Effect Of Strabismus Correction Surgery In The Treatment Of Amblyopia With Strabismus

PurposeTo analyze the effects of strabismus correction before complete amblyopia correction and continuous amblyopia treatment after operation on visual improvement and visual function reconstruction in patients with strabismus complicated with amblyopia.MethodsUsing a retrospective cohort study,Patients diagnosed by the same attending physician with strabismus and amblyopia were selected.There was no improvement in amblyopia after 3 months of standard amblyopia treatment,After the re-examination of ophthalmology to exclude the related organic diseases leading to poor vision,actively change the treatment plan of amblyopia(Adjustment of refractive correction method,increase of covering time or increase/change of training program,etc.)After 3 months of follow-up,the visual acuity improvement was still less than 2 lines(international standard visual acuity chart)or could not be maintained stable.When the children and their parents’ compliance with amblyopia treatment gradually decreases and they have a strong desire to correct the eye position,they should be treated with strabismus correction,a total of 100 cases,namely the surgical group.According to the type of strabismus,the surgery group was divided into 43 cases of esotropia,48 cases of exotropia,and 9 cases of vertical strabismus.According to the age of onset,there were 39 cases in 0-3 years group,51 cases in 4-7 years group,and 10 cases in 8-12 years group.According to the age of operation,there were 58 cases in the 3-7 years group,34 cases in the 8-12 years group,and 8 cases in the 13-15 years group.According to whether the visual function was completely destroyed,85 cases were divided into the group of complete visual function destruction(no simultaneous visual function),15 cases were divided into the group of incomplete visual function(at least simultaneous visual function),Patients were selected after children and their parents understood the advantages and disadvantages and choose to continue the amblyopia training,a total of 40 cases,namely the non-surgical group.In this group,strabismus surgery was performed when binocular vision was close to balance.Visual acuity was measured by international standard visual acuity chart,and tertiary visual function(simultaneous visual function,fusion function,and stereoscopic visual function)was measured by synoptophore,Titmus near stereoscopic view method was used to measure near stereoscopic vision function.The visual acuity and visual function of patients in the surgery group and non-surgery group were compared before intervention and 1 month,3 months and 6 months after intervention.To avoid visual acuity and visual function bias caused by different strabismus types,the visual acuity and visual function of esotropia,exotropia and vertical strabismus in the operation group and non-operation group were compared before intervention and 1,3 and 6 months after intervention.Observing the difference of visual acuity and binocular vision function between operation group and operation group at 1 month,3 months,6 months and 1 year after operation.To observe the effects of strabismus correction on visual acuity and visual function in different types of strabismus,different age of onset,different age of operation,and complete or incomplete destruction of visual function before operation.Results1.The optimal corrected monocular visual acuity of amblyopia in the surgery group and non-surgery group was p>0.05 before intervention and 1 month after intervention,with no statistically significant difference between the two groups.At 3 months and 6 months after intervention,P=0.024,P=0.020,P<0.05,the differences between groups were statistically significant.Median and interquartile intervals showed that the visual acuity of the surgery group was better than that of the non-surgery group,that is to say,at 3 and 6 months after surgery,the best corrected single ocular vision of amblyopic eyes was better than that of the non-surgery group.The optimal corrected binocular vision of the surgery group and the non-surgery group was P>0.05 before intervention and 1 month after intervention,and the difference between the two groups was not statistically significant.at 3 and 6 months after intervention,P=0.017,P=0.022,P<0.05,and the difference between groups was statistically significant,That is,the optimal corrected binocular vision was also better in the surgery group at 3 and 6 months after surgery than in the non-surgery group.2.There was no statistically significant difference in visual function between the surgery group and the non-surgery group before intervention(P>0.05).The frequency and percentage of visual function showed that the visual function of the operation group was better than that of the non-operation group after intervention.The simultaneous visual function at 1,3 and 6 months after intervention was analyzed,and the results were P=0.049,P=0.044 and P=0.01,respectively,P<0.05,the difference was statistically significant.At 1,3 and 6 months after intervention,the results of fused visual function were P=0.014,P=0.046,P<0.001,P<0.05,the difference was statistically significant.That is to say,both visual function and fusion function of the surgery group were better than those of the non-surgery group after intervention.The Titmus near-stereoscopic function before intervention in the surgical and non-surgical groups were P>0.05,the difference was not statistically significant.Titmus near-stereoscopic vision function at 1,3,and 6 months after intervention were P=0.042,P=0.036,P=0.026,P<0.05,the difference was statistically significant,and with the passage of time,the significance of the difference increased gradually,That is,after intervention,the near-stereoscopic vision function of the operation group is better than that of the non-operation group.3.In the esotropia group,the best corrected monocular visual acuity and the best corrected binocular visual acuity at 3 and 6 months after intervention were