Repka Michael X, Holmes Jonathan M, Melia B Michele, Beck Roy W, Gearinger Matthew D, Tamkins Susanna M, Wheeler David T
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J AAPOS. 2005 Dec;9(6):542-5. doi: 10.1016/j.jaapos.2005.07.009.
We sought to describe the change in ocular alignment at 2 years after treatment of amblyopia in children younger than 7 years of age at enrollment.
A randomized clinical trial of patching versus atropine for 6 months followed by standard clinical care for 18 months was conducted in 357 children with anisometropic, strabismic, or combined amblyopia (20/40-20/100) whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment was evaluated at enrollment and after 2 years of follow-up.
At enrollment when tested at distance fixation, 161 (45%) children were orthotropic, 91 (25%) had a microtropia (1-8 Delta), and 105 (29%) had a heterotropia >8 Delta. Of the 161 patients with no strabismus, similar proportions of patients initially assigned to the patching and atropine groups developed new strabismus by 2 years (18% vs. 16%, P = 0.84). Of these cases of new strabismus, only 2 patients in the patching group and 3 patients in the atropine group developed a deviation that was greater than 8 Delta. Microtropia at enrollment progressed to a deviation greater than 8 Delta with similar frequency in both treatment groups (13% vs. 15%, P = 1.00). Of the 105 patients with strabismus greater than 8 Delta at enrollment, 13% of those in the patching group and 16% of those in the atropine group improved to orthotropia without strabismus surgery. Strabismus surgery was performed in 32 patients during the 2-year study period.
Patients who had amblyopia treatment with patching or atropine for 6 months followed by standard clinical care were found to have similar rates of deterioration and improvement of ocular alignment. When parents begin amblyopia treatment for children without strabismus, they should be warned of the possibility of development of strabismus, although it is most often a small angle deviation. Strabismus resolved after amblyopia therapy in some cases.
我们试图描述入组时年龄小于7岁的儿童弱视治疗2年后眼位的变化情况。
对357例屈光参差性、斜视性或混合性弱视（视力20/40 - 20/100）且入组时年龄在3至7岁以下的儿童进行了一项随机临床试验，其中一组采用遮盖疗法6个月，随后进行18个月的标准临床护理，另一组采用阿托品疗法6个月，随后进行18个月的标准临床护理。在入组时和随访2年后评估眼位。
在入组时进行远距离注视测试时，161例（45%）儿童眼位正常，91例（25%）有微小斜视（1 - 8棱镜度），105例（29%）有斜视度>8棱镜度的斜视。在161例无斜视的患者中，最初分配到遮盖组和阿托品组的患者在2年时出现新斜视的比例相似（18%对16%，P = 0.84）。在这些新斜视病例中，遮盖组仅有2例患者和阿托品组仅有3例患者出现的斜视度大于8棱镜度。入组时的微小斜视在两个治疗组中进展为斜视度大于8棱镜度的频率相似（13%对15%，P = 1.00）。在入组时斜视度大于8棱镜度的105例患者中，遮盖组13%的患者和阿托品组16%的患者在未进行斜视手术的情况下改善为眼位正常。在为期2年的研究期间，有3个2例患者接受了斜视手术。
接受6个月遮盖或阿托品弱视治疗并随后接受标准临床护理的患者，其眼位恶化和改善的发生率相似。当家长开始为无斜视的儿童进行弱视治疗时，应告知他们儿童有发生斜视的可能性，尽管大多数情况下是小角度偏差。在某些情况下，弱视治疗后斜视会得到解决。
