作者：王小莉,陈莉,任梅 作者单位：710004）中国陕西省西安市第四医院眼科
【摘要】 观察遮盖法治疗弱视的效果，同时分析不同遮盖时间、年龄差异、发病原因及弱视程度的疗效特点从而探讨其在弱视治疗中的临床意义。
【关键词】 弱视；全天遮盖法；遮盖法
Investigation of occlusion therapy for the treatment of amblyopia XiaoLi Wang, Li Chen, Mei Ren Department of Ophthalmology, the Fourth Hospital of Xian City, Xian 710004, Shaanxi Province, China Abstract AIM: To observe the effect of occlusion therapy for the treatment of amblyopia, and to analyze the time of occlusion, age, causes of disease and degrees of amblyopia and explore clinical significance of occlusion therapy for the treatment of amblyopia.
METHODS: In this retrospective study, 107 infants(143 eyes) who attended strabismus and amblyopia department of our hospital from July 2005 to July 2008, including 45 males(69 eyes) and 62 females(74 eyes),were included, and the average age was 5.3. Of them, there were 26 eyes with strabismic amblyopia, 37 eyes with anisometropic amblyopia, 80 eyes with ametropic amblyopia, 43 eyes with mild amblyopia, 81 eyes with midrange amblyopia and 19 eyes with severe amblyopia. The patients were divided into complete occlusion group, 4 hours occlusion group and correction group. The best corrected visual acuities, lines of vision improvement and recovery rate of amblyopia of the three groups were observed and recorded during the one year followup.
RESULTS: Visual acuities were improved 2.4 lines in occlusion group, 1.7 lines in correction group. Visual acuities were improved significantly in occlusion group compared with that in the control group (P<0.05). Recovery rate of visual acuities of 0.8 or higher was 11.5%(11 eyes) in occlusion group and 8.5%(4 eyes) in the control group, and the difference was significant between the two groups（P<0.05）.There was no significant difference between 4h occlusion group and complete occlusion group for the treatment of mild to moderate amblyopia, but the difference between 4 hours occlusion group and complete occlusion group for the treatment of severe amblyopia was significant（χ2=13.57,P<0.05）. Average visual acuities were 0.41, 0.56 and 0.67 in the 3rdmo，the 6thmonth and the 12thmonth in 4 hours occlusion group respectively, and were 0.38,0.68 and 0.72 in the 3rdmonth，the 6thmonth and the 12thmonth in complete occlusion group respectively. The visual acuity improved obviously in the 6thmonth in complete occlusion group compared with that in the 4 hours occlusion group, but the difference was not significant（χ2=2.0,P=0.60
CONCLUSION: Occlusion seems to be frequently used and effective for the treatment of amblyopia. Incontinuous occlusion can be used to treat mild or moderate amblyopia, and severe amblyopia can be treated by complete occlusion. The key of treatment seems to be keep the patients compliance.
