弱视儿童的临床概况和遮盖治疗结果

Clinical profile of amblyopia and outcome of occlusion therapy in pediatric populations attending a referral hospital

摘要:

目的：研究弱视的临床表现，以及对弱视患者进行遮盖治疗的效果。

方法：纵向研究。收集2015-04/2016-04 Dhulikhel医院眼科1 092例患者数据。对检出的弱视60例患儿的视力、主诉、年龄、屈光状态、双眼屈光度和注视方式进行评估。并对检出的弱视患儿进行遮盖治疗。

结果：在研究期间接受检查的1 092例儿童中，60例(5.49%)为弱视患者，其中，女性35例(58.30%)，男性25例(41.70%)，平均年龄为8.87±3.29岁。在43.3%(n=26)的弱视儿童中，经线性弱视是最常见的亚型，其次是远视性屈光参差性弱视(20%，n=12)。最常见的屈光不正是散光，占58.30%，其次是远视(22.50%)和近视(7.50%)。配戴眼镜联合遮盖治疗和主动视觉训练的依从性为73.30%(n=44)。3mo后不同治疗策略对弱视眼视力有显著改善(P=0.002)。

结论：在尼泊尔等发展中国家，弱视发病率和相关的视力损害仍然是一个公共卫生问题。意识的缺乏，社区或学龄前儿童视力筛查的缺乏，会导致儿童较晚出现症状，并最终导致明显的视力损害。通过筛选就诊地点、及时转诊和适当的干预措施，这种状况可得到改善。

Abstract:

AIM: To study clinical profile of amblyopia and also the outcomes of occlusion therapy among the amblyopes.

METHODS: This was a hospital-based longitudinal study by design. Data were collected from April 2015 to April 2016 in Ophthalmology Department of Dhulikhel Hospital. Presenting visual acuity, chief complaint at presentation, age at presentation, refractive status, binocularity and fixation patterns were assessed in all the children with amblyopia. Improvement in visual acuity was also noted in all the subjects after occlusion therapy, which is a most commonly used modality of treatment for amblyopia.

RESULTS: Among 1 092 children examined during the study period, 60(5.49%)were amblyopic. Among them, 35(58.30%)were females and 25(41.70%)were males. The mean age at presentation was 8.87±3.29 years. Meridional amblyopia was the most prevalent subtype seen in 43.3%(n=26)of children followed by anisohypermetropic amblyopia(20%, n=12). The most common refractive error was astigmatism accounting for 58.30% of the total cases followed by hypermetropia(22.50%)and myopia(7.50%). Compliance with spectacle wear combined with occlusion therapy and active vision therapy was 73.30%(n=44). There was a statistically significant improvement in visual acuity of the amblyopic eyes after the different treatment strategies after 3mo(P=0.002).

CONCLUSION: Prevalence of amblyopia and associated visual impairment is still a public health issue in developing countries like Nepal. Lack of awareness and lack of community or preschool vision screening for children lead to late presentation and significant visual impairment associated with the condition. The burden can easily be reduced with screening camps, timely referrals and proper interventions.