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双眼视知觉网络训练对弱视治疗短期视力提升效果的临床研究

2020-09-11 17:22:51 来源: 多宝视

·226· 中华眼科医学杂志(电子版)2020 年 8 月 第 10 卷 第 4 期 Chin J Ophthalmol  (Med Electronic Edition), August 2020, Vol. 10, No. 4

    ·论著·

双眼视知觉网络训练对弱视治疗短期视力

提升效果的临床研究


朱敏娟1 邓宏伟2  陶政暘3 钟华红2 陈静2   贾惠莉2   周谟圣4   周薇微2   林宇5

皇冠即时比分DOI: 10. 3877/ cma. j. issn. 2095-2007. 2020. 04. 006

基金项目:广东省科技计划项目(2016A020220002)

作者单位:518040 深圳,暨南大学 2018 级硕士研究生1;518040 暨南大学附属深圳市眼科医院斜视与小儿眼科2;518040 深圳,暨南大学 2019 级硕士研究生3;510003 广州视景医疗软件有限公司4;518031 深圳市宇数科技有限公司5

通信作者:邓宏伟,Email: dhw110@126. com


【摘要】   目的    探讨双眼视知觉网络训练中,影响最佳矫正视力( BCVA) 值提升的相关因素以及各种训练内容的功效。方法    选取 2018 年 10 月至 2019 年 2 月于深圳市眼科医院斜视与小儿眼科门诊就诊的双眼弱视患者 29 例( 58只眼 )。其中,男性 18 例( 36只眼 ),女性 11 例( 22只眼 );年龄 3 ~15 岁,平均年龄( 6.1 ± 2.6 )岁。将所有患者按照屈光状态和弱视类型进行分组。全部患者均采用 SJ-RS-WL2015 型多媒体能训练治系统的网络平台进行训练 3 个月,检查并记录训练前和训练后,患者的最佳矫正视力、患眼屈光状态和患者的弱视类型。采用数 ± 准差或中位数( 四分位间距 )描述患者的年龄、训练次数、BCVA 值和等效球镜 ( SE ) 。采用配对 t 检验或 Wilcoxon 符号秩和检验,比较练前后患者 BCVA 值和 SE 异。采用 Spearman 相关性系数法,分析训练前后患者 BCVA 的提高值分别与训练前 BCVA 值和 SE 的相关性。用 Mann-Whitney U 秩和检验,练前后不同弱视类型组患者的 BCVA 值与 SE。采用单因素和多因素回归分析,寻找影响患者 BCVA 值的关因素。结果    所有患者中,屈光不患者有 13 例( 26 只眼 ),占 44. 8%;屈光参差性弱视患者有 11 例( 22 只眼 ),占 37. 9%;斜视性弱视患者有 4 例( 8 只眼 ),占13. 8%;患者有 1 例 ( 2 只眼 ) ,占 3. 5% 。训练后 3 个月,患者右眼和左眼的平均 BCVA 提高值分别为  0. 14 ± 0. 13 )和( 0. 18 ± 0. 15 ), Spearman 分析,右眼和左眼 BCVA 的提高值与训练前 BCVA 值均呈负相关,其相关性有统计学意义 ( r =-0. 753,-0. 439; P<0. 05 )。患者左眼 SE 提高值分别为 (-0. 15 ± 0. 78 ) D 和 (-0. 25 ± 0. 79 ) D,经 Spearman 相关分析,右眼和左眼 SE 的提高值与训练前眼 SE 不存线性关系,其相关统计学意义( r =-0. 339,-0. 270; P > 0. 05 ) 。训练后 3 个月, SE ≤ 3. 00 D 组、3. 00 D ≤ SE ≤ 6. 00 D 组和 SE > 6. 00 D 组患者右眼 BCVA 的提高值分为 0. 00 ( 0. 10 ) 、0. 20 ( 0. 10 ) 和 0. 20 ( 0. 10 );左眼 BCVA 的提高值分别为 0. 00 ( 0. 20 ) 、0. 30 ( 0. 15 ) 和 0. 10 ( 0. 20 ) 。三组患者右眼 SE 的提高值分别 0. 00 ( 0. 00 ) D、0. 00 ( 1. 19 ) D 和-1. 12 ( 0. 75 ) D; 左眼 SE 的提高分别为(-0. 01 ± 0. 52 )D、(-0. 24 ± 0. 84 )D 和(-0. 72 ± 0. 96 )D。屈光不正性弱视组和屈光参差性弱视组患者,右眼和左眼 SE 提高值的比较,组间的差异无统计学意义 ( Z = 1. 412, 1. 968; P >0. 05 ) 。精细刺激、视觉技巧、Gabor 训练、对比敏感度和信息提取等不训练内容对患者右眼 BCVA 提高值影响的比较,差异无统计学意义 ( t = 0. 092, 1. 614, 0. 028, 0. 340, -1. 016; P>0. 05 ); 对患者左眼 BCVA 提高值的比较,差异无统计学意义 ( t =-0. 007, 0. 572, 0. 484, 1. 889, 0. 530; P>0. 05 ) 。训练后 3 个月,患者立体视的平均值为 (-146. 90 ± 290. 26) ″。

