分開不足患者治療前后水平掃視速度特點的研究
發(fā)布時間：2019-06-05 03:31
【摘要】：目的:結(jié)合分開不足的臨床特點,通過對患者組與正常健康組水平掃視速度特點對比結(jié)果的分析,對本病的治療效果進行評價,從而提高對本病的認(rèn)識。方法:本研究為回顧性研究,研究對象為連續(xù)收集的2014年10月至2016年3月在天津市眼科醫(yī)院確診并接受治療的15例“分開不足”患者做為患者組(P組),共30只眼;將隨機選取的16例正常人,共32只眼作為對照組(N組)。使用紅外眼動儀對兩眼先后進行測量并記錄各組外轉(zhuǎn)、內(nèi)轉(zhuǎn)10°、20°時水平掃視速度的數(shù)據(jù),將收集的紅外眼動數(shù)據(jù)進行數(shù)據(jù)格式轉(zhuǎn)換后導(dǎo)入Metlab數(shù)據(jù)處理軟件繼而進行數(shù)據(jù)的離線篩選和處理。結(jié)合治療前后詳細(xì)的臨床資料,觀察項目包括發(fā)病年齡、頭顱MRI、CT檢查,治療前后的臨床表現(xiàn)及不同注視角度時水平掃視平均峰值速度,通過分別比較兩組(N組、P組)不同水平運動注視角度條件下平均峰值速度,以及比較患者組治療前(P1組)后(P2組)平均峰值速度,對本病的治療效果進行評價。所有患者隨訪時間為3個月~2年,平均為7.3個月。所有統(tǒng)計學(xué)分析均使用SPSS 11.5統(tǒng)計軟件分析處理。峰值速度組間進行兩獨立樣本t檢驗,組內(nèi)峰值速度進行配對t檢驗,均以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1.15例患者術(shù)前均僅于視遠(yuǎn)時出現(xiàn)同側(cè)復(fù)視,且各方向復(fù)視像距離無明顯差異。6例患者緩慢起病,9例患者急性起病且癥狀較為穩(wěn)定。1例患者有Miller-Fisher綜合征病史,2例患者有高血壓病史,1例患者有安眠類藥物攝入3個月史,行神經(jīng)科會診及頭顱MRI、CT檢查均回報未見明顯異常。術(shù)前內(nèi)斜度5m:+14PD~+40PD,33cm:+6PD~+25PD。分開性融合范圍為:-1°~-4°,平均-2.5°;集合性融合范圍為:+6°~+21°,平均+11.9°。近立體視范圍為:60"~3000",平均733.3"。AC/A值范圍為0.7-4.0,平均2.5。行手術(shù)治療患者14例(共15只眼),外直肌手術(shù)縮短量為4.0~7.5mm;在屈光矯正基礎(chǔ)上加配三棱鏡矯正患者1例。治療后2例患者在術(shù)后第6周裸眼時出現(xiàn)短暫的視遠(yuǎn)復(fù)視,但戴鏡后復(fù)視癥狀消失;3例視近時出現(xiàn)視物疲勞癥狀,其余患者復(fù)視癥狀均消失且未見明顯眼部不適癥狀;術(shù)后末次隨訪結(jié)果為:斜視度數(shù)5m:-4PD~+8PD,33cm:-8PD~+6PD。分開性融合范圍為:-2°~-5°,平均-3.0°;集合性融合范圍為:+10°~+24°,平均+16.8°。近立體視范圍為:40"~800",平均243.3"。AC/A值范圍為1.3-5.0,平均3.1。2.患者組治療前(P1組)與對照組(N組)相比,相同眼球運動注視角度條件下,內(nèi)、外轉(zhuǎn)時P1組平均峰值速度均較N組低,但P0.05,差異無統(tǒng)計學(xué)意義。治療前患者組(P1組)與末次隨訪患者組(P2組)相比,外轉(zhuǎn)、內(nèi)轉(zhuǎn)10°時的平均峰值速度P2組較P1組有改善,但P0.05差異無統(tǒng)計學(xué)差異;外轉(zhuǎn)、內(nèi)轉(zhuǎn)20°時的平均峰值速度P2組較P1組有改善且P0.05,差異有統(tǒng)計學(xué)意義。結(jié)論:1.分開不足患者組水平掃視外轉(zhuǎn)10°、20°時的平均峰值速度與正常健康人組相比有差異,但差異無統(tǒng)計學(xué)意義,支持分開不足是不同于展神經(jīng)麻痹的一種獨立疾病。2.手術(shù)量為4.0~7.5mm的外直肌加強手術(shù)對消除復(fù)視,矯正14PD~40PD視遠(yuǎn)性內(nèi)斜視,改善雙眼視功能具有較好的療效。3.手術(shù)治療可以提高患者雙眼眼球水平掃視速度且外轉(zhuǎn)20°注視角度時掃視速度提高更顯著。
[Abstract]:Objective: To evaluate the treatment effect of the disease by analyzing the characteristics of the horizontal saccade velocity of the patient group and the normal healthy group, and to improve the understanding of the disease. Methods: This study was a retrospective study. The subjects of the study were continuously collected from October 2014 to March 2016, and 15 patients with "to be separated from each other" who were diagnosed and treated in the Eye Hospital of Tianjin were treated as the patient group (P group) in 30 eyes, and the randomly selected 16 normal persons were randomly selected. A total of 32 eyes were treated as control group (N group). And the data of the horizontal glance speed at the time of the external rotation, the internal rotation of 10 degrees and the 20 degrees of each group are recorded by using an infrared eye movement instrument, and the collected infrared eye movement data is converted into a Metlab data processing software and then subjected to offline screening and processing of the data. Combined with the detailed clinical data before and after treatment, the observation items included the age of the onset, the MRI of the head, the CT examination, the clinical manifestation before and after the treatment and the average peak velocity of the horizontal saccade at different fixation angles, and by comparing the two groups (N groups, The mean peak velocity of P (P group) at different levels was observed, and the mean peak velocity of the (P2) group was compared with that of the patients before and after treatment (group P1), and the treatment effect of the disease was evaluated. The follow-up time of all patients was 3 months to 2 years, with an average of 7.3 months. All statistical analyses were processed using the SPSS 11.5 statistical software. The peak velocity of the group was tested by t-test and the peak