调节异常所致视力下降的临床分析

doi:10.3760/cma.j.issn.1674-845X.2018.09.006

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摘要

目的：观察调节异常所致远或近视力下降的临床特点及临床疗效。方法：回顾性系列病例研究。收集2014年2月至2016年2月因视力下降在中国人民解放军武汉总医院眼科就诊，经验光和视功能检查确诊的因调节异常导致视力下降的25例患者的临床资料，在屈光矫正的基础上联合睫状肌麻痹剂并行反转拍、调节交替训练和Brock线等视功能训练，分析其临床特点及治疗效果。采用配对t检验和Wilcoxon秩和检验进行统计分析。结果：①25例患者初诊时年龄6～24岁。4例外院诊断为“球后视神经炎”，1例外院配戴角膜塑形镜后效果欠佳就诊，2例准分子激光治疗近视术后视力下降，11例用眼过度后视力下降，7例仅因视力下降就诊。②疗效：基线裸眼远视力为4.19±0.34、等效球镜度（SE）为（-7.95±3.10）D、最佳矫正视力（BCVA）为4.28±0.32；21例给予托吡卡胺后SE为（-0.06±0.86）D、BCVA为4.43±0.15；14例应用阿托品凝胶后SE为（+1.24±0.84）D、BCVA为4.93±0.14。给予视功能训练3个月12次后，视功能项目指标较前改善，负相对调节（NRA）训练前后分别是+1.76±0.61、+2.49±0.15（t=-3.780，P<0.001），正相对调节（PRA）训练前后分别是-1.26±0.76、-2.43±0.34（t=3.977，P<0.001），调节灵敏度（Flipper拍）训练前后分别是0周/分（cpm）（负片通过困难）和10.6 cpm（Z=-4.012，P<0.001）。随访中矫正视力及屈光度未见变化。结论：对于排除眼部器质性疾病的视力下降患者，要重视视功能检查；对调节异常所致视力下降患者，在传统治疗的基础上，加用视功能训练，可使视力恢复并稳定。

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	常枫
	陈云辉
	陈晓
	李梅
	周萍
	周和政

关键词 ：调节异常, 视功能检查, 视功能训练

Abstract：

Objective: To observe binocular vision characteristics in the diagnosis and treatment of accommodative dysfunctional vision loss patients. Methods: In this retrospective study, 25 participants with accommodative dysfunctional vision loss were enrolled at the Ophthalmic Center, Wuhan General Hospital of the People's Liberation Army from February 2014 to February 2016. All patients had routine examinations that excluded eye disease, amblyopia risk factors, and systemic disease. Based on binocular vision characteristics, all patients participated in visual function examination and training. Each patient’s binocular vision was checked under cycloplegia to assess the effect of accommodative relaxation on visual acuity and binocular vision. All data were statistically analyzed with paired t-tests and Wilcoxon tests.results: Patients ranged in age from 6 to 24 years. Four patients were misdiagnosed as retrobulbar optic neuritis, one patient's symptom was poor uncorrected visual acuity (UCVA) after orthokeratology, two patients were referred to us because of blurred vision after femtosecond LASIK surgery, eleven patients' vision declined after overuse of eyes, seven patients complained of reduced distance vision only. The patients' baseline (25 cases) uncorrected visual acuity was 4.19±0.34, and the spherical equivalent (SE) was-7.95±3.10 diopter (D), the best corrected visual acuity (BCVA) was 4.28±0.32. After cycloplegia with tropicamide eyedrops (21 cases), the SE was -0.06±0.86 D, the BCVA was 4.43±0.15. After using atropine eye ointment (14 cases), the SE was +1.24±0.84 D, the BCVA was 4.93±0.14. After 3 months' vision training, visual function indexes improved. Negative relative accommodation before and after training was 1.76±0.61 D, 2.49±0.15 D (t=-3.780, P<0.001). Positive relative accommodation was -1.26±0.76 D,-2.43±0.34 D(t=3.977, P<0.001). Accommodative facility was 0 cycle/min (cpm), 10.6 cpm (Z=-4.012,P<0.001). BCVA and SE remained stable. conclusions: Patient functional vision loss was caused by accommodative abnormities. Upon basic treatments combined with visual function examination and training, visual acuity was improved and remained stable.

Key words： accommodative dysfunctional vision loss visual function examination visual function training

收稿日期: 2018-05-23

通讯作者: 常枫（ORCID：0000-0001-8259-7055），Email：wuhanmaple@126.com 周和政（ORCID：0000-0002-2695-7439），Email：zhoueye@qq.com

引用本文:

常枫,陈云辉,陈晓,李梅,周萍,周和政. 调节异常所致视力下降的临床分析[J]. 中华眼视光学与视觉科学杂志, 2018, 20(9): 541-545. Feng Chang,Yunhui Chen,Xiao Chen,Mei Li,Ping Zhou,Hezheng Zhou. Acquired Visual Loss Attributed to an Accommodative Dysfunction. Chinese Journal of Optometry Ophthalmology and Visual science, 2018, 20(9): 541-545. DOI: 10.3760/cma.j.issn.1674-845X.2018.09.006

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https://www.cjoovs.com/CN/ 10.3760/cma.j.issn.1674-845X.2018.09.006 或 https://www.cjoovs.com/CN/Y2018/V20/I9/541

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