Therapeutic Effect of Comprehensive Therapy on Elder Children with Amblyopia_West China Medical Journal

Authors：

CHEN Bingjie ,  LIU Longqian

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Longqian, Email: mellrince@163.com

Keywords：

弱视; 大龄儿童; 综合疗法; 对比敏感度; 立体视锐度

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【摘要】　目的　观察综合疗法治疗大龄儿童弱视的疗效。　方法　回顾分析2008年1月-2010年10月在我院初诊并经综合治疗的8～13岁弱视儿童62例85只眼的临床资料。治疗前最佳矫正视力0.1~0.7，平均0.46±0.17。观察患者经弱视综合治疗后视力、空间对比敏感度及立体视提升效果。　结果　治疗后视力正常22例31只眼（36.5%），进步29例39只眼（45.9%），无效11例15只眼（17.6%）；总有效率82.4%，与治疗前相比，差异有统计学意义（P lt;0.001）。空间对比敏感度基本正常11例16只眼（18.8%），进步43例58只眼（68.2%），无效8例11只眼（12.9%）。弱视眼在1.5、3、6三个低空间频率的对比敏感度值与治疗前相比提升有统计学意义（P lt;0.001）；在12和18两个高空间频率，对比敏感度值与治疗前相比提升无统计学意义（P gt;0.05）。立体视锐度正常12例（19.4%），进步26例（41.9%），无效24例（38.7%），立体视锐度与治疗前相比提升具有统计学意义（P lt;0.001）。　结论　综合疗法治疗大龄儿童弱视能取得令人较为满意的疗效，患儿视力显著提升，低到中等频率空间对比敏感度及立体视锐度也有较大提升。
【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.

Citation： CHEN Bingjie,LIU Longqian. Therapeutic Effect of Comprehensive Therapy on Elder Children with Amblyopia. West China Medical Journal, 2011, 26(4): 568-571. doi: Copy

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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.
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1. 　中华医学会全国儿童弱视斜视防治学组. 弱视的定义、分类及疗效评价标准[J]. 中国斜视与小儿眼科杂志, 1996, 4(3): 97- 99.
2. 　刘家琦, 郭静秋. 弱视斜视临床与发病机理的研究[J]. 北京医科大学学报, 1992, 24(4): 289.
3. 　阴正勤. 弱视发病机制研究进展[J]. 中国斜视与小儿眼科杂志, 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. 　阴正勤, 余涛, 陈莉. 斜视性弱视猫发育过程视皮层神经元NMDA2R1表达的免疫组织化学电镜观察[J]. 中华眼科杂志, 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. 　黄佳, 瞿小妹, 薛枫. 视觉敏感期后弱视的可塑性研究进展[J]. 眼视光学杂志, 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.

West China Medical Journal

Therapeutic Effect of Comprehensive Therapy on Elder Children with Amblyopia

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