儿童弱视经不同遮盖方法治疗前后视觉电生理的变化

Clinical observation of P-VEP before and after treatment in amblyopia children by different cover methods

摘要:

目的：应用图形视觉诱发电位检查评价不同遮盖方法在治疗弱视中的疗效。 方法：采用前瞻性研究方法从儿童视光专科门诊中选取年龄在3~6岁136例单眼弱视儿童，将其分为全日遮盖组69例和部分遮盖组67例，在准确屈光矫正基础上，分别每天遮盖健眼10h以上和遮盖健眼5h，并同时进行等量精细目力训练，分别于治疗后1mo和6mo对图形视觉诱发电位（P100波幅值及潜时）检测结果及视力提高程度进行分析。 结果:发现136例弱视患儿经过两种不同遮盖法治疗1mo后，全日遮盖组与治疗前相比P100波幅值增加、潜时缩短，差异有统计学意义（P<0.05）,部分遮盖组与治疗前相比P100波幅值、潜时差异无统计学意义（P>0.05），两组之间比较差异有统计学意义，两组视力提高程度：基本治愈率、进步率和总有效率差异有统计学意义（P<0.05），治疗6mo后，全日遮盖组与治疗前相比P100波幅值增加、潜时缩短，差异有统计学意义（P<0.05）。部分遮盖组与治疗前相比P100波幅值、潜时差异有统计学意义（P<0.05），两组之间比较差异无统计学意义（P>0.05），两组视力提高程度：基本治愈率、进步率和总有效率差异无统计学意义（P>0.05）。 结论：弱视经两种不同遮盖方法治疗后，早期全日遮盖组P100波幅值及潜时较治疗前得到改善，部分遮盖组较治疗前无明显变化，视力提高程度两组有差异，说明全日遮盖法治疗弱视近期疗效较部分遮盖法为佳，长期来看，两组P100波幅值及潜时无明显差异，两组视力提高结果分析无明显差异，进一步说明全日遮盖法与部分遮盖法长期疗效相同，说明弱视治疗过程中定期检测图形视觉诱发电位能评价治疗效果，从而指导下一步治疗。

Abstract:

AIM:To evaluate the effect of different cover methods in treatment of amblyopia with pattern visual evoked potential (P-VEP). METHODS:A prospective study was conducted with 136 monocularamblyopia children, aged 3-6 years old, selected from children optometry specialist out-patient. They were divided into covered group(69 cases) and partially covered group(67 cases), respectively. On the basis of accurate refractive correction, the healthy eye from each group was covered for 10, 5 hours per day, and at the same time, the same amount of fine eyesight training was conducted, respectively. P-VEP (P100 amplitude and potential) test results and visual acuity improvement were analyzed. RESULTS:One month after treatment, compared with before treatment, P100 amplitude increased and latency was shortened in full cover group, and the difference was statistically significant (P<0.05), while those differences in the partially covered group were not statistically significant (P>0.05), while the difference between the two groups was statistically significant; 6 months after treatment, the visual acuity increment: cure rate, progress rate and total efficiency rate between the two groups was statistically significant(P<0.05), the difference of the P100 amplitude, latency shortening in covered group was statistically significant compared with before treatment (P <0.05), and the differences between the two groups were not statistically significant(P >0.05); the visual acuity increment: cure rate, progress rate and total efficiency rate between the two groups was not statistically significant(P >0.05). CONCLUSION:The P100 amplitude and latency were improved in cover group after amblyopia treatment in early period, partially covered group had no obvious changes than before treatment, there were significant changes in visual acuity increment in the two groups, indicating that cover group has better efficacy than the partially covered group. In the long term, no significant difference was found between the P100 amplitude, latency and visual acuity, which further indicate that the long-term efficacy of the two methods is the same and regular PVEP test can evaluate the therapeutic effect and provide guide for further treatment.