velocity in the group was paired t-test, which was statistically significant with the difference of P0.05. Results:1.15 patients had the same ipsilateral diplopia before operation. in 1 case, there were a history of Miller-Fisher's syndrome,2 had a medical history of hypertension,1 patient had a history of 3-month intake of sleep-type drugs, a neurology consultation and a head MRI, There was no obvious abnormality in the return of CT examination. The preoperative slope was 5 m: + 14PD + 40PD, 33cm: + 6PD + 25PD. The range of the separation fusion is: -1 擄 ~ -4 擄, mean-2.5 擄; the range of the combined fusion is + 6 擄 ~ + 21 擄, and the mean + 11.9 擄. The near-stereoscopic range is:60 "~ 3000", with an average of 733.3 ". The AC/ A value ranges from 0.7 to 4.0, averaging 2.5. 14 patients (15 eyes) were treated with operation, and the reduction of the external rectus muscle was 4.0-7.5 mm, and one case was treated with three-prism correction on the basis of refractive correction. After the treatment, two patients had a short visual and diplopia at the 6-week open-hole, but the symptoms of diplopia disappeared after the wearing of the lens; the symptoms of visual fatigue appeared in 3 cases, and the symptoms of the rest of the patients disappeared without obvious ocular discomfort; the result of the last follow-up was as follows: the degree of strabismus was 5 m: -4PD ~ + 8PD, 33cm:-8PD ~ + 6PD. The range of the separation fusion is: -2 擄 ~ -5 擄, average-3.0 擄; the range of the combined fusion is + 10 擄 ~ + 24 擄, and the mean + 16.8 擄. The near-stereoscopic range is:40" to 800 ", average 243.3". The AC/ A value range is 1.3-5.0, average 3.1.2. Compared with the control group (group N), the average peak velocity of P1 group was lower in the first group (group P1) than in the control group (group N), but the mean peak velocity of P1 group was lower than that of the control group (P <0.05). The mean peak velocity in the first group (P1 group) and the last follow-up group (group P2) was improved in the first group (group P1) compared with that of the last follow-up group (group P2). The difference is of statistical significance. Conclusion:1. The average peak velocity at 20 擄 was different from that of the normal control group, but the difference was not statistically significant, and the support of the separation was different from that of the normal control group. The operation amount was 4.0 ~ 7.5mm, the external rectus muscle strengthening operation was effective in eliminating diplopia, correcting 14PD-40PD, and improving the binocular vision function. The operation treatment can improve the glance speed of the eyes of the patients and the glance speed is improved more remarkably when the eyes of the two eyes are rotated by 20 degrees.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R777.41
本文編號：2493224
[Abstract]:Objective: To evaluate the treatment effect of the disease by analyzing the characteristics of the horizontal saccade velocity of the patient group and the normal healthy group, and to improve the understanding of the disease. Methods: This study was a retrospective study. The subjects of the study were continuously collected from October 2014 to March 2016, and 15 patients with "to be separated from each other" who were diagnosed and treated in the Eye Hospital of Tianjin were treated as the patient group (P group) in 30 eyes, and the randomly selected 16 normal persons were randomly selected. A total of 32 eyes were treated as control group (N group). And the data of the horizontal glance speed at the time of the external rotation, the internal rotation of 10 degrees and the 20 degrees of each group are recorded by using an infrared eye movement instrument, and the collected infrared eye movement data is converted into a Metlab data