Schmucker Christine, Kleijnen Jos, Grosselfinger Robert, Riemsma Rob, Antes Gerd, Lange Stefan, Lagrèze Wolf
German Cochrane Center, Institute of Medical Biometry and Medical Informatics, Department of Medical Biometry and Statistics, University Hospital Freiburg, Freiburg, Germany.
Ophthalmic Epidemiol. 2010 Jan-Feb;17(1):7-17. doi: 10.3109/09286580903312301.
To evaluate the effectiveness of early in comparison to late(r) treatment in children with (1) amblyopia or (2) its risk factors, such as refractive errors and strabismus.
Eight bibliographic databases were searched with no limitation to a specific year of publication or language. Studies including children and juveniles with amblyopia or its risk factors were considered for this review.
In total, five studies (three direct comparisons within one study; one indirect comparison between two studies) met the inclusion criteria. (1) Treatment of amblyopia: one comparison suggested that amblyopia treatment in preschool children is more effective than treatment later in life. However, a subgroup analysis of children who have never received any treatment indicated that patching may also have an effect after the "sensitive phase." The second comparison showed that a delay in treatment until the age of 5 did not seem to influence effectiveness. (2) Treatment of amblyogenic risk factors: two comparisons showed that hyperopia treatment and strabismus surgery (outcome: remaining amblyopia) is more effective under 2 years of age than later in life. However, the studies showed methodological weaknesses (for example, a high loss to follow-up, unmasked outcome assessments) limiting the validity of their findings. The current literature does not provide data evaluating quality of life or school performance.
Uncertainties remain about the age at which treatment for amblyopia or its risk factors is most effective. Beside methodological limitations, the design of the studies made it challenging to address this question sufficiently.
评估早期治疗与晚期治疗相比，对患有（1）弱视或（2）其危险因素（如屈光不正和斜视）的儿童的有效性。
检索了八个文献数据库，对出版年份或语言没有特定限制。本综述纳入了包括患有弱视或其危险因素的儿童和青少年的研究。
共有五项研究（一项研究中有三项直接比较；两项研究之间有一项间接比较）符合纳入标准。（1）弱视治疗：一项比较表明，学龄前儿童的弱视治疗比成年后的治疗更有效。然而，对从未接受过任何治疗的儿童进行的亚组分析表明，在“敏感期”之后进行遮盖治疗也可能有效果。第二项比较表明，延迟到5岁治疗似乎并不影响疗效。（2）致弱视危险因素的治疗：两项比较表明，远视治疗和斜视手术（结果：残留弱视）在2岁以下进行比成年后更有效。然而，这些研究显示出方法学上的弱点（例如，随访失访率高、结果评估未设盲），限制了其研究结果的有效性。目前的文献没有提供评估生活质量或学业成绩的数据。
关于弱视或其危险因素最有效的治疗年龄仍存在不确定性。除了方法学上的局限性外，研究设计也使得充分解决这个问题具有挑战性。
