調節性内斜視の治療予後 Prognosis of binocularity in accommodative esotropia

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<B>目的)</B>調節性内斜視、部分調節性内斜視の両眼視機能予後につき検討する。<BR><B>対象と方法)</B>対象は2005年から2008年までに兵庫医科大学病院眼科を受診し、調節性内斜視または部分調節性内斜視の治療を開始し2年以上経過を追えた53例(平均4.5歳)である。調節性内斜視は32例(平均4.6歳)、部分調節性内斜視21例(平均4.5歳)であった。完全屈折矯正眼鏡装用の上、経過観察または保存的治療(フレネル膜プリズムなど)あるいは観血的治療を行い、2年後の両眼視機能に影響を与える因子を検討した。<BR><B>結果)</B>調節性内斜視でTitmus stereo testの正常立体視である100秒以下を獲得できたものは13例(41%)であったが、測定不能も13例(41%)認められた。予後不良因子としては初診時視力0.3以下、眼鏡装用開始1ヶ月後の眼位で斜位にならないものがあげられた。部分調節性内斜視では正常立体視を獲得したのは4例(19%)であった。フレネル膜プリズム装用群とフレネル膜プリズム装用と手術併用群は、経過観察群と手術群の2群より両眼視機能予後が良好であった。<BR><B>結論)</B>良好な両眼視機能を獲得するためには厳密な眼位管理が必要であり、特に部分調節性内斜視では手術までの期間もフレネル膜プリズム装用による眼位矯正を行う事が望ましいと考えられた。

<B>Purpose:</B> To investigate the binocularity in patients with accommodative esotropia and partial accommodative esotropia.<BR><B>Subjects and Methods:</B> Subjects were 53 consecutive patients (average age: 4.5 years) who were diagnosed with accommodative esotropia and partial accommodative esotropia at Hyogo College of Medicine Hospital between 2005 and 2008 and were followed up for a period of at least 2 years. Of 53, 32 patients (average age, 4.6 years) had accommodative esotropia and 21 patients (average age, 4.5 years) had partial accommodative esotropia. After wearing glasses corrected by cycloplegics, the subjects were managed with Fresnel membrane prisms, treated surgically or followed up without treatment. We investigated the factors that had influenced their binocularity. <BR><B>Results:</B> Of the 32 patients with accommodative esotropia, 13 (41%) patients demonstrated normal stereopsis less than 100_ by Titmus stereo test and 13 (41%) patients had no stereopsis. The risk factors for poor binocularity included the initial visual acuity less than 0.3 and the eye position showing esotropia after 1-month treatment with glasses. Four patients (19%) with partial accommodative esotropia demonstrated normal stereopsis. Patients treated with Fresnel membrane prisms and those treated with a combination of Fresnel membrane prisms and strabismus surgery showed better binocularity than the patients without treatment and those treated with strabismus surgery alone. <BR><B>Conclusion:</B> In order to achieve stereopsis, it is necessary to manage the eye position within esophoria or orthophoria, with or without schedule for strabismus surgery. In addition, it is effective to wear glasses with Fresnel membrane until surgery, especially for patients with partial accommodative esotropia.<BR><B>Conclusion:</B> The maintenance of eye position is essential for good binocularity. Particularly, using Fresnel membrane prism to maintain the eye position until surgery might be effective in patients with partial accommodative esotropia.

収録刊行物

  • Japanese orthoptic journal

    Japanese orthoptic journal 40, 41-46, 2011-12-26

    公益社団法人 日本視能訓練士協会

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各種コード

  • NII論文ID(NAID)
    10030281465
  • NII書誌ID(NCID)
    AN10084015
  • 本文言語コード
    JPN
  • 資料種別
    REV
  • ISSN
    03875172
  • データ提供元
    CJP書誌  J-STAGE 
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