结论    短期双眼视知觉网络训练有助于弱视患者 BCVA 值的提升。患者的初始 BCVA 值越低,训练后 BCVA 的提高值越大。不同屈光状态与不同弱视类型组患者 BCVA 的提高值相当。然而,不同的训练内容对患者 BCVA 值的提升效果仍无法确认。

【关键词】双眼视知觉训练; 弱视; 网络; 训练内容

Analysis of the effect of binocular visual perception learning based on network training on short- term visual acuity improvement in amblyopia treatment 

Zhu Minjuan1, Deng Hongwei2,Tao Zhengyang3,  Zhong Huahong2, Chen Jing2, Jia Huili2, Zhou Mosheng4, Zhou Weiwei2, LinYu5. 1Master's degree 2018, Jinan University, Shenzhen 518040, China; 2Department of Strabismus and Pediatric Ophthalmology, Shenzhen Eye Hospital, Jinan University; Shenzhen 518040, China; 3Master' s degree 2019, JinanUniversity, Shenzhen 518040, China; 4Guangzhou Shijing Medical Software Co. Ltd. , Guangzhou 510003, China; 5Shenzhen Withsum Technology Limited, Shenzhen 518031, China

Corresponding author: Deng Hongwei, Email: dhw110@ 126. com

【Abstract】 Objective To explore the related factors of amblyopia about the improvement of corrected visual acuity and the efficacy of various training contents after 3 months of binocular visual perception learning through network training. Methods A total of 29 patients( 58 eyes) with binocular amblyopia were selected from the outpatient Department of Strabismus and Pediatric Ophthalmology in Shenzhen Eye Hospital from October 2018 to February 2019. There were 18 males cases( 36 eyes ), 11 females cases( 22 eyes ); age 3 to 15 years-old, mean( 6. 1 ± 2. 6 ) years-old. All patients were divided into groupes according to different refractive status and different types of amblyopia. All patients were trained on the network platform of SJ-RS-WL2015 multimedia visual function training treatment system and the best corrected visual acuity( BCVA ) , refractive states, and amblyopia types of patients were examined and recorded before and after 3 months of training. Age, number of training , BCVA, spherical equivalent( SE ) were expressed by mean ± standard deviation or median ( interquartile range ). Paired t-test or Wilcoxon signed rank test were used to compare the differences of the BCVA and SE of patients before and after training. Spearman correlation was used to analyze the correlation among the increased value of BCVA and BCVA value and SE after binocular visual perception network training. Mann-Whitney U rank sum test analysis was used to compare the BCVA value and SE degree of patients with different types of amblyopia before and after training. The single factor and multiple factor regression analysis were used to find the relevant factors that affect the patient' s BCVA. Results Among all patients, 13 cases( 26 eyes ) with ametropic amblyopia, were accounting for 44. 8%; 11 cases( 22 eyes ) with anisometropic amblyopia,were accounting for 37. 9%; 4 cases( 8 eyes ) with strabismic amblyopia,were accounting for 13. 8% and 1 case( 2 eyes ) with form-deprivation amblyopia,were accounting for 3. 5%. After training three months,the average increases of BCVA of the right eye and the left eye were( 0. 14 ± 0. 13 ) and( 0. 18 ± 0. 15 ), respectively; and the Spearman correlation analysis showed that the correlation were statistically significant( r =-0. 753,-0. 439; P<0. 05 ). The average increases of SE of the right eye and the left eye were( -0. 15 ± 0. 78 ) D and (-0. 25 ± 0. 79 ) D respectively, and the Spearman correlation analysis showed that the correlation were non-statistically significant ( r =- 0. 339,- 0. 270; P>0. 05 ). After training three months, the increases of BCVA of the right eye in SE ≤ 3. 00 D group,3. 00 D ≤ SE ≤ 6. 00 D group and SE >6. 00 D group were 0. 00 ( 0. 10 ) D, 0. 20 ( 0. 10 ) D and 0. 20 ( 0. 10 ) D, respectively; the increases of BCVA of the left eye in three groups were 0. 00 ( 0. 20 ) , 0. 30 ( 0. 15 ) and 0. 10 ( 0. 20 ), respectively.  The increases of SE of the right eye in there groups were 0. 00 ( 0. 00 ) D, 0. 00 ( 1. 19 ) D and-1. 12 ( 0. 75 ) D, respectively; the increases of SE of the left eye were (-0. 01 ± 0. 52 ) D ,(-0. 24 ± 0. 84 ) D and(-0. 72 ± 0. 96 ) D, respectively. There was non-statistically significant in the increases of SE between the right and left eyes in the ametropic amblyopia group and the anisometropic amblyopia group( Z= 1. 412, 1. 968; P>0. 05 ).  Different training contents such as fine stimulation, visual skills, Gabor, contrast sensitivity and information extraction had non-statistically significant with the increases of BCVA in the right eye( t=0. 092, 1. 614, 0. 028, 0. 340,-1. 016; P>0. 05); those of the increases of BCVA in the left eye had non-statistically significant( t=-0. 007, 0. 572, 0. 484, 1. 889, 0. 530; P>0. 05 ). After training three months, the average stereopsis were(-146. 897 ± 290. 260)△. Conclusions Short-term application of binocular visual perception network training is effective for improving BCVA in amblyopia. The lower the patient's initial BCVA value, the greater the increase in BCVA after training. The improvement of BCVA of patients with different refractive status and different types of amblyopia is equivalent. Initial BCVA determines the improvement of BCVA after training, but the effect of different training contents on BCVA can not be confirmed for the time being.

