摘要目的 研究连续全遮盖治疗8 ～14岁学龄期屈光参差性弱视儿童的有效性及安全性.方法 前瞻性系列病例研究.收集8 ～14岁的单纯屈光参差弱视儿童43例,采用连续全遮盖治疗3个月(遮盖日与非遮盖日比例为29∶1).运用ETDRS视力表和Optec 6500视功能检测仪测量治疗前、治疗1个月后及治疗3个月后的视力和对比敏感度函数,通过视力和对比敏感度所衍生的对比敏感度函数曲线下面积(AULCSF)、峰值对比敏感度(Smax)、Smax所对应的空间频率(Fmax)以及截至空间频率(CutSF)进行空间视功能评价.对治疗前后数据进行方差齐性检验和单因素方差分析,进一步采用Bonferroni法进行两两比较.结果 连续全遮盖治疗前、治疗后1和3个月的双眼视力分别为-0.70 ±0.30,-0.57±0.29,-0.47±0.28,AULCSF的差值分别为0.78±0.48,0.63 ±0.43、0.53 ±0.42,各组间差异均有统计学意义(F=6.406,P＜0.01;F =3.517,P=0.028).进一步进行两两比较显示,治疗3个月后双眼视力差值和双眼AULCSF差值与治疗前相比差异均有统计学意义(P ＜0.01;P =0.02).连续全遮盖治疗前、治疗后1和3个月的弱视眼视力、AULCSF和CutSF各组间差异均有统计学意义(F =6.906,4.016,5.717;P ＜0.05).进一步两两比较显示,治疗后3个月弱视眼视力、AULCSF和CutSF与治疗前相比差异均有统计学意义(P＜0.05).连续全遮盖治疗前、治疗后1和3个月的非弱视眼视力和AULCSF、弱视眼Smax和Fmax,各组间差异均无统计学意义(F＝0.243,0.265,0.949,2.934;P＞0.05);分别进行两两比较显示治疗前后各阶段间差异均无统计学意义(P＞0.05).结论 针对8～ 14岁的屈光参差性弱视学龄期儿童进行连续全遮盖治疗是可行的,疗效显著,能够改善视觉高频端分辨率,同时非弱视眼在连续全遮盖(29:1)治疗3个月后未出现视功能减退.

abstractsObjective To investigate the efficacy and safety of full-time patching therapy of anisometropic amblyopia in children aged 8-14 years.Methods It was a prospective case series study.Forty-three patients with anisometropic amblyopia without strabismus (ranged from 8-14 years,mean 10.8 years) were included in this study.All of the patients received eye patching for the entire day,29 days a month,during the first 3 months.Distance best corrected visual acuity in LogMAR units; cycloplegic refraction and contrast sensitivity function were performed on all the patients before treatment,at a month later of full-time patching therapy,and all recorded at 3 months later,and evaluation the spatial function with visual acuity,the area under the log contrast sensitivity function (AULCSF),the co-ordinates of the peak of the CSF (maximum sensitivity,Smax,and the spatial frequency at which it occurs,Fmax) and the cut-off spatial frequency.Difference amoug groups was evaluated by analysis of variance (One-Way ANOVA),and the Bonferroni test investigated the pairwise comparison of the groups.Results The degree of amblyopia and the D-value of binocular AULCSF of before full-cover treatment,after one month's and three months' full-cover treatment were-0.70 ± 0.30,-0.57 ± 0.29,-0.47 ± 0.28 and 0.78 ± 0.48,0.63 ±0.43,0.53 ±0.42,respectively,which showed statistically significant differences (F =6.406,P ＜ 0.01 ; F =3.517,P =0.028).The degree of amblyopia,the D-value of binocular AULCSF after three months' full-cover treatment had significant difference compared with those before full-cover treatment (P ＜ 0.01 ; P =0.02).There were statistically significant differences along with time in the best corrected visual acuity (BCVA) of the amblyopic eye,AULCSF and CutSF (F =6.906,P ＜ 0.01 ; F =4.016,P =0.02 ; F =5.717,P ＜0.01).The BCVA of the amblyopic eye,AULCSF and CutSF after three months' full-cover treatment had significant difference compared with those before full-cover treatment (P ＜ 0.01 ; P =0.028; P ＜0.01).However,the BCVA,AULCSF of the normal eye,and Smax,Frmax of amblyopic eye showed no statistically significant differences among groups along with time (F =0.243,P =0.785 ; F =0.265,P =0.768; F=0.949,P =0.390; F =2.934,P =0.057).Conclusions The present results show that continuous full-time patching in older children with anisometropic amblyopia improves visual acuity,and cut off spatial sensitivity with no serious complications.The use of continuous full-time patching in after-school children to improve amblyopia seems promising.