Li X T, He S Y, Wang J, Liu Y, Liang Y M, Zhang W
Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China.
Institute of Modern Optics, Nankai University, Tianjin 300350, China.
Zhonghua Yan Ke Za Zhi. 2025 Aug 11;61(8):618-625. doi: 10.3760/cma.j.cn112142-20241009-00439.
To investigate the accuracy of the gaze-tilt test in predicting the postoperative head posture improvement in patients with congenital superior oblique palsy (CSOP). A diagnostic test was conducted, enrolling children aged 3 to 6 years diagnosed with unilateral CSOP and scheduled for unilateral inferior oblique weakening surgery at Tianjin Eye Hospital between May 2023 and January 2024. Preoperatively, the single eye cover test and the gaze-tilt test were used to assess the patients' compensatory head posture improvement. The overall predictive accuracy, predictive accuracy for different head position improvement outcomes, and error rates (false positive rate and false negative rate) of the two methods were compared by evaluating the predicted outcomes against the actual head postures at postoperative day 1 and month 1. The paired -test, paired Wilcoxon signed-rank test, and paired chi-square test were used for statistical analysis. Thirty-two children were included in the final analysis, consisting of 17 males and 15 females. The preoperative head tilt angle was 77.50°(75.00°, 80.75°). The head tilt angles at postoperative day 1 and month 1 were 88.00°(82.64°, 89.99°) and 88.90°(87.35°, 90.00°), respectively. The gaze-tilt test predicted the postoperative head position tilt angle of 87.00°(86.00°, 89.07°), which was significantly different from the angle of 83.00°(80.27°, 87.30°) predicted by the single eye cover test (<0.05). Compared with the actual tilt position angle on postoperative day 1, the gaze-tilt test showed no statistically significant difference (>0.05), but the single eye cover test showed significant difference (<0.05). The predictive accuracy of the complete head position improvement was significantly higher for the gaze-tilt test [postoperative day 1: 86.36%(19/22), postoperative month 1: 81.48% (22/27)] compared to the single eye cover test [postoperative day 1: 50.00% (11/22), postoperative month 1: 44.44% (12/27)] (both <0.05). The false negative rate of the gaze-tilt test was lower than that of the single eye cover test. The prediction error of the gaze-tilt test (postoperative day 1:-0.53°±4.17°, postoperative month 1: 1.67°±4.26°) was smaller than that of the single eye cover test (postoperative day 1: 2.81°±4.61°, postoperative month 1: 5.01°±4.90°), with statistically significant differences (both <0.05). Compared to the single eye cover test, the gaze-tilt test demonstrated higher accuracy and smaller predictive errors in predicting the postoperative head posture improvement in patients with CSOP.
探讨注视-倾斜试验预测先天性上斜肌麻痹（CSOP）患者术后头部姿势改善情况的准确性。进行了一项诊断试验，纳入2023年5月至2024年1月期间在天津眼科医院诊断为单侧CSOP且计划行单侧下斜肌减弱手术的3至6岁儿童。术前，采用单眼遮盖试验和注视-倾斜试验评估患者代偿性头部姿势的改善情况。通过将术后第1天和第1个月的预测结果与实际头部姿势进行对比，比较两种方法的总体预测准确性、不同头部位置改善结果的预测准确性以及错误率（假阳性率和假阴性率）。采用配对t检验、配对Wilcoxon符号秩检验和配对卡方检验进行统计分析。最终纳入分析的32名儿童中，男性17名，女性15名。术前头部倾斜角度为77.50°（75.00°，80.75°）。术后第1天和第1个月的头部倾斜角度分别为88.00°（82.64°，89.99°）和88.90°（87.35°，90.00°）。注视-倾斜试验预测的术后头部位置倾斜角度为87.00°（86.00°，89.07°），与单眼遮盖试验预测的83.00°（80.27°，87.30°）角度有显著差异（<0.05）。与术后第1天的实际倾斜位置角度相比，注视-倾斜试验无统计学显著差异（>0.05），但单眼遮盖试验有显著差异（<0.05）。与单眼遮盖试验相比，注视-倾斜试验在预测CSOP患者术后头部姿势改善方面，完全头部位置改善的预测准确性显著更高[术后第1天：86.36%（19/22），术后第1个月：81.48%（22/27）] [单眼遮盖试验：术后第1天：50.00%（11/22），术后第1个月：44.44%（12/27）]（均<0.05）。注视-倾斜试验的假阴性率低于单眼遮盖试验。注视-倾斜试验的预测误差（术后第1天：-0.53°±4.17°，术后第1个月：1.67°±4.26°）小于单眼遮盖试验（术后第1天：2.81°±4.61°，术后第1个月：5.01°±4.90°），差异有统计学意义（均<0.05）。与单眼遮盖试验相比，注视-倾斜试验在预测CSOP患者术后头部姿势改善方面显示出更高的准确性和更小的预测误差。
