【摘要】 目的: 通过医院集中弱视训练与传统家庭弱视训练方法的比较，探讨医院集中训练模式对提高弱视训练的依从性和疗效的作用。方法:将3～11岁的门诊弱视儿童，根据中华医学会眼科学会儿童弱视斜视防治学组制定的弱视诊断、分类标准，经常规散瞳验光和矫正屈光不正，随机分为医院集中训练组和传统家庭训练组，采用精细目力训练、视觉刺激疗法(circular activate machine,CAM)、后像疗法等，比较两组疗效。平均治疗3～6mo，随访2a。结果:医院集中训练组100例173眼中，基本治愈136眼，进步33眼，无效4眼，总有效率97.7%。传统家庭训练组50例90眼中，基本治愈35眼，进步37眼，无效18眼，总有效率80.0%。两组总疗效比较(P<0.01),差异有极显著性。(1)弱视程度与疗效的比较：两组轻度、中度弱视之间的疗效比较(P<0.01),差异均有极显著性;医院集中训练组优于传统家庭训练组。两组重度弱视之间的疗效比较,差异无显著性。(2)弱视性质与疗效的比较：两组屈光不正性弱视的疗效比较、两组斜视性弱视的疗效比较(P<0.01),差异均有极显著性;两组屈光参差性弱视的疗效比较(P<0.05)，差异有显著性，集中训练组比家庭训练组疗效突出。(3)年龄与疗效的比较：两组3～6岁弱视的疗效比较、7～11岁弱视的疗效比较(P<0.05),差异均有极显著性，集中训练组比家庭训练组疗效突出。结论:医院集中训练模式对于治疗儿童弱视具有一定的优势，特别是从弱视程度，性质以及年龄上显示比传统家庭训练模式更为有效，这有助于提高弱视训练的依从性。
【关键词】 弱视;医院集中训练;依从性
Comparison of hospital intensive training and family training for amplyopiaXiaoQin Jin, Feng Xu, Xi Wu1 Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xiantao, Xiantao 433000, Hubei Province, China; 2 Department of Ophthalmology, the Peoples Hospital, Beijing University, Beijing 100044, ChinaAbstractAIM: To validate the compliance and efficacy in hospital intensive training by comparing hospital intensive training and family training.METHODS: Outpatients, aging from 3 to 11, diagnosed and sorted according to the standards made by Chinese Medical Association Children Amplyopia and Strabismus Prevention and Cure Group received mydriatic optometry and were remedied refractive error as routine, then randomly united into hospital intensive training group and family training group. We compared the efficacy after fine eyesight training, circular activate machine(CAM) stimalator and pleoptics therapies. The patients were treated for 36 months, followed by 2 years. RESULTS: We chose 173 eyes from 100 cases for the hospital intensive training group, of which 136 eyes recovered, 33 eyes improved, no efficacy for 7 eyes, the total effective rate was 97.7%. There were 90 eyes from 50 cases for the family training group, of which 35 eyes recovered, 37 eyes improved, no efficacy for 18 eyes, the total effective rate was 80.0%. There was significant difference between the two group(P<0.01). (1) Relations between severity and efficacy: the efficacy between the mild and moderate amplyopic subjects of the two groups were both significantly different(P<0.01); The efficacy for the severe amplyopic subjects of the two groups had no significant difference. (2) Relations between different sorts of amplyopia and efficacy: The efficacy of the refractive amplyopia and strabismic amplyopia had significant difference for both groups(P<0.01); There was difference for the anisometropic amplyopia of the two groups(P<0.05), and hospital intensive training group was better. (3) Relations between age and efficacy: There was significant difference for the 36 years old subjects and 711 years old subjects of the two teams(P<0.05), hospital intensive training had more advantages.CONCLUSION: Given amplyopic severity, sorts and age, hospital intensive training is more effective than family training and has more advantages. It is helpful in improving compliance of amplyopia training.
KEYWORDS: amplyopia; hospital intensive training; 0引言
弱视是造成儿童视力低下的最常见疾病。也是儿童可避免盲的研究对象。经典的弱视治疗方法主要包括准确矫正屈光不正以消除形觉剥夺，通过遮盖疗法来消除异常的双眼交互作用[1]，精细目力训练，则是让弱视儿童通过动手操作和目力训练达到视觉刺激和提高视力，缩短疗程的一种辅助治疗。但是，弱视治疗疗效与治疗过程中的依从性是密切相关的[2]。为了探讨提高弱视训练的依从性，近4a我们开展了医院集中训练模式并与传统家庭训练模式进行疗效分析比较，现报告如下。
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