KEYWORDS: amblyopia; fulltime occlusion; occlusion
方法：回顾性研究，自200506/200806就诊于我院斜弱视门诊患儿107例143眼，男（45例69眼），女（62例74眼）。平均年龄5.3岁，其中斜视性弱视26眼，屈光参差性弱视37眼,屈光不正性弱视80眼，轻度弱视43眼，中度弱视81眼，重度弱视19眼。根据治疗方法不同随机分组为完全遮盖组、4h遮盖组、单纯配镜矫正组。随访1a中观察并记录3组患儿最佳矫正视力，视力提高行数及弱视治愈率。
结果：遮盖组视力平均提高2.4行，单纯戴镜组视力平均提高1.7行，遮盖组较对照组视力提高明显(P<0.05)。视力提高达0.8以上治愈率为遮盖组（11眼，11.5%），对照组（4眼，8.5%），遮盖组治愈率明显高于对照组（P<0.05）。间断遮盖和全日遮盖两种方法对轻度和中度弱视组视力提高无统计学差异（轻度χ2=0.84,P=0.77；中度χ2=0.91,P=0.57），重度弱视组患者全日遮盖较间断遮盖视力明显提高（χ2=13.57,P<0.05）。间断遮盖４h组在3，6，12mo视力平均分别为0.41,0.56,0.67；全日遮盖组在3，6，12mo视力平均分别为0.38,0.68,0.72，其中第6mo全日遮盖组视力改善较间断遮盖组明显增高趋势但无统计学意义（χ2=2.0, P=0.60）。
结论：遮盖法是弱视治疗中常用且有效的治疗方法，对于轻中度弱视可采用间断遮盖的方法，重度弱视采用全天遮盖的方法，维持患者的依从性是治疗的关键。
0引言
弱视是视觉发育期，由于异常的视觉经验，造成单眼或双眼的最佳矫正视力低于正常，临床检查无可见的器质性病变，经恰当治疗后视力可以提高或完全恢复。弱视一直是造成儿童单眼视力损伤的重要原因[13]。其发病机制目前尚不明确主要认为是视觉发育早期，双眼视觉刺激的输入失去平衡的结果，其中占优势的为主眼，劣势者成为弱视眼，或者由于视觉剥夺所引起的单眼或双眼视力低下。在弱视的治疗中，遮盖法是临床上弱视治疗的常用方法, 已有200a以上的历史。尽管已有许多研究报道遮盖治疗可以改善弱视眼的视力[4]，但每日遮盖治疗的时间，即部分遮盖和全日遮盖哪个更有效，是很多学者一直争论的热点，同时对待屈光矫正眼镜治疗弱视和遮盖法治疗弱视两种方法的疗效分析亦缺少相关研究。我们自200506在门诊收集的弱视患者随机分入不同治疗组共143眼进行比较研究，旨在评价遮盖法在临床工作中的实际应用价值。
1对象和方法
1.1对象 回顾性研究，收集自200506/200806就诊于我院斜弱视门诊患儿107例143眼，男45例69眼，女62例74眼，年龄为3～7（平均5.3）岁。其中斜视性弱视26眼，屈光参差性弱视37眼，屈光不正性弱视80眼。轻度弱视43眼，中度弱视81眼，重度弱视19眼。根据治疗方法不同随机分组为完全遮盖组、4h遮盖组、单纯配镜矫正对照3组。随访1a中观察并记录3组患儿最佳矫正视力，视力提高行数及弱视治愈率。排除过去6mo内进行过弱视的治疗；目前正在进行斜视治疗；合并有造成视力减退的眼部疾病；近视度数≥6.00D；以前有过内眼及屈光手术史（表1）。
1.2方法 全部病例均散瞳验光, 配戴合适的矫正眼镜，根据视力、眼位、注视性质等情况每0.5～1a调整眼镜。本研究以家庭治疗为主, 每月医院复诊由医生指导治疗。遮盖组分为:(1)间断遮盖组：即每日仅遮盖4h，要求在写作业时遮盖，并联合至少1h精细训练，包括描图及穿针；(2)全日遮盖组：除晚上睡觉摘取眼罩外，余时间均遮盖弱视眼，根据患儿年龄选择不同遮盖比率（3 岁患儿连续遮盖4d，放开健眼1d；4～6岁患儿连续遮盖6d，放开健眼1d；7岁患儿连续遮盖1mo）。对照组仅配戴矫正眼镜，具体原则为：内斜患者中远视给予足矫；正位眼远视、近视下调0.50D配镜；外斜合并中、远视在±2.00D 范围内调整, 最佳视力戴镜, 近视给予足矫。本研究中弱视的治愈标准参考中华眼科学会全国儿童弱视斜视防治学组1987年制定的疗效评价标准。治愈后做双眼单视训练, 随访时间为1a以上。使用SPSS 13.0统计软件组内比较用paired ttest，组间比较ANOVA和unpaired ttest统计方法。
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