p=0.020 and P=0.001,P=0.014,P=0.007,P<0.05,the difference was statistically significant.Median and interquartile intervals showed that the visual acuity of the surgery group was better than that of the non-surgery group.1 month after intervention,P=0.119(P>0.05,no statistically significant difference),P=0.025(P<0.05,statistically significant difference).In the exotropia group,the best corrected monocular visual acuity and the best corrected binocular visual acuity at 3 and 6 months after intervention were P=0.011,P=0.050,P=0.002,P=0.031,P<0,05,the difference was statistically significant.Median and interquartile intervals showed that the visual acuity of the surgery group was better than that of the non-surgery group.In the vertical strabismus group,the best corrected monocular visual acuity and the best corrected binocular visual acuity were all P>0.05,the difference was not statistically significant.The frequency of simultaneous visual function,fusion function,near and far stereoscopic visual function in the surgery group and the non-surgery group was smaller,which could not be analyzed statistically.4.For patients with strabismus complicated with amblyopia after strabismus correction,both the best corrected monocular vision and the best corrected binocular vision of amblyopia were improved compared with those before surgery.Preoperative and postoperative amblyopia at different time points of the best correction of single eye vision,P<0.0015 the progressive significant level is less than 0.05,the difference is statistically significant.The best corrected binocular visual acuity was found at different time points preoperatively and postoperatively,P<0.001,and the difference was statistically significant.5.The functional frequency and percentage of simultaneous vision,fusion vision stereoscopic vision and Titmus near-stereoscopic vision were improved at different time points before and after surgery.Statistical analysis showed that P<0.001,P=0.001,P<0.001,P=0.004,all P<0.05,and the differences were statistically significant.6.There was no significant difference in the best corrected monocular visual acuity and best corrected binocular visual acuity of amblyopic eyes between different types of strabismus in the operation group before and after operation.However,preoperative and postoperative amblyopia and binocular visual acuity in different strabismus groups were significantly different,P<0.001.The positive frequency of visual function was too low to be statistically significant.7.The difference of visual acuity distribution between different ages of onset and operation in the operation group was statistically significant,which was consistent with visual acuity development characteristics.The best corrected monocular vision and the best corrected binocular vision in amblyopic eyes showed proggessive significance(P<0.05),except that the optimal corrected binocular vision before surgery and the optimal corrected binocular vision in amblyopic eyes showed no statistical significance at all time points in each group before surgery and after surgery,P=0.095(P>0.05).The difference was statistically significant.The positive frequency of visual function was too low to be statistically significant.8.The surgery group was divided into complete destruction group and incomplete destruction group according to whether the preoperative three-level visual function was completely destroyed.The best corrected monocular visual acuity and the best corrected binocular visual acuity of amblyopia were both P>0.05 between the two groups before and after operation,and the differences were not statistically significant.In the group with complete destruction of tertiary visual function,the best corrected monocular visual acuity and the best corrected binocular visual acuity of amblyopia were improved at different time points before and after surgery.The statistical analysis showed that P<0.001 and P<0.001 showed progressive significance,and the differences were statistically significant,and the best corrected monocular vision before surgery and 1 month,3 months,6 months and 1 year after surgery showed P<0.001,P<0.001,P<0.001,P<0.001,all P<0.05,and the difference of vision improvement was statistically significant.In the group with incomplete visual function,the best corrected monocular visual acuity of amblyopic eyes at different time points before and after surgery was significantly different,P<1.000,showing gradual significance.The differences between preoperative and postoperative 1 month,3 months,6 months and 1 year were statistically significant,P=1.000(P>0.05,no statistical significance),P=0.039,P<0.001,P<0.001.That is to say,the improvement in vision was meaningful.Although the difference between preoperative and postoperative time points was gradually significant,the differences between preoperative and postoperative time points were P=1.000,P=1.000,P=0.433 and P=0.179,all P>0.05,and the difference was not statistically significant.Conclusion1.For patients with strabismus combined with amblyopia,if the visual acuity improvement is not very good after amblyopia treatment,the best corrected monocular acuity and the best corrected binocular acuity of amblyopia after strabismus correction surgery have good improvement compared with the patients with amblyopia training only.2.Simultaneous visual function,visual function,fusion function,far-stereosco-p is function and Titmus near-stereoscopic vision function can be recovered ear-li er because of the early correction of strabismus position.3.The optimal corrected monocular vision and binocular vision of amblyopic eyes can be effectively improved after continuous treatment of amblyopic eyes with different strabismus types,age of onset and age of operation,and binocular vision function is also improved after operation.4.Strabismus correction is beneficial for amblyopia in improving the best corrected monocular visual acuity and the best corrected binocular visual acuity regardless of whether the preoperative tertiary visual function is completely destroyed.