育。

间歇性外斜视手术前后的视功能变化分析张启珍;罗顺利【摘要】目的探讨间歇性外斜视患者手术前后的视功能变化.方法收集我院2007年1月至2010年10月行矫正手术的间歇性外斜视患者78例,根据外斜视类型及斜视度大小选择手术方式,分别行双眼外直肌后退缩短术、单眼外直肌后退缩短加内直肌缩短术与双眼外直肌后退缩短加内直肌缩短术,所有患者进行术前、术后1周及术后12个月三级视功能测定,检查双眼同时视、融合视及立体视Ⅲ级视功能,观察术后1周及12个月时眼位.结果术前无双眼视功能者40例、具有I级视功能者38例、具有Ⅱ级视功能者22例.术后1周无双眼视功能者、具有Ⅰ级视功能者、具有Ⅱ级视功能者分别31例、47例、32例,术后12个月分别为14例、64例、40例；术后l周、12个月与术前比较,差异均有统计学意义(均为P＜0.05).术前具有远立体视者19例,近立体视者19例,术后1周分别为25例、22例,术后12个月分别为38例、34例；术后1周、12个月与术前相比,差异均有统计学意义(均为P＜O.05).术后l周正位64例,轻度欠矫8例,轻度过矫6例；术后12个月正位65例,轻度欠矫7例,轻度过矫5例,明显欠矫1例.结论及时行矫正手术对间歇性外斜视患者双眼视功能的恢复至关重要,尤其是立体视觉.【期刊名称】《眼科新进展》【年(卷),期】2012(032)002【总页数】3页(P183-185)【关键词】间歇性外斜视;手术治疗;视功能【作者】张启珍;罗顺利【作者单位】466000 河南省周口市,周口市眼科医院;466000 河南省周口市,周口市眼科医院【正文语种】中文间歇性外斜视是后天性共同性外斜视中较为常见的一种类型，介于外隐斜和恒定性外斜视之间，约占47.7%［1］。