processing software and then subjected to offline screening and processing of the data. Combined with the detailed clinical data before and after treatment, the observation items included the age of the onset, the MRI of the head, the CT examination, the clinical manifestation before and after the treatment and the average peak velocity of the horizontal saccade at different fixation angles, and by comparing the two groups (N groups, The mean peak velocity of P (P group) at different levels was observed, and the mean peak velocity of the (P2) group was compared with that of the patients before and after treatment (group P1), and the treatment effect of the disease was evaluated. The follow-up time of all patients was 3 months to 2 years, with an average of 7.3 months. All statistical analyses were processed using the SPSS 11.5 statistical software. The peak velocity of the group was tested by t-test and the peak velocity in the group was paired t-test, which was statistically significant with the difference of P0.05. Results:1.15 patients had the same ipsilateral diplopia before operation. in 1 case, there were a history of Miller-Fisher's syndrome,2 had a medical history of hypertension,1 patient had a history of 3-month intake of sleep-type drugs, a neurology consultation and a head MRI, There was no obvious abnormality in the return of CT examination. The preoperative slope was 5 m: + 14PD + 40PD, 33cm: + 6PD + 25PD. The range of the separation fusion is: -1 擄 ~ -4 擄, mean-2.5 擄; the range of the combined fusion is + 6 擄 ~ + 21 擄, and the mean + 11.9 擄. The near-stereoscopic range is:60 "~ 3000", with an average of 733.3 ". The AC/ A value ranges from 0.7 to 4.0, averaging 2.5. 14 patients (15 eyes) were treated with operation, and the reduction of the external rectus muscle was 4.0-7.5 mm, and one case was treated with three-prism correction on the basis of refractive correction. After the treatment, two patients had a short visual and diplopia at the 6-week open-hole, but the symptoms of diplopia disappeared after the wearing of the lens; the symptoms of visual fatigue appeared in 3 cases, and the symptoms of the rest of the patients disappeared without obvious ocular discomfort; the result of the last follow-up was as follows: the degree of strabismus was 5 m: -4PD ~ + 8PD, 33cm:-8PD ~ + 6PD. The range of the separation fusion is: -2 擄 ~ -5 擄, average-3.0 擄; the range of the combined fusion is + 10 擄 ~ + 24 擄, and the mean + 16.8 擄. The near-stereoscopic range is:40" to 800 ", average 243.3". The AC/ A value range is 1.3-5.0, average 3.1.2. Compared with the control group (group N), the average peak velocity of P1 group was lower in the first group (group P1) than in the control group (group N), but the mean peak velocity of P1 group was lower than that of the control group (P <0.05). The mean peak velocity in the first group (P1 group) and the last follow-up group (group P2) was improved in the first group (group P1) compared with that of the last follow-up group (group P2). The difference is of statistical significance. Conclusion:1. The average peak velocity at 20 擄 was different from that of the normal control group, but the difference was not statistically significant, and the support of the separation was different from that of the normal control group. The operation amount was 4.0 ~ 7.5mm, the external rectus muscle strengthening operation was effective in eliminating diplopia, correcting 14PD-40PD, and improving the binocular vision function. The operation treatment can improve the glance speed of the eyes of the patients and the glance speed is improved more remarkably when the eyes of the two eyes are rotated by 20 degrees.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R777.41
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