【Key words】 Binocular visual perception learning; Amblyopia; Network; Training content

皇冠即时比分弱视是一种常见的儿童视觉发育异常疾病,发病率为 2% ~4% 。近年来,新技术和新途径的不断涌现,促进了弱视治疗的发展。其中,双眼视知觉训练的治疗效果不断被各国研究者证实,并逐渐应用于临床[1-4]。当前,虚拟现实技术以及其网络应用已开始在多个领域普及,网络平台训练法已被引入到双眼视知觉训练的模式中,丰富了弱视治疗的手段[5]。本研究探讨各种训练内容的功效和影响最佳矫正视力( best corrected visual acuity, BCVA) 值的相关因素,旨在为优化网络虚拟现实双眼视知觉弱视训练的疗效提供参考。

ZILIAOYUFANGFA

一、一般资料

皇冠即时比分XUANQU 2018 NIAN 10 YUEZHI 2019 NIAN 2 YUEYUSHENZHENSHIYANKEYIYUANXIESHIYUXIAOERYANKEJIUZHENDE 29 LI( 58 ZHIYAN )SHUANGYANRUOSHIHUANZHE。QIZHONG,NANXING 18 LI( 36 ZHIYAN ),NVXING 11 LI( 22 ZHIYAN );NIANLING 3 ~15 SUI,PINGJUNNIANLING( 6. 1 ± 2. 6 )SUI。BENYANJIUJINGSHENZHENSHIYANKEYIYUANLUNLIWEIYUANHUIPIZHUN,HUANZHEJIJIASHUJUNQIANSHUZHIQINGTONGYISHU。

二、纳入与排除标准

1. NARUBIAOZHUN:

( 1 )根据 2011 年弱视诊断共识的标准,诊断为双眼弱视,注视性质为中心注视者[6];
( 2 )能配合本研究中各项检查者;
( 3 )3 岁 ≤ 年龄 ≤ 15 岁;
皇冠即时比分( 4 )能够按要求完成全部训练者。

2. PAICHUBIAOZHUN:

( 1 )合并有其他眼部器质性疾病者,如屈光间质混浊、眼底病变和眼球震颤等;
( 2 )有眼部外伤史及手术史者;
( 3 )有颅脑及神经系统疾病者;
皇冠即时比分( 4 )不能完成全部训练并配合各项检查者。

三、 分组的方法

皇冠即时比分1. GENJUHUANZHEDEQUGUANGZHUANGTAIFENZU:FENWEIDENGXIAOQIUJING( spherical equivalent, SE ) ≤ 3. 00 D、3. 00 D ≤ SE ≤ 6. 00 D JI SE>6. 00 D DENG 3 GEZU。

皇冠即时比分2. GENJUHUANZHEDERUOSHILEIXINGFENZU: GENJU 2011 NIANRUOSHIZHENDUANZHUANJIAGONGSHIZHONGDEBIAOZHUN,JIANGHUANZHEFENWEIXIESHIXINGRUOSHI、QUGUANGCANCHAXINGRUOSHI、QUGUANGBUZHENGXINGRUOSHIHEXINGJUEBODUOXINGRUO

皇冠即时比分SHIDENG 4 GEZU[6]。

四、 检查的方法

皇冠即时比分JIANCHABINGJILUXUNLIANQIANYUXUNLIANHOU 3 GEYUE,HUANZHEDE BCVA ZHI、YANWEI、QUGUANGZHUANGTAI、ZHUSHIXINGZHI、SHUANGYANSANJISHIGONGNENGHEJINJULILITISHIGONGNENG。

1. BCVA DEJIANCHA:CAIYONGBIAOZHUNDUISHUYUANSHILIBIAO( JIANGSUSUHONGYILIAOQIXIEYOUXIANGONGSISHENGCHAN )JIANCEHUANZHEDE BCVA ZHI。XUYAODAIJINGJIAOZHENGYANWEIJISHILIZHE,ANPEIJINGYUANZEPEIJINGJIAOZHENG。

2. 眼位的检查:采用角膜映光联合遮盖去遮盖法检查患者的眼位。
皇冠即时比分3. 屈光状态的检查:所有患者均行 YZ6E 型检影镜( 苏州六六视觉科技股份有限公司生产 )检影验光。对于年龄 ≤ 6 岁的患者,采用 1% 浓度阿托品凝胶( 沈阳兴齐眼药股份有限公司生产 )滴眼,3 次/d,连续 3 d;对于年龄 > 6 岁的患者,采用复方托吡卡胺滴眼液( 沈阳兴齐眼药股份有限公司生产 )滴眼,10 min/次,连续 3 次。

4. ZHUSHIXINGZHIDEJIANCHA:CAIYONG YZ6F XINGJIANYANJING( SUZHOULIULIUSHIJUEKEJIGUFENYOUXIANGONGSISHENGCHAN )JIANCHAHUANZHEDEHUANGBANZHONGXINWEIZHI。

