【摘要】 探讨弱视综合训练治疗不同年龄儿童弱视效果分析。方法：对196例347眼弱视眼进行综合治疗，3～11岁弱视儿童用10g/L阿托品眼膏进行散瞳检影，11岁以上的儿童进行复方托品卡胺眼液点眼进行散瞳检影验光，复检后配戴合适眼镜，进行弱视综合治疗。结果：在本组病例中从弱视程度与疗效比较，弱视的基本治愈率为70.0%;从患儿治疗弱视的年龄与疗效的比较，基本治愈率为75.5%;从屈光性质与疗效的比较，弱视基本治愈率为78.4%;从患儿坚持治疗的时间与疗效的比较，弱视基本治愈率为61.4%。结论：综合疗法的疗效与弱视的类型、程度、年龄及坚持治疗时间密切相关,治疗时间越早、弱视程度越轻、坚持治疗时间越长，疗效越好。
【关键词】 综合疗法;弱视;疗效
Analysis of curative effect of comprehensive therapy on children amblyopiaing Xie, LinYing Xie,Ying LuoDepartment of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000， Jiangxi Province, ChinaAbstractAIM:To search the effect of synthesis treatment for children amblyopia of different ages. METHODS: A total of 347 eyes of 196 children were conducted the comprehensive therapy.Retinoscopy optometry was conducted after mydriasis by 10g/L Atropine on amblyopia children aged 3 to 11 years, retinoscopy optometry was conducted after mydriasis by compound tropicamide on amblyopia children aged over 11 years, and then the comprehensive amblyopia therapy was conducted to those who fitted for eyeglasses after reexamined.RESULTS: The basic amblyopia cure rate was 70.0% by the comparison between amblyopia degree and curative effect in this group. The basic amblyopia cure rate was 75.5% by the comparison between the age of amblyopia children and curative effect. The basic amblyopia cure rate was 78.4% by the comparison between refractive status and curative effect. The basic amblyopia cure rate was 61.4% by the comparison between adherence to treatment time and curative effect.CONCLUSION: The curative effect of the synthesis treatment has a close relationship with the amblyopia type, degree, age and adherence to treatment time.The earlier it begins, the lighter the amblyopia degree is, the longer the adherence to treatment time is, the better the curative effect would be.
KEYWORDS: comprehensive therapy; amblyopia; curative effect
0 引言
弱视是一种严重妨碍儿童视觉发育的眼病,常伴有斜视、屈光参差或屈光不正。弱视是儿童时期较常见的视觉发育相关性眼病，但眼部无明显器质性病变，以功能性因素为主所引起的远视力≤0.8且不能矫正 [1]。弱视的发病率为1.6%～3.6%,在医疗条件缺乏地区则更高[2]。我国的儿童弱视发病率为2.43%[3]。我们总结了近年来用综合疗法治疗各类儿童弱视196例347眼，取得较好的治疗效果，并随诊3a以上，现将疗效分析如下。
1 对象和方法
1.1 对象
儿童弱视患者196例347眼，其中男102例，女94例;年龄3～15(平均6.7)岁，其中3～6岁者264眼，7～11岁者73眼，12～15岁者10眼;屈光不正性弱视248眼，屈光参差性弱视54眼，斜视性弱视45眼;中心注视性弱视312眼，旁中心注视性弱视35眼;轻度弱视(0.6～0.8)133眼，中度弱视(0.2～0.5)178眼，重度弱视(≤0.1)36眼;坚持治疗3～6mo者89眼，7～12mo者124眼，13～18mo者134眼。所有患者眼前节、眼球运动、眼底基本正常，神经系统异常。
1.2 方法
全部病例经眼科常规查眼前节、眼位、眼底, 同视机查双眼单视立体功能, 排除器质性病变。10g/L阿托品眼膏3次/d,连续3d涂眼后, 检影确定屈光状态, 1mo后复查视力、眼位等。11 岁以上儿童采用复方托品卡胺眼液散瞳验光,每5min 1次，共5次，30min后再次验光，第2d复检。对屈光不正性弱视和屈光参差性弱视需要配戴合适的眼镜矫正，一般远视内斜视给足矫, 外斜视欠矫; 近视内斜视欠矫,外斜视全矫,散光给全矫。在戴镜后给予综合弱视治疗：(1)遮盖法：根据患儿的弱视的程度和年龄大小选择严格遮盖或间断遮盖,每0.5～1mo复诊一次。对双眼弱视患儿可每眼各3d交替遮盖，同时要注意防止遮盖性弱视的发生;对单眼弱视患儿可遮盖健眼，采用6∶1，4∶2，3∶3等进行遮盖;(2)精细目力训练：采用穿针、穿珠子、描红、拼图等;(3)仪器法训练：对有旁中心注视的患儿可采用海丁格刷、后像治疗。联合应用红光闪烁仪、CAM，图标类增视精细目力训练，1次/d，10～20min/次。(4)阿托品压抑疗法：是对遮盖疗法依从性不好者的替代选择，或者作为遮盖疗法的维持治疗和巩固疗法。是作为轻、中度弱视(视力>0.2)的首选治疗。阿托品压抑疗法则有更高的依从性和更强的接受性，并且受压抑的健眼仍能接受低频视觉信号，因此较少引起遮盖性弱视。疗效评价标准：根据1996年中华眼科学会全国儿童弱视斜视防治学组的弱视治疗评价[1]: 无效: 视力退步、不变或仅提高1行者;进步:视力增进2行及2行以上者;基本痊愈: 视力恢复到≥0.9者;痊愈: 经过3a随访,视力保持正常者。
统计学分析：采用SPSS 14.0统计软件包进行分析，计数资料比较采用χ2 检验，以P<0.05为有显著性差异。
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