Singh Anupam, Patnaik Nisheeta, Mittal Sanjeev K, Bhadoria Ajeet S, Panyala Rakesh, Samanta Ramanuj, Kumar Barun, Chawla Omna
Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2022 Feb 6;14(2):e21964. doi: 10.7759/cureus.21964. eCollection 2022 Feb.
The purpose of the present study was to determine the factors that affect the outcome of strabismus surgery in terms of improvement in stereopsis and binocularity.
Data were collected prospectively from patients with childhood-onset, concomitant, constant strabismus greater than 30 prism diopters (PD) with postoperative alignment within 10 PD. Pre- and postoperative stereopsis and binocularity testing were performed using the Titmus fly test, random dot test, Bagolini striated glass test, and Worth four dot test at one, four, and 12 weeks postoperatively.
A total of 73 patients (55% males and 45% females) who underwent surgery at our center were studied. The mean age at the time of surgery was 16 ± 7.7 years (range: 5-35 years). We found that factors such as age of strabismus onset, type of deviation, and amblyopia had a statistically significant influence on the postoperative surgical outcome. A statistically insignificant relationship was noted with gender, refractive error, and duration of strabismus. Patients who had strabismus after six months of age noticed a significant improvement in stereopsis (p-value = 0.000) than those who had strabismus before six months of age (pvalue = 0.660). Further, there was a statistically significant improvement in patients having exotropia (p-value = 0.018) or combined horizontal and vertical deviations (pvalue = 0.000), but there was no significant improvement in patients with esotropia (pvalue = 0.180). Moreover, non-amblyopes had a significantly better postoperative stereopsis than amblyopes (p-value = 0.006). Although there was no association between preoperative deviation and improvement in stereopsis (p-value = 0.081), patients having preoperative deviation in the range of 31-45 PD had a statistically significant improvement in stereopsis (p-value = 0.000). There was no significant difference between postoperative residual deviation and final stereopsis (p-value > 0.05). All the results were the same for both the Titmus test and the random dot test. Binocular fusion was observed in 34 subjects, and uniocular suppression was noted in 38 subjects preoperatively. It was observed that only one patient gained binocular single vision postoperatively.
The presence of amblyopia, esotropia, early onset of strabismus (within six months of age), and a larger preoperative deviation (>45 PD) were associated with poorer stereopsis. In patients with horizontal strabismus, the coexistence of vertical deviation had a positive impact on the postoperative stereopsis. Gender, refractive error, and duration of strabismus did not influence the final stereopsis in our study.
本研究的目的是确定在立体视和双眼视改善方面影响斜视手术结果的因素。
前瞻性收集患有儿童期发病、共同性、恒定斜视且斜视度数大于30棱镜度（PD）且术后眼位矫正至10 PD以内的患者的数据。术后1周、4周和12周使用Titmus飞点试验、随机点试验、Bagolini条纹镜试验和Worth四点试验进行术前和术后立体视及双眼视测试。
对在我们中心接受手术的73例患者（55%为男性，45%为女性）进行了研究。手术时的平均年龄为16±7.7岁（范围：5 - 35岁）。我们发现斜视发病年龄、斜视类型和弱视等因素对术后手术结果有统计学上的显著影响。性别、屈光不正和斜视持续时间与手术结果的关系无统计学意义。6个月后发病的斜视患者比6个月前发病的斜视患者立体视改善更显著（p值 = 0.000），而6个月前发病的斜视患者立体视改善不显著（p值 = 0.660）。此外，外斜视患者（p值 = 0.018）或水平与垂直混合性斜视患者（p值 = 0.000）术后立体视有统计学上的显著改善，而内斜视患者术后立体视无显著改善（p值 = 0.180）。而且，非弱视患者术后立体视明显优于弱视患者（ppp值 = 0.006）。虽然术前斜视度数与立体视改善之间无关联（p值 = 0.081），但术前斜视度数在31 - 45 PD范围内的患者立体视有统计学上的显著改善（p值 = 0.000）。术后残余斜视度数与最终立体视之间无显著差异（p值 > 0.05）。Titmus试验和随机点试验的所有结果相同。术前34例患者观察到双眼融合，38例患者存在单眼抑制。术后仅1例患者获得双眼单视。
弱视、内斜视、斜视早发（6个月内）和术前斜视度数较大（>45 PD）与较差的立体视相关。在水平斜视患者中，垂直斜视的共存对术后立体视有积极影响。在我们的研究中，性别、屈光不正和斜视持续时间不影响最终立体视。
