■本研究旨在探讨增强现实(AR)可塑性模型对合并外斜视患儿术后视功能恢复的临床应用效果。
在2019年9月至2021年10月期间,在深圳市儿童医院就诊的28例合并外斜视患者(男9例,女19例)被纳入本研究。患者的平均年龄为6.4±1.8岁。术后康复训练采用基于患者检查结果开发的个性化AR双眼视知觉可塑性模型进行。一个月后,3个月,6个月的训练,患者返回医院进行感知眼位检查,静态零阶立体视觉,动态一阶精细立体视觉,和动态二阶粗立体视觉来比较眼位控制和立体视觉功能的变化。
■经过6个月的眼位训练,28例患者的水平感知眼位明显低于训练前。第1个月和第3个月眼位与训练前比较差异无统计学意义(第1个月:z=-2.255,p=0.024>0.017;第3个月:z=-2.277,p=0.023>0.017;第6个月:z=-3.051,p=0.002<0.017)。训练后垂直感知眼位与训练前比较差异无统计学意义(第1个月:z=-0.252,p=0.801>0.017;第3个月:z=-1.189,p=0.234>0.017;第6个月:z=-2.225,p=0.026>0.017)。训练前后0.8-m静态零阶立体视觉差异无统计学意义(第1个月:z=-2.111,p=0.035>0.017;第3个月:z=-1.097,p=0.273>0.017;第6个月:z=-1.653,p=0.098>0.017)。1.5米静态零阶立体视觉在1个月后有所改善,3个月,与训练前相比,训练6个月(第1个月:z=-3.134,p=0.002<0.017;第3个月:z=-2.835,p=0.005<0.017;第6个月:z=-3.096,p=0.002<0.017)。在训练前后对28例患者进行了动态一阶精细立体视觉和动态二阶粗立体视觉测量。患者1和18在训练前没有动态一级精细立体视觉,但两个月后都恢复了动态立体视觉,3个月,6个月的训练。患者16在训练前没有动态一阶精细立体视觉或动态二阶粗立体视觉,但是一阶和二阶立体视觉在1个月后被重建,3个月,6个月的训练。
■伴随的外斜视手术改善了眼肌水平的基本问题,但患者的知觉眼位和大脑视觉水平的视觉功能缺陷仍然存在。这可能部分解释了术后临床效果不佳。AR可塑性模型可以改善患者的水平感知眼位和多维立体功能,其临床效果值得进一步研究。
UNASSIGNED: This
study aimed to investigate the clinical application effect