随着年龄的增长，间歇性外斜视患者的融合和调节性集合功能逐渐减弱，如治疗不及时，就会错过双眼视功能形成的可塑期，最后导致代偿能力丧失，发展为恒定性外斜视［2］。

间歇性外斜视儿童手术前后双眼单视功能的临床分析王娟;刘素江【摘要】· AIM:To analyze the clinical features of binocular visual functionin children with intermittent exotropia before and after operation,so as to provide theoretical basis for surgical treatment of intermittent exotropia.· METHODS:Enrolled forty patients with intermittent exotropia in our hospital from January 2016 to January 2017,in which 64 eyes received operation.All patients underwent surgical treatment and were followed up for 6wk,to compare the proportion o f patients with Ⅰ,Ⅱ and Ⅲ of visual function before and after the treatment.Seeing WORTH four hole lamp near and far respectively were used to compare central and peripheral fusion before and at 2wk and 6wk after operation.Yan's random dot stereogram (Stereoscopic Test Charts,STC) was used to evaluate the near stereopsis,and synoptophore (STC) picture for distant stereopsis evaluation before and at 2wk and 6wk after operation.· RESULTS:There were 26 cases (65％),9 cases (22.5％),5 cases (12.5％) with preoperative vision function of Ⅰ,Ⅱ and Ⅲ respectively;10 cases (25％),17 cases (42.5％) and 13 cases (32.5％) at 2wk after operation;8 cases (20％),18 cases (45％),14 cases (35％) at 6wk after surgery;the differences between the proportion before and2wk after operation,before and 6wk after operation were significant (P＜0.05).WORTH four hole lamp examination showed preoperative proportion of patients with central fusion was significantly lower than that at 2wk and 6wk after surgery;the proportion at 2wk was significantly lower than that at6wk after surgery,the difference was statistically significant (P＜0.05).The proportion of patients with peripheral fusion at 2 and 6wk after operation was significantly higher than that before operation (P＜ 0.05),but the proportion at 2wk was not different from 6wk (P＞0.05).The near stereopsis at 2 and 6wk after operation was significantly improved than that before operation (P＜ 0.05),but that at 2wk was not different from 6wk (P＞0.05).The proportion of patients with distant stereopsis at 2wk (24 cases,60％) and 6wk (39 cases,97.5％) after operation was significantly higher than that before operation (6 cases,15％,P＜0.05),but the proportion at 2wk was not different from 6wk (P＞0.05).· CONCLUSION:Intermittent exotropia correction surgery can significantly improve the binocular single vision and save the deterioration of patients with far,near stereopsis and central fusion.%目的:对间歇性外斜视儿童手术前后双眼单视功能进行临床分析,为间歇性外斜视的手术治疗提供理论依据.方法:选取对象为2016-01/2017-01于我院斜视与小儿眼科治疗的间歇性外斜视儿童患者40例,40例患者中手术眼为64眼.所有患者均采用斜视矫正手术治疗,术后随访6wk,比较治疗前后存在Ⅰ、Ⅱ、Ⅲ级视功能人数比例,采用视近、视远WORTH四孔灯分别对患者术前和术后2、6wk的中央及周边融合情况进行比较,采用颜少明颜氏随机点立体图(stereoscopic test charts,STC)评价术前和术后2、6wk近立体视,采用同视机画片对患者术前、术后2、6wk的远立体视进行评估.结果:视功能Ⅰ、Ⅱ、Ⅲ级术前人数分别为26例(65％)、9例(22.5％)、5例(12.5％),术后2wk分别为10例(25％)、17例(42.5％)、13例(32.5％),术后6wk分别为8例(20％)、18例(45％)、14例(35％),术前与术后2、6wk比较差异具有统计学意义(P＜0.05),术后2wk和6wk比较差异无统计学意义(P＞0.05);WORTH四孔灯检查结果显示术前中央融合人数比例显著低于术后2、6wk,术后6wk中央融合人数显著高于术后2wk人数,差异具有统计学意义(P＜O.05);术后2、6wk周边融合人数显著高于术前,差异具有统计学意义(P＜0.05),术后2、6wk比较差异无统计学意义(P＞0.05);术后2、6wk近立体视较术前显著改善,差异具有统计学意义(P＜0.05),术后2、6wk比较差异无统计学意义(P＞0.05);术后2、6wk远立体视人数比例分别为24例(60％)与39例(97.5％),较术前6例(15％)显著改善,差异具有统计学意义(P＜0.05),术后2、6wk比较差异无统计学意义(P＞0.05).结论:间歇性外斜视儿童行矫正手术能显著改善双眼单视功能,挽救患者的远、近立体视以及中央融合功能.【期刊名称】《国际眼科杂志》【年(卷),期】2018(018)006【总页数】3页(P1160-1162)【关键词】间歇性外斜视手术;双眼单视功能;临床分析【作者】王娟;刘素江【作者单位】054000 中国河北省邢台市,河北省眼科医院斜视与小儿眼科;054000 中国河北省邢台市,河北省眼科医院斜视与小儿眼科【正文语种】中文0 引言间歇性外斜视是常见的共同性斜视种类，约占到所有外斜视患者的80%以上，7岁以下儿童发病率最高[1]。

间歇性外斜视患儿手术前后视功能状况分析王娟;韩爱军【摘要】目的探讨不同年龄段间歇性外斜视(IXT)患儿手术前双眼视功能及术后双眼视功能恢复状况.方法选取河北省眼科医院2014年3月至2016年12月收治的IXT患儿136例,根据不同年龄段视觉的发育水平,分为Ⅰ组和Ⅱ组.术前对患儿进行散瞳验光和眼球运动检查,根据每个患儿外斜视情况选择相应的手术方式,比较两组患儿术前、术后眼位情况和同视机双眼视功能.结果Ⅰ组IXT患儿术后眼位正位率低于Ⅱ组,但两组术后眼位正位、过矫、欠矫发生率比较,差异均无统计学意义(均P>0.05);两组IXT患儿术后Ⅱ级、Ⅲ级同视机患者显著高于术前,无及Ⅰ级同视机患者显著低于术前.术后无双眼视功能者明显减少,其中Ⅰ组双眼视功能恢复到Ⅲ级者显著高于Ⅱ组;术前有融合功能的IXT患儿术后视功能恢复率为69.2%,高于术前无融合功能的IXT患儿,且差异有统计学意义(χ2=4.012,P<0.05).结论 IXT的手术成功率与患儿年龄(发病年龄与手术年龄)、术前病情发展等因素相关,尽早采取手术治疗能提高手术成功率.%Objective To explore the binocular visual function and postoperative binocular visual function recovery in children with intermittent exotropia(IXT)at different ages.Methods Totally 136 children with IXT admitted to Hebei Ophthalmology Hospital from March 2014 to December 2016 were selected.They were divided into group Ⅰ and group Ⅱ according to the developmental level of vision at different ages.All of the children accepted mydriatic optometry and eye movement examination before operation. Different surgical procedures were selected for children according to exotropia condition,and eye position and binocular visual function of children with synoptophore were comparedbetween two groups before and after operation.Results The positive rate of eye position in group Ⅰ was lower than that in group Ⅱ,but there was no significant difference between two groups after operation(P>0.05).The cases of synoptophore of gradeⅡ and grade Ⅲ in two groups were significantly more after operation than those before operation,but those of without synoptophore or synoptophore of grade Ⅱ were remarkably fewer than before operation.The number of non double eye visual function was significantly reduced after operation,and the number of group I with double binocular function to grade Ⅲ was significantly higher than that of group Ⅱ.The recovery rate of visual function of IXT in children with fusion function before operation was 69.2%,which was higher than that of IXT without fusion function before operation,and the difference was statistically significant(χ2=4.012,P<0.05).Conclusion The success rate of IXT is related to the age of the children(onset age and age of the operation)and the development of the patient's condition.The early operation can improve the success rate of the operation.【期刊名称】《中国妇幼健康研究》【年(卷),期】2018(029)005【总页数】4页(P667-670)【关键词】间歇性外斜视;双眼视功能;眼位;恢复【作者】王娟;韩爱军【作者单位】河北省眼科医院,河北邢台054000;河北省眼科医院,河北邢台054000【正文语种】中文【中图分类】R779.6间歇性外斜视(intermittent exotropia，IXT)属于从隐性外斜视发展为恒定性外斜视的一个过渡状态，是中枢神经系统的支配异常使双眼的集合和分开出现不平衡及发育异常的解剖机械性因素共同作用的结果,常发生于5岁前儿童[1-2]。

