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目的观察儿童高度屈光参差性弱视患者接受LASIK后立体视觉的恢复情况及其矫治儿童高度屈光参差性弱视的疗效。设计前瞻性非随机自身对照观察。研究对象36例36眼行LASIK手术的6～12岁高度屈光参差性弱视儿童患者。方法患者在LASIK术前、术后3、6及12个月检查视力、屈光度,采用颜氏立体视觉检查图检查立体视觉。立体视锐度≤60″为有中央立体视;80″～800″为有周边立体视;>800″为立体视盲。按最佳矫正视力分为轻、中、重度弱视三组。主要指标立体视锐度。结果 LASIK术后12个月裸眼视力、最佳矫正视力、屈光参差程度较术前均明显改善(P均<0.05)。术前、术后6个月和术后12个月立体视盲分别占55.6%(20例)、33.3%(12例)和16.7%(6例)(P均<0.05)。术后12个月轻度弱视组100%恢复了立体视,其中40.0%(8例)恢复了中央立体视;中度弱视组有10.0%(1例)恢复了中央立体视,70.0%(7例)恢复了周边立体视;而重度弱视组仅33.3%(2例)恢复了周边立体视(P均<0.05)。术后12个月,年龄<10岁者与≥10岁者分别有89.5%、76.5%恢复了立体视(P=0.351)。结论屈光参差性弱视儿童立体视建立与弱视程度、弱视治疗时间有关。对于不能耐受戴镜矫正的严重屈光参差性弱视患儿,LASIK手术是一种安全、有效的治疗手段,术后可能恢复正常或部分立体视。
Objective To observe the recovery of stereopsis after LASIK in children with high anisometropic amblyopia and its effect on correction of children with high anisometropic amblyopia. Design prospective non-random self-control observation. Thirty-six patients (36 eyes) with high anisometropic amblyopia who underwent LASIK surgery from 6 to 12 years old were included in this study. Methods Patients underwent visual acuity and refraction at 3, 6 and 12 months after LASIK, and stereopsis was examined by Yan’s stereoscopic examination. Stereoscopic sharpness ≤ 60 “for the central stereopsis; 80” ~ 800 “for the surrounding stereopsis;> 800” stereopsis. According to the best corrected visual acuity into light, moderate and severe amblyopia three groups. The main indicators of stereoscopic sharpness. Results The uncorrected visual acuity, best corrected visual acuity and anisometropia were significantly improved 12 months after LASIK (all P <0.05). There were 55.6% (20 cases), 33.3% (12 cases) and 16.7% (6 cases) of preoperative, postoperative 6 months and postoperative 12 months respectively (all P <0.05). In 12 months after operation, 100% of mild amblyopia patients recovered stereopsis, of which 40.0% (8 cases) recovered central stereopsis; 10.0% (1 case) of moderate amblyopia recovered central stereopsis, 70.0% (7) Cases) restored peripheral stereopsis; and severe amblyopia group only 33.3% (2 cases) restored peripheral stereopsis (P all <0.05). At 12 months after operation, 89.5% of patients <10 years old and ≥10 years old, respectively, and 76.5% recovered stereopsis (P = 0.351). Conclusion The establishment of stereopsis in children with anisometropic amblyopia is related to the degree of amblyopia and the time of amblyopia treatment. LASIK surgery is a safe and effective treatment for children with severe anisometropic amblyopia who can not tolerate wearing glasses and may resume normal or partial stereopsis after surgery.