5. SHUANGYANSHIGONGNENGDEJIANCHA:CAIYONG YZ23B XINGTONGSHIJI( SUZHOULIULIUSHIJUEKEJIGUFENYOUXIANGONGSISHENGCHAN )XINGSHUANGYANSANJISHIGONGNENGJIANCHA。FENBIECAIYONGMENCHEHUAPIAN、MAODIEHUAPIANHESHUZIHUAPIANJIANCHAHUANZHEDEⅠJISHIGONGNENG( TONGSHISHI )、ⅡJISHIGONGNENG( RONGHESHI )HEⅢJISHIGONGNENG( YUANLITISHI)。CAIYONG FLY TUPU( MEIGUO Vision Assessment GONGSISHENGCHAN )JIANCHAHUANZHEDEJINJULILITISHIGONGNENG。

五、训练的方法

皇冠即时比分CAIYONG SJ-RS-WL2015 XINGDUOMEITISHIJUEGONGNENGXUNLIANZHILIAOXITONGDEWANGLUOPINGTAI( GUANGZHOUSHIJINGYILIAORUANJIANYOUXIANGONGSISHENGCHAN )XINGSHUANGYANSHIZHIJUEWANGLUOXUNLIAN。SUOYOUHUANZHEJUNXINGJINGXICIJIXUNLIAN、SHIJUEJIQIAOXUNLIAN、Gabor XUNLIAN、DUIBIMINGANDUXUNLIANHEXINXITIQUXUNLIANDENG 5 ZHONGXUNLIANNEIRONG,GONGXUNLIAN 3 GEYUE, 2 CI/d,15 min/CI。SUOYOUXUNLIANJUNTONGGUODIANNAOZAIXIANWANCHENG。QIZHONG,JINGXICIJIXUNLIANBAOKUOXIAOQIUCHUANGGUAN、ZHILIQIUHEJINGXIMIAODIANDENGXUNLIANNEIRONG;SHIJUEJIQIAOXUNLIANBAOKUOSHIJUEZHUISHIXUNLIAN、SHITINGZHENGHEXUNLIANHESHIJUEBIANBIEXUNLIANDENGXUNLIANNEIRONG;Gabor XUNLIAN、DUIBIMINGANDUXUNLIANHEXINXITIQUXUNLIANZHUYAOYI Gabor XINHAOWEICIJIYUAN,Gabor XUNLIANBAOKUO Gabor BAN E ZIKAIKOUFANGXIANG、LUNKUOZHIJUEHE Gabor YOUBIAOXUNLIANDENGXUNLIANNEIRONG;DUIBIMINGANDUXUNLIANBAOKUO E ZIMUZHAOBUTONG、DIANSHUZIHEZHAOBUTONGDENGXUNLIANNEIRONG;XINXITIQUXUNLIANBAOKUOZHAOXIANGTONG、WUXUJI Gabor DIANHESHANSHUOJI Gabor DIANDENGXUNLIANNEIRONG。JIANTU 1 ~5。


图1 精细刺激训练内容截图 图1A 示小球闯关; 图1B 示智力棋; 图1C 示精细描点等训练内容 图2 视觉技巧训练内容截图 图 2A 示视觉追随反弹球训练; 图 2B 视听整合弹钢琴训练; 图 2C 视觉辨别找差异训练等训练内容 图3 Gabor 训练内容截图 图 3A 示 Gabor 斑 E 字开口方向; 图 3B 示轮廓知觉; 图 3C 示游标等训练内容 图4 对比敏感度训练内容截图 图 4A 示 E 字母找不同; 图 4B 点数字; 图 4C 找不同等训练内容 图5 信息提取训练内容截图 图 5A 示找相同; 图 5B 示无序击 Gabor 点; 图 5C 示闪烁击 Gabor 点等训练内容

六、统计学分析方法

CAIYONG R RUANJIANJINXINGTONGJIXUEFENXI。CAIYONGJUNSHU ± BIAOZHUNCHAHUOZHONGWEISHU( SIFENWEIJIANJU )MIAOSHUHUANZHEDENIANLING、XUNLIANCISHU、BCVA ZHIHE SE。CAIYONGPEIDUI t JIANYANHUO Wilcoxon FUHAOZHIHEJIANYAN,BIJIAOXUNLIANQIANHOUHUANZHE BCVA ZHIHE SE DECHAYI。CAIYONG Spearman XIANGGUANXINGXISHUFA,FENXIXINGSHUANGYANSHIZHIJUEWANGLUOXUNLIANHOU,HUANZHE BCVA DETIGAOZHIFENBIEYUXUNLIANQIAN BCVA ZHIHE SE DEXIANGGUANXING。CAIYONG Mann-Whitney U ZHIHEJIANYAN,BIJIAOXUNLIANQIANHOUBUTONGRUOSHILEIXINGZUHUANZHEDE BCVA ZHIYU SE。JIANGHUANZHEDENIANLING、XINGBIE、ZHUSHIXINGZHI、RUOSHILEIXING、FENKAI、JIHE、FENKAIYUJIHEDEJUEDUIZHIHE、LITISHI、XUNLIANYANBIE、JINGXICIJI、SHIJUEJIQIAO、Gabor XUNLIAN、DUIBIMINGANDU、XINXITIQU、RONGHEGONGNENG、TONGSHIZHIJUE A、TONGSHIZHIJUE B HELITISHIJUEYIJI 3 GEYUENEIDEXUNLIANCISHU、YOUYAN( ZUOYAN )QIUJINGZHI、YOUYAN( ZUOYAN )ZHUJINGZHI、YOUYAN( ZUOYAN )ZHOUXIANGZHIHEYOUYAN( ZUOYAN )BCVA ZHIZUOWEIZIBIANLIANG,JIANGYOUYAN( ZUOYAN )BCVA TIGAOZHIZUOWEIYINBIANLIANG,GOUJIANDANYINSUHEDUOYINSUXIANXINGHUIGUIMOXING。YI P<0. 05 WEICHAYIYOUTONGJIXUEYIYI。


