立体視機能が不良な不同視弱視症例の検討 Factors influencing stereoacuity outcome in anisometropic amblyopia

<B>目的：</B>治療後の立体視機能が不良な不同視弱視症例の特徴を検出すること。<BR><B>対象及び方法：</B>不同視差1.00D以上、乱視度1.50D以下で神経学的に異常のない遠視性不同視弱視で、治療後の最高矯正視力が0.8以上の27例を対象とした。調節麻痺薬使用下で屈折検査を行い、完全矯正眼鏡を処方し部分遮閉を行った。TNOステレオテスト（以下TNO）の結果によってA群：120″以下の21例、B群：120″が獲得できなかった6例の2群に分類し、1．遮閉時間　2．不同視差と治療前視力　3．不同視差と遮閉時間　4．治療前視力と遮閉時間　5．治療前後の立体視機能の変化について統計学的に比較した。<BR><B>結果：</B>1．遮閉時間は、両群の間に有意差は認めなかった。2．A群では不同視差と治療前視力の間に有意な相関が認められた（p<0.01）が、B群では認めなかった。3．不同視差と遮閉時間との間には、両群ともに有意な相関は認めなかった。4．A群では治療前視力と遮閉時間との間に有意な相関が認められた（p<0.05）が、B群では認めなかった。5．両群間の治療前後の立体視の変化に有意差が認められた（p<0.001）。<BR><B>結論：</B>立体視機能が不良な症例は、不同視差と治療前視力、治療前視力と遮閉時間の間に相関は認めなかった。

<B>Purpose:</B> To determine the factors in abnormal stereoacuity(worse than 120 seconds of arc by TNO stereo test-TNO) in patients with anisometropic amblyopia.<BR><B>Subject and methods:</B> We retrospectively reviewed the charts of 27 patients with anisometropic amblyopia who had the best corrected visual acuity of >0.8 after treatment.Inclusion criteria were:anosometropia≥1.00 diopter, astigmatism≤1.5 diopter, absence of ocular and neurological disorders. We prescribed a complete correction glasses by cycloplegic refraction and part time occlusion. The patients were divided into two groups by the best TNO stereoacuity: group A with 21 patients who had stereoacuity of 120 seconds of arc or better;and group B with 6 patients who had stereoacuity worse than 120 seconds of arc. We statistically analyzed between the two groups;(1)total amount of occlusion worn (hours) to achieve the best visual acuity;(2)a correlation between the degree of anisometropia and the initial visual acuity;(3)a correlation between the degree of anisometropia and total amount of occlusion worn;(4)a correlation between the initial visual acuity and total amount of occlusion worn;(5)the improvement of stereoacuity before and after treatment.<BR><B>Result:</B> (1)Total amount of occlusion worn was not significantly different between the two groups. (2)As for group A, a significant correlation was identified between the degree of anisometropia and the initial visual acuity (p<0.05) whereas as for group B, no significant correlation was identified. (3) Between both groups, there was no significant correlation identified between the degree of anisometropia and total amount of occlusion worn.(4) As for groups A, there was a significant correlation between the initial visual acuity and total amount of occlusion worn (p<0.05) whereas ,for group of B, no significant correlation was identified.(5) Between the two groups, a significant difference was identified in the improvement of stereoacuity before and after treatment between two groups(p<0.001).<BR><B>Conclusion:</B> For patients with abnormal stereoacuity, there was no significant correlation identified between 1)the degree of anisometropia and the initial visual acuity and 2)between the initial visual acuity and total amount of occlusion worn.