•118 •国际眼科纵览 202丨年4 月第45 卷第2 期Int Rev Ophthalmol，Apr. 2021，V o丨■45，No. 2•综述•间歇性外斜视矫正术后回退的相关因素分析彭婷婷余新平温州医科大学附属眼视光医院，温州325027通信作者：余新平，Email:yu-xinping@163. com【摘要】间歇性外斜视在青少年常见，其发病机制不明，术后回退率高。

其术后效果回退可能与手术方式、手术年龄、术前斜视度、术前屈光度、术后早期眼位以及联合非手术治疗等有关，但目前对此的相关性仍存在一定的争议。

然而术后早期眼位过矫、联合非手术治疗可以降低间歇性外斜视术后回退的风险。

（国际眼科纵览，202/，45://8-/2J)【关键词】间歇性外斜;手术治疗;术后效果D0I：10.3760/ cma. j. issn. 1673 -5803.2021.02.006Factors related regression after intermittent exotropia surgeryPeng Tingling，Yu XinpingThe Eye Hospital of Wenzhou Medical University，Wenzhou 325027, ChinaCorresponding author：Yu Xinping, Email：******************【A bstract】Intermittent exotropia is a common type of strabismus in adolescents. Its unknown patho­genesis and high postoperative regression rate are a hot spot in clinical research. This article reviews the cor­relation between the postoperative regression and the surgical method, surgical age, preoperative angle of de­viation ,preoperative refractive power, early postoperative eye position, and combined non-surgical treat­ment. At present, above factors are controversial about the correlation with postoperative regression. Howev­er ,early postoperative eye position overcorrection and combined non-surgical treatment can reduce the risk ofpostoperative regression in intermittent exotropia. (hit Rev Ophthalmol, 2021, 45：118-123)【Key words】intermittent exotropia; surgical treatment; postoperative effectDOI：10.3760/ cma. j. issn. 1673 -5803.2021.02.006间歇性外斜视是青少年常见眼病，尤以东亚地 区更为常见，我国儿童和青少年的患病率约3.5% ~4%+3]。

间歇性外斜视术后立体视恢复效果分析作者：韦志伟孙莉来源：《维吾尔医药》2013年第05期摘要：目的探讨间歇性外斜视立体视功能的恢复情况。

方法将间歇性外斜视患者116例行三棱镜检查、眼球运动检查、同视机常规三级功能检查、线状镜不同检查距离（6 m及33 cm）双眼视觉功能检查，以及Titmus立体图立体视觉检查。

术后随访6～48月，平均24月。

结果术前中心立体视觉者33例占28.45%，黄斑立体视者42例占36.21%，周边立体视者18例占15.52%，无远、近立体视觉者23例占19.83%，而无远立体视觉者总计60例占51.72%，手术年龄越小，术后立体视功能的恢复率越高，4～7岁术后立体视功能的恢复率明显高于其它三个阶段的高年龄组（P关键词：间歇性外斜视；术后；立体视功能间歇性外斜视是斜视中最常见的一种，是儿童常见的眼病，是介于外隐斜和恒定性外斜视之间的一种过渡型斜视，发病率高，占外斜视的80%[1]，且多幼年发病。