结果

一、纳入本研究患者组成的情况

皇冠即时比分NARUBENYANJIUDEHUANZHEZHONG,QUGUANGBUZHENGXINGRUOSHIHUANZHEYOU 13 LI( 26 ZHIYAN ),ZHAN 44. 8%;QUGUANGCANCHAXINGRUOSHIHUANZHEYOU 11 LI( 22 ZHIYAN ),ZHAN 37. 9%;XIESHIXINGRUOSHIHUANZHEYOU 4 LI( 8 ZHIYAN ),ZHAN 13. 8%;XINGJUEBODUOXINGRUOSHIHUANZHEYOU 1 LI( 2 ZHIYAN ),ZHAN 3. 5%。SUOYOUHUANZHEJUNWEIZHONGXINZHUSHI,WUQITAYANBUQIZHIXINGJIBING。

二、 训练后 BCVA 提高值与训练前 BCVA 值的比较

皇冠即时比分XUNLIANHOU 3 GEYUE,HUANZHEYOUYANHEZUOYAN BCVA DEPINGJUNTIGAOZHIFENBIEWEI( 0. 14 ± 0. 13 )HE( 0. 18 ± 0. 15 ),CHAYIYOUTONGJIXUEYIYI( W = 2. 10, 2. 53; P< 0. 05) 。JING Spearman XIANGGUANFENXI,HUANZHESHUANGYAN BCVA DETIGAOZHIYUXUNLIANQIAN BCVA ZHICHENGFUXIANGGUAN,QIXIANGGUANXINGYOUTONGJIXUEYIYI( r =-0. 753,-0.439; P<0. 05) 。JIANBIAO1,TU6 HETU7。




三、 训练后 SE 提高值与训练前 SE 的比较

XUNLIANHOU 3 GEYUE,HUANZHEYOUYAN SE DEPINGJUNTIGAOZHIWEI(-0. 15 ± 0. 78 )D,CHAYIWUTONGJIXUEYIYI( W = 0. 42, P>0. 05 );ZUOYAN SE DEPINGJUNTIGAOZHIWEI(-0. 25 ± 0. 79 )D,CHAYIWUTONGJIXUEYIYI( t =-1. 73,P > 0. 05) 。JING Spearman XIANGGUANFENXI,HUANZHESHUANGYAN SE DETIGAOZHIYUXUNLIANQIAN SE BUCUNZAIXIANXINGGUANXI,QIXIANGGUANXINGWUTONGJIXUEYIYI ( r =-0. 339,-0. 270; P > 0. 05) 。JIANBIAO 1,TU 8 HETU 9。

四、 不同屈光状态组训练后 BCVA 提高值和 SE 提高值的检查结果

XUNLIANHOU 3 GEYUE,SE ≤ 3. 00 D ZU、3. 00 D ≤ SE ≤ 6. 00 D ZUHE SE > 6. 00 D ZUHUANZHEYOUYAN BCVA DETIGAOZHIFENBIEWEI 0. 00 ( 0. 10 ) 、0. 20 ( 0. 10 )HE 0. 20( 0. 10 ) ;ZUOYAN BCVA DETIGAOZHIFENBIEWEI 0. 00( 0. 20 )、0. 30( 0. 15 )HE 0. 10( 0. 20 )。SANZUHUANZHEYOUYAN SE DETIGAOZHIFENBIEWEI 0. 00( 0. 00 )D、0. 00( 1. 19 )D HE-1. 12( 0. 75 )D;ZUOYAN SE DETIGAOZHIFENBIEWEI(-0. 01 ± 0. 52 )D、(-0. 24 ± 0. 84 )D HE(-0. 72 ± 0. 96 )D。YINGEZUYANGBENLIANGJIAOSHAO,WEIXINGTONGJIXUEFENXI。

五、 不同弱视类型组训练后 BCVA 提高值和 SE 提高值的比较

XUNLIANHOU 3 GEYUE,QUGUANGCANCHAXINGRUOSHIZUHEQUGUANGBUZHENGXINGRUOSHIZUHUANZHEYOUYAN BCVA DETIGAOZHIFENBIEWEI 0. 20( 0. 10 )HE 0. 10( 0. 10 );ZUOYAN BCVA DETIGAOZHIFENBIEWEI 0. 20( 0. 10 )HE 0. 30( 0. 30 )。LIANGZUHUANZHEYOUYAN SE DETIGAOZHIFENBIEWEI 0. 00( 0. 62 )D HE 0. 00( 0. 00 )D;ZUOYAN SE DETIGAOZHIFENBIEWEI-0. 38( 1. 06 )D HE0. 00( 0. 12 )D。JING Mann-Whitney U ZHIHEJIANYANFENXI,LIANGZUHUANZHEYOUYANHEZUOYAN BCVA TIGAOZHIZUJIANDEBIJIAO,CHAYIWUTONGJIXUEYIYI( Z =3. 397, 0. 247; P>0. 05 );HUANZHEYOUYANHEZUOYAN SE TIGAOZHIZUJIANDEBIJIAO,CHAYIWUTONGJIXUEYIYI( Z =1. 412, 1. 968; P>0. 05) 。YINXINGJUEBODUOXINGRUOSHIZUHEXIESHIXINGRUOSHIZUHUANZHEYANGBENLIANGJIAOSHAO,WEICANYUSHUJUTONGJI。JIANBIAO 2。


