健眼点阿托品后提高弱视儿童眼罩遮盖的依从性

doi:10.3760/cma.j.cn115909-20190423-00119

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摘要目的：观察健眼点阿托品后能否提高患儿对眼罩遮盖的依从性，探寻解决眼罩遮盖依从性差的方法。方法：前瞻性研究。选取2015年2月至2017年2月期间在河南省濮阳市眼科医院就诊的初次配镜的单眼弱视儿童136例，弱视眼戴镜视力≤0.3，年龄7～9岁。在讲明2种方法的优缺点之后依据家长自愿选择的原则，根据遮盖治疗方式分为观察组（68例）和对照组（68例）：观察组在每天用眼罩遮盖不少于6 h的基础上联合浓度为1%的阿托品凝胶每周一和周三晚上各点1次健眼；对照组每天只用眼罩遮盖不少于6 h。让家长及老师密切观察眼罩摘戴情况，在3、6、12个月时分别对比2组眼罩遮盖依从性的良好率及视力提高行数，采用卡方检验和独立样本t检验进行数据统计学分析。结果：治疗3、6、12个月，观察组患者治疗依从性（94%、87%、78%）与对照组（75%、 65%、57%）差异有统计学意义（χ2 =9.517，P=0.002；χ2 =9.003，P=0.002；χ2 =6.585，P=0.010）；观察组治疗有效率（44%、63%、76%）与对照组（28%、43%、59%）比较差异有统计学意义（χ2 =3.860， P=0.049；χ2 =5.785，P=0.016；χ2 =4.838，P=0.028）；治疗前观察组和对照组弱视眼矫正视力分别为 0.77±0.19和0.72±0.21，差异无统计学意义（t=0.663，P=0.607）；3、6、12个月时患者弱视眼矫正视力观察组均优于对照组（t=-2.355，P=0.011；t=-3.619，P=0.002；t=-4.922，P<0.001）。治疗12个月，观察组和对照组总治愈率分别为56%和38%，差异有统计学意义（χ2 =4.250，P=0.039）；实际治愈率为72%和67%，差异无统计学意义（χ2 =0.269，P=0.604）。结论：对于需要遮盖治疗的弱视患者给予1% 阿托品凝胶点健眼辅助后，眼罩遮盖依从性和有效率显著提高，总治愈率明显优于单纯遮盖者。

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关键词 ：健眼, 依从性, 阿托品, 眼罩遮盖

Abstract：Objective: To observe whether healthy eye treated with atropine can improve children's compliance with eye occlusion. Methods: This was a prospective study. From February 2015 to February 2017, 136 eyes of 136 amblyopic children aged 7 to 9 years who were treated in Puyang Eye Hospital and were prescribed glasses for the first time, with a corrected vision of ≤0.3 in amblyopia, and whose age met the criteria for cover therapy were selected. The data from three months, six months and one year after treatment were statistically analyzed. During the observation period, the patients were divided into two groups based on the occlusion treatment method: the observation group (group A, 68 cases) was covered with an eyepatch for not less than 6 hours per day on the basis of atropine's healthy eyes on Mondays and Wednesdays. The control group (group B, 68 cases) was simply covered with an eye patch for not less than 6 hours per day. Parents and teachers were asked to closely observe the removal and wearing of the blindfolds and compare the compliance and improvement of visual acuity of the two groups after three months, six months and one year. Chi-square test and independent t test were used. Results: The treatment compliances of group A (94%, 87%, 78%) and group B (75%, 65%, 57%) were significantly different (χ2 =9.517, P=0.002; χ2 =9.003, P=0.002; χ2 =6.585, P=0.010). The effective treatment rate for group A (44%, 63%, 76%) was significantly different from group B (28%, 12%, 59%)(χ2 =3.860, P=0.049; χ2 =5.785, P=0.016; χ2 =4.838, P=0.028). The corrected visual acuity of amblyopia in group A was better than that in group B 3, 6, 12 months after treatment (t=-2.355, P=0.011; t=-3.619, P=0.002; t=-4.922, P<0.001). One year later, the total cure rates for group A and group B were 56% and 38%, which were statistically significant (χ2 =4.250, P=0.039). The actual cure rates were 72% and 67% which were not statistically significant (χ2 =0.269, P=0.604). Conclusions: For amblyopia patients who need occlusiontherapy, atropine can significantly improve compliance and the effectivityrate, and the total cure rate is significantly better than that of simple occlusion.

Key words： dominant eye compliance atropine blinkers eyeshade occlusion

收稿日期: 2019-04-23

通讯作者: 王华德（ORCID：0000-0002-5416-7741），Email：2236362771@qq.com

引用本文:

王华德裴晓娜沈兰魏琳. 健眼点阿托品后提高弱视儿童眼罩遮盖的依从性[J]. 中华眼视光学与视觉科学杂志, 2020, 22(5): 374-378. Huade Wang, Xiaona Pei, Lan Shen, Lin Wei. Comparative Observation on Improving Eyeshade Covering Compliance after Atropine was Applied to Healthy Eyes. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(5): 374-378. DOI: 10.3760/cma.j.cn115909-20190423-00119

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20190423-00119 或 https://www.cjoovs.com/CN/Y2020/V22/I5/374

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