摘要：
目的:探讨视功能参数对集合不足患者视疲劳症状的影响,以期找到能反映集合不足患者视疲劳程度的相关指标.方法:回顾性研究.从2013年7月至2017年7月温州医科大学附属眼视光医院就诊的集合不足患者中,随机抽取58例,年龄为(22.7±9.3)岁,排除斜视、眼部疾病、外伤史、屈光参差以及调节功能障碍.根据视疲劳症状问卷(CISS)总分按疲劳程度由重到轻分为重度组、中度组、轻度或无症状组3组,其中重度组20例,中度组19例,轻度或无症状组19例,分析其远/近隐斜量(PD/PN)、近距BO侧模糊点(PB)、恢复点(PR)与视疲劳程度的关系.使用Sheard法则Psheard=2/3PN-1/3PB以及隐斜与恢复点差值PR-N=PR-PN(PD/PN为外隐斜,计算用正数)进行计算.Psheard大于0说明不满足Sheard法则,PR-N小于0说明恢复点小于隐斜.使用方差分析进行数据比较.结果:视疲劳重度组(-9.5△±4.1△),中度组(-5.0△±3.1△),轻度或无症状组(-13.6△±5.4△)的PN比较差异有统计学意义(F=19.458,P＜0.001).3组间PB、PR差异均无统计学意义.3组Psheard值(重度组为1.9△±3.0△,中度组为-2.1△±3.0△,轻度或无症状组为3.4△±3.1△)差异有统计学意义(F=16.670,P＜0.001),中度组与轻度或无症状组、重度组之间差异均有统计学意义(均P＜0.05).中度组Psheard小于0,说明满足Sheard法则.轻度或无症状组和重度组Psheard大于0,不满足Sheard法则.重度组PR-N值为-5.6△±3.2△(95％CI:-7.4△,-4.3△),中度组为0.6△±4.6△(95％CI:-1.6△,2.9△),轻度或无症状组为-11.6△±6.5△(95％CI:-14.8△,-8.5△),3组间差异有统计学意义(F=29.127,P＜0.001),组间两两比较差异均有统计学意义(均P＜0.05).结论:隐斜和恢复点的关系对集合不足患者的视疲劳症状有影响,当恢复点小于或略大于隐斜量,即PR-N＜2.86△(中度组95％CI),容易出现视疲劳.当PR-N＜-8.49△(轻度或无症状组95％CI),可能发生近距的间歇性抑制,症状反而减轻.%Objective:To investigate the effect of vergence parameters on asthenopia of patients with convergence insufficiency,and find some parameters to reflect the level of asthenopia.Methods:We recruited 58 patients with convergence insufficiency from Eye Hospital,Wenzhou Medical University (34 Males,24 Female,Age 22.7±9.3 year) randomly,excluding strabismus,eye disease,trauma,anisometropia and dysfunction of accommodation.We divided these patients into three groups according to the values of symptom questionnaires using CISS,20 patients insevere group,19 patients in moderate group,and 19 patientsin mild group,respectively,We analyzed the near phoria (PD/PN),blur point (PB) for near,the relationship between recover point (PR) and level of asthenopia.We used the Sheard's rule:PSheard=2/3PN-1/3PB,and the difference value between phoria and recovery point:PR-N=PR-PN (PD/PN was exophoria using positive value).Psheard＞0 means it was not match the Sheard's rule.PR-N＜0 meaned recover point was smaller than phoria.So using the analysis of Variance (ANOVA).Results:PN in sever group (-9.5△±4.1 △),moderate group (-5.0△±3.1 △),mild group (-13.6△±5.4△),the difference between each two groups were significant (F=19.458,P＜0.001).There were no significant difference among these three groups on PB and PR (P＞0.05).Psheard in sever group,moderate group and mild group was 1.9△±3.0△,-2.1△±3.0△,3.4△±3.1△,respectively,with significant difference (F=16.670,P＜0.001).There were statistically significant difference between moderate group and mild group,and between moderate group and severe group (P＜0.05).In moderate group,Psheard＜0,meaned it matched the Sheard's rule.The other two groups could not match the Sheard's rule.PR-N in sever,moderate,mild group was (-5.6△±3.2△;95％CI:-7.4△,-4.3△),(0.6△±4.6△;95％CI:-1.6△,2.9△),(-11.6△±6.5△;95％CI:-14.8△,-8.5△),respectively,with significant difference (F=29.127,P＜0.001).There were statistically significant difference between each two groups (P＜0.05).Conclusions:The relationship between phoria and recover pointwill influence the grade of asthenopia of CI patients.Asthenopia may appear when the value of recover point is close to phoria,if PR-N is smaller than 2.86△ (95％CI of moderate group).And intermittent suppression may appear at near tasks to alleviate symptoms,while PR-N is smaller than-8.49△ (95％CI of mild lever group).