六、 影响训练后 BCVA 提高值单因素和多因素线性回归分析的结果

皇冠即时比分JINGDANYINSUHUIGUIFENXI,HUANZHEDEYOUYAN SE、YOUYANZHOUXIANG、YOUYAN BCVA ZHIHETONGSHIZHIJUE A YUYOUYAN BCVA DETIGAOZHIYOUXIANZHUXIANGGUANXING( t = 2. 32, 2. 07.-5. 24,-2. 17; P<0. 05 )。ANZHAOCHICHIXINXIZUIXIAOZHUNZE,DUIRUXUANYINSUNARUMOXINGJINYIBUCAIYONGDUOYUANXIANXINGHUIGUIFENXI。CAIYONGZHUBUFASHAIXUANBIANLIANG,DEDAOZUIYOUMOXING。DUOYINSUXIANXINGHUIGUIJIEGUOXIANSHI,HUANZHEYOUYAN BCVA DEHUIGUIXISHUWEI-0. 35,CHAYIYOUTONGJIXUEYIYI( t =-5. 21, P<0. 05 )。JIYOUYAN BCVA DECHUSHIZHIMEIZENGJIA 1 GEDANWEI,YOUYAN BCVA DETIGAOZHIJIANSHAO 0. 35 GEDANWEI。JIANBIAO 3。


JINGDANYINSUHUIGUIFENXI,HUANZHEDENIANLING、ZUOYAN BCVA ZHI、XUNLIANYANBIEYUZUOYAN BCVA DETIGAOYOUXIANZHUXIANGGUANXING ( t =-2. 13,-3. 35,2. 27; P<0. 05) 。ANZHAOCHICHIXINXIZUIXIAOZHUNZE,DUIRUXUANYINSUNARUMOXING,JINYIBUCAIYONGDUOYUANXIANXINGHUIGUIFENXI。CAIYONGZHUBUFASHAIXUANBIANLIANG,DEDAOZUIYOUMOXING。DUOYINSUXIANXINGHUIGUIJIEGUOXIANSHI,HUANZHEZUOYAN BCVA DEHUIGUIXISHUWEI-0. 32,CHAYIYOUTONGJIXUEYIYI( t =-3. 35, P<0. 05 )。JIZUOYAN BCVA DECHUSHIZHIMEIZENGJIA 1 GEDANWEI,ZUOYANBCVA DETIGAOZHIJIANSHAO0.32 GEDANWEI。JIANBIAO4。



七、患者立体视功能的变化
训练后 3 个月,患者Ⅰ级( 同时视 )和Ⅱ级视功能( 融合视 )正常。Ⅲ级视功能( 远立体视 )的平均弱视是一种大脑接受异常刺激引起的神经功能值为(-146. 897 ± 290. 260 ) ″。由于数据的标准差异常。患者大脑皮层的损伤不仅局限于初级与高级过大,故未行统计学分析。

讨论

皇冠即时比分RUOSHISHIYIZHONGDANAOJIESHOUYICHANGCIJIYINQIDESHENJINGGONGNENGYICHANG。HUANZHEDANAOPICENGDESUNSHANGBUJINJUXIANYUCHUJIYUGAOJISHIPICENGCHU,HAIHUILEIJIYUZHIXIANGLIANDECHUANDAOTONGLUHEFUZADESHISHENJINGWANGLUO[7]。JINNIANLAI,YEJIEPUBIANRENWEIRUOSHIDEBENZHISHIYIGESHUANGYANWENTI,JIRUOSHIHUANZHEDESHILIZHANGAIJIFAYUYICHANGDESHUANGYANJIANYIZHI,DANYANRUOSHIKENENGSHISHUANGYANSHIGONGNENGYICHANGSUOZHI[8]。SHENJINGSHENGLIXUEYANJIUJIEGUOBIAOMING,ZAISHIPICENG V1 QUYISHANGDESUOYOUSHIPICENGZHONG,SHENJINGYUANDOUSHIYOUSHUANGYANGONGTONGQUDONGDE。MUQIANCHANGYONGDERUOSHIZHILIAOFANGFA,RUZHEGAILIAOFAHEDANYANZHIJUEXUEXIFA,JINQIANGDIAOLEZHONGSURUOSHIYANDESHITONGLU,HULVELEDUISHUANGYANBULIANGJIAOHUZUOYONGDEJIUZHENG。DUIYUGAOJISHIJUETONGDAOQUESUNDEHUANZHE,SHANGSHUZHILIAOFANGSHIWUMINGXIANBANGZHU。RANER,SHUANGYANSHIZHIJUEXUNLIANZAIRUOSHIZHILIAOZHONGDEJIJIZUOYONGYIDEDAOLEXUEZHEDEGUANGFANRENKE。CAIYONGSHUANGYANSHIZHIJUEXUNLIANTIGAOHUANZHEDESHUANGYANSHIGONGNENG,KENENGCHENGWEIERTONGHUOCHENGRENRUOSHIZHILIAODEGUANJIANTUPOKOU。