它是一种能被融合功能所控制正位的斜视，但由于其融合机能不稳定，其斜视角经常发生改变。

在思想集中时正位，在走神、疲劳、疾病和充分破坏融合时斜视度充分暴露，表现出外斜[2]。

治疗该病的主要方法是手术矫正眼位以获得恢复双眼视功能，由于视近可控制正位，因此对立体视觉的破坏与其它类型斜视相比较还是具有其特殊性，国内已有报道[3，4]，我们通过降低手术后的眼球回归，巩固恢复双眼立体视功能，现对我院手术矫正的116例间歇性外斜视的资料和手术效果进行总结分析报道如下。

1资料与方法1.1一般资料选取2008年1月～2012年1月我院收治的间歇性外斜视患者116例，术后随访2年，其中男69例，女47例，年龄4～42岁，手术年龄4～42岁，矫正视力0.9以上53例占45.69%，混合性散光及高度近视而引起的弱视9例占7.76%，其余视力全部恢复正常。

1.2方法1.2.1检查方法（1）进行外眼、眼前段、屈光间质及眼底检查，排除眼部器质性病变。

间歇性外斜视术后视觉恢复临床分析发表时间：2016-02-03T10:04:59.300Z 来源：《中国耳鼻咽喉头颈外科》2015年12月第12期供稿作者：赵静1 通讯作者胡守龙2 孙卫铎3韩惠芳4 韩爱军5[导读] 1、3、4、5 河北省眼科医院 2首都医科大学附属北京儿童医院间歇性外斜视术后视觉有所改善。

（1、3、4、5 河北省眼科医院 2首都医科大学附属北京儿童医院）摘要目的探讨间歇性斜视患儿手术前后双眼视力的变化。

方法赫斯棱镜分析20例间歇性外斜视患儿，术后随访2-30周，进行2-6次赫斯棱镜分析。

结果术后中央斜视平均值为8.1±7.3°，其中8例为A或V型。

剩余12例接受再次手术，术后得到了明显改善，大约为5°。

结论间歇性外斜视术后视觉有所改善。

关键词间歇性外斜视；术后随访；赫斯棱镜中图分类号：R777.41 文献标识码：AChanges in Binocular Alignment after Surgery for Concomitantand Pattern Intermittent ExotropiaZhaojing Hu Shoulong Sun Weiduo Han Huifang Han Aijun(Strabismus with pediatric ophthalmology, Hebei Eye hospital, Handan 054000,P.R.China )Abstract Purpose To observe the clinical feature and therapeutic efficacy of congenital esotropia and to discuss the significant of early treatment. Methods We prospectively performed Hess screen analysis in 20 exotropic patients (mean age 42 ± 16 yrs) before and two to six times after strabismus surgery, with a post-operative follow-up of 2–108 weeks. Results Mean pre-operative central gaze exotropia was 8.6 ± 7.1°. Twelve cases were concomitant, while 8 exhibited A or V patterns. Twelve cases were re-operations. In initial surgery for concomitant exotropia, there was a well-defined exotropic drift approaching 5° by 30 weeks postoperatively. Conclusions Alignment following strabismus surgery differs in concomitant vs. pattern exotropia. Initial over-correction of about 5° is advisable for concomitant exotropia, but should be avoided in A and V patterns.Key words Intermittent exotropia；Alignment；post-operative follow-up间歇性外斜视的发病率很高，占斜视的80％以上。

临床医药文献杂志Journal of Clinical Medical2019 年 第 6 卷第 15 期2019 Vol.6 No.1560间歇性外斜视手术前后双眼单视功能的状况分析杨美茹（哈尔滨爱尔眼科医院，黑龙江 哈尔滨 150000）【摘要】目的 观察间歇性外斜视手术前后双眼单视功能的变化情况。

方法 将76例间歇性外斜视患儿分为有双眼视功能组（34例）和无双眼视功能组（42例），根据斜视度行斜视矫正手术，手术前后分别检测I 级视功能、Ⅱ级视功能和Ⅲ级视功能，对手术前后的结果进行分析。

结果 本次研究的所有患儿手术前后差异均较为明显，有统计学意义（P ＜0.05）。

结论 手术治疗对间歇性外斜视患儿双眼视功能的重建效果非常好。

【关键词】手术；双眼视觉【中图分类号】R777.4+1 【文献标识码】A 【文章编号】ISSN.2095-8242.2019.15.60.01间歇性外斜视发病主要是外展和集合功能的平衡失调所致，如治疗不及时或治疗方法不当，就会影响双眼视功能的形成。