一、 传统弱视治疗方法的不足

皇冠即时比分CHUANTONGDERUOSHIZHILIAOFANGSHIBAOKUOZHEGAIZHILIAOFAHEATUOPINYAYILIAOFADENG。QIZHONG,ZUIJINGDIANDEZHEGAIZHILIAOFAYIYOU200 NIANZUOYOUDELISHI,LINCHUANGLIAOXIAOYIDEDAOYANKEYISHIMENDEYIZHIRENKE,ZHIJINRENGBEIGUANGFANYINGYONG。RANER,YOUYUHUANZHEDEYICONGXINGCHA,CHUANTONGDERUOSHIZHILIAOGUOCHENGZHONGCHANGCHANGCHUXIANJISHOUDEWENTI。RUZHEGAIZHILIAOFAZHILIAOZHOUQIZHANG、TINGZHIZHEGAIHOUYIFUFAYIJIYISHIHUANZHECHANSHENGZIBEIXINLIDENG[5, 9-14]。YAYILIAOFADEDIYICONGXINGYUHUANZHEDEBULIANGSHEHUIXINLIYINSUCUNZAIMIQIELIANXI,BINGZUIZHONGDAOZHILIAOXIAOJIANGDI[15]。RUHEGENGHAODITIGAORUOSHIHUANZHEDEYICONGXING,YICHENGWEIZHIYUERUOSHIZHILIAOFANGFAYOUXIAOXINGDEGUANJIANYINSU[16]。TONGSHI,CHUANTONGDERUOSHIZHILIAOFANGFAZHIGUANZHUHUANYANSHIMINDUDEHUIFU,DUISHUANGYANSHIGONGNENGDEGAISHANBINGWUYICHU,QIEYOUKENENGZAOCHENGJIANYAN[17-18]。YIWANGGUANDIANRENWEI,CHUANTONGDERUOSHIZHILIAOFANGFADUIYUNIANLINGCHAOGUO 12 SUIDERUOSHIHUANZHE,ZHILIAOXIAOGUOBUJIA;DUIYUCHENGNIANRUOSHIHUANZHEDEXUEXI、GONGZUOHESHEJIAOSHENGHUOSUOCHANSHENGDEYINGXIANGJUYOUHUIMIEXING[19]。

二、 双眼视知觉网络训练的优点

SHUANGYANSHIZHIJUEWANGLUOXUNLIANDEYOUXISHEJISHITONGGUOJIANGDIZHENGCHANGYANHEFEIRUOSHIYANJIESHOUYUNDONGDIANDEGUANGLIANGDU,YIJIANGDIGAIYANSHISHENJINGCHUANRUDEQIANGDU,CONGERSHISHUANGYANDEGANZHIDADAOPINGHENG。YUCHUANTONGDERUOSHIZHILIAOFANGFAXIANGBI,SHUANGYANSHIZHIJUEWANGLUOXUNLIANGENGJIAGUANZHUHUANZHESHUANGYANSHIGONGNENGDEJIANLIYUHUIFU,NENGGOUSHISHUANGYANDEDAOJUNHENGDEFAZHAN。CIWAI,SHUANGYANSHIZHIJUEWANGLUOXUNLIANJIANGCHUANTONGDEDANJIYIDUIYIXIANCHANGXUNLIANMOSHIFENGFUWEIWANGLUOGEXINGHUAXUNLIANMOSHI,JIANSHAOLEHUANZHEWANGFANYIYUANHUOXUNLIANJIGOUDESHIJIAN,ZENGJIALEHUANZHEDEXUNLIANJIANCHIDUHEXUNLIANXIAONENG,ZAIYIDINGCHENGDUSHANGSUODUANLEZHILIAODELIAOCHENG[20]。CIWAI,SHUANGYANSHIZHIJUEXUNLIANDELIAOXIAOWENDING,BIMIANLECHUANTONGZHILIAOZHONGHUANZHEYIFUFADEQINGKUANG[21-22]。Kelly DENG[23]DUI 41 LI 4 ~ 10 SUIDERUOSHIHUANZHEXINGSHUANGYANSHIZHIJUEXUNLIAN2 ZHOUHOUDEJIEGUOXIANSHI,HUANZHEDESHILITISHENG,LITISHIGONGNENGHERONGHESHIGONGNENGDEYIZHICHENGDUJUNDEDAOGAISHAN。Li DENG[21, 24]DEYANJIUJIEGUOBIAOMING,RUOSHIHUANZHEXINGDUANQISHUANGYANSHIZHIJUEXUNLIANHOU,SHILIJUNDEDAOTISHENG,QIETINGZHIXUNLIANHOUDEZHILIAOXIAOGUOWENDING。DUOXIANGYANJIUJIEGUOBIAOMING,CHENGNIANRUOSHIHUANZHEKETONGGUODUOCISHUANGYANSHIZHIJUEXUNLIANGAISHANSHIGONGNENG[2, 22, 25-26]。Hess DENG[25]DEYANJIUJIEGUOBIAOMING,RUOSHIHUANZHEXINGZHANGQISHUANGYANSHIZHIJUEXUNLIANHOU,SHILITIGAO,SHUANGYANRONGHESHIGONGNENGDEZENGQIANGYIZHIJIANSHAO,LITISHIGONGNENGDEDAOGAISHAN。 Hess DENG[26]DUI 13 ~50 SUIRUOSHIHUANZHEXINGSHUANGYANSHIPINYOUXIZHILIAO 10 ~30 h HOUDEJIEGUOXIANSHI,HUANZHEDESHILITISHENG,LITISHIGONGNENGDEDAOMINGXIANGAISHAN。Li DENG[22]DEYANJIUYEDECHUTONGYANGDEJIEGUO。XIANRAN,DUIYUCHENGNIANRUOSHIHUANZHE,SHUANGYANFENSHIXIADERUOSHIXUNLIANDUIYUSHIMINDUHELITISHIMINGANDUDEGAISHAN,JUNMINGXIANYOUYUDANYANRUOSHIXUNLIAN。RANER,YOUYUSHIYANSHEJICUNZAIQUEXIAN,SHANGSHUYANJIUJIEGUOZHINENGZUOWEIXUNZHENGYIXUEZHONGJIAODIJIBIEDEZHENGJU[27]。ZHIDEZHUYIDESHI,LUXUKAIZHANDELINCHUANGSUIJIDUIZHAOSHIYANQUDELEKEXIDECHENGGUO。Kelly DENG[28]ZAIYIXIANGDANZHONGXINLINCHUANGSUIJIDUIZHAOSHIYANZHONG,BIJIAOLEXINGSHUANGYANSHIZHIJUEXUNLIANYUZHEGAIZHILIAODE 4 ~ 10 SUIRUOSHIHUANZHEDEZHILIAOXIAOGUO,FAXIANPINGBANDIANNAOYOUXISHUANGMUXUNLIANZUHUANZHEDEZHILIAOXIAOGUOYOUYUZHEGAIZHILIAOZU。 Gambacorta DENG[1]FENBIECAIYONGZHEGAIFAYUSHIPINZHONGDUANYOUXISHUANGMUXUNLIANFAZHILIAORUOSHIHUANZHEDEJIEGUOBIAOMING,SHIPINZHONGDUANYOUXISHUANGMUXUNLIANZUHUANZHEDELITISHIGONGNENGDEGAISHANHESHIMINDUDETIGAOGENGMINGXIAN,QIEGAIFANGFAZAIZHILIAOYICONGDUSHANGJUYOUXIANZHUYOUSHI。