为进一步观察其术后的恢复情况，现选取我院2016年1月～2018年10月收治的患者对其手术前后情况进行分析，并作出如下报道。

1 资料与方法1.1 一般资料选取的76例患儿中，男40例，女36例，年龄5～13岁，平均9岁。

双眼裸眼或矫正视力均≥0.8，所有患者术后均随访6个月以上。

经同视机检查：术前无同时视功能者42例，具有I 级视功能者42例，具有Ⅱ级视功能者21例，具有Ⅲ级视功能者8例。

患者斜视度为-25度～-95度，平均-60度。

1.2 方法术前对视力、外眼及眼底进行常规检查，排除器质性病变。

用复方托吡卡胺滴眼液常规散瞳，来矫正屈光不正。

用同视机、线状镜、Titmus 来检查双眼视功能，用三棱镜检测33 cm 、5 m 距离斜视度。

对患儿随访时间为6个月。

1.3 统计学方法采用t 和x 2来检验。

P ＜0.05表示有统计学意义。

间歇性外斜视术后眼位回退影响因素的相关性分析王欢柴松刘慧杰姜娇摘要：目的：分析影响间歇性外斜视患者术后远期眼位回退量的相关因素。

方法:选择2012-12-17至2013-12-11在河北医科大学第二医院眼科进行手术治疗的间歇性外斜视病人65例，测量术后第一天及术后一周的眼位，并且对52例患者进行3~12月的随访，测量眼位回退量，分析影响眼位回退的相关因素。

结果：65例间歇性外斜视患者术后第一周的眼位较术后第一天的眼位已有明显回退，回退了大约1.78个PD。

52例随访患者远期眼位明显回退，且眼位回退量均数为7.654±6.7574PD。

其中术前有近立体视患者较无近立体视者术后远期眼位回退量大，集合不足型的患者较基本型患者术后眼位回退量大，术后第一天眼位内隐斜的患者较外隐斜的患者术后远期眼位回退量大，且发现术后第一天眼位与术后远期眼位回退量之间呈线性相关（r=0.324，P =0.019）。

结论：间歇性外斜视患者手术后远期眼位回退量与术后第一天眼位、术前有无近立体视、斜视类型有关，与年龄、性别、有无家族史、发病年龄、屈光状态、眼轴长度、斜视度大小、术前有无同时视、手术麻醉方式以及不同手术方式等无关。

基金项目：河北省卫生厅指导项目（20130519）作者单位：河北省石家庄市，河北医科大学第二医院眼科(柴松，刘慧杰、姜娇为在读研究生)，050000；河北省秦皇岛市第二医院（王欢），066600；通讯作者：柴松，Email：chai_song@关键字：间歇性外斜视；斜视矫正；斜视类型；近立体视；眼位回退；斜视度；斜视术后。

图书分类号：R246.82。

Abstract ：Objective：Analysis the influence factors of eye position return after surgery in patients with intermittent exotropia. Methods：To measure the eye position of 65 patients with intermittent exotropia who had received the surgery since 2012-12 to 2013-12 at first day and one week after surgery. 52 of 65 patients ware followed up for 3-13 months, the amount of the eye position return was measured and influence factors were analyzed. Results：The eye position was found returned 1.78PD at the one week after operation in the 65 patients. During the follow-up the mean amount of regression was approximately 7.654±6.7574PD in the 52 patients. The mean amount of regression in the patients preoperative who had no near stereoscopic was found less than the patients who had near stereoscopic. The patients with lack of collection type regressed more than in the patients with basic type. The eye position returned more in the patients with esophoria than in the patients with exotropia at first day after surgery. The linear relationship was found in eye position between the firstday and long-term.Conclusions：The amount of eye position return in the intermittent exotropia patients was found correlated with the eye position at the first day, preoperative near stereoscopic, type of exotropia, and no relationship with age, sex, family history, age of onset, refractive status, length of eye, strabismus angle, binocular visual, anesthesia, operation method.Key words：Intermittent exotropia; Type of exotropia; Eye position return; Near stereopsis间歇性外斜视介于外隐斜与恒定性外斜视之间，是中高度的外隐斜，在精神不集中、疲劳和长时间近距离阅读后转变成显性外斜视，相对于高加索人，亚洲人的患病率更高[1-2]，约占外斜视中的80%。