三、双眼视知觉网络训练的治疗效果

XINGDUANQISHUANGYANSHIZHIJUEWANGLUOXUNLIANHOU,RUOSHIHUANZHEDE BCVA ZHIJUNDEDAOTISHENG,QIEXUNLIANQIANDE BCVA ZHIYUEXIAO,XUNLIANHOU BCVA DETIGAOZHIYUEDA。GAIJIEGUOYUDALIANGYANJIUJIEGUOWENHE[21-24]。TANGWEIWEIDENG[29]DUI 107 LIRUOSHIHUANZHEXING 3 GEYUESHIZHIJUEXUNLIANHOUDEJIEGUOBIAOMING,ZHONGDURUOSHIHUANZHEDEXUNLIANXIAOGUOYOUYUQINGDURUOSHIHUANZHE,YUBENYANJIUZHONGJIEGUOYIZHI。RANER,LIAIJUNDENG[20]DEYANJIUJIEGUOBIAOMING,DUOMEITIXUNLIANXITONGDUIYUQINGDUYUZHONGDURUOSHIHUANZHEDEZHILIAOXIAOGUOJIAOHAO,DUIYUZHONGDURUOSHIHUANZHEDEZHILIAOXIAOGUOSHAOCHA。MUQIAN,DUIYUBUTONGCHENGDURUOSHIDEHUANZHE,SHUANGYANSHIZHIJUEWANGLUOXUNLIANDELIAOXIAOHAIXUYAOJINYIBUDEYANJIU,BUTONGDEXUNLIANNEIRONGDUIHUANZHE BCVA ZHIDEYINGXIANGZANSHIWUFAQUEREN[20]。

四、本研究的不足
本研究中,不同屈光状态组患者 BCVA 的提高值未得出统计学差异,可能与分组后样本量较少有关。后续需进一步扩大样本量,以全面评估双眼视知觉网络训练的疗效。然而,根据临床工作中的观察结果以及既往大量的研究结果可知,双眼视知觉训练可有效改善弱视患者的立体视功能[23,30]。此外,本研究中,患者的年龄分布集中在 7 岁左右,存在不能配合检查的可能。

综上所述,以双眼视知觉网络训练治疗弱视,行短期训练后,患者的视敏度提高,视功能恢复。由于双眼视知觉网络训练具有不受地点限制、训练效果可及时上传以及训练内容可实时跟踪调整的优点,为广大弱视患者提供了方便。日后,双眼视知觉网络训练可能成为一种有效的弱视治疗手段。

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——————————————————————————————————————————————————————————————————————————————— 更改声明
本刊发表于 2020 年第 10 卷第 3 期的“外伤性视网膜脱离术后复发的临床特征分析”一文,该文 DOI: 10. 3877/cma. j. issn. 2095-2007. 2020. 03. 005。现声明第四作者姓名“杨光然”更改为“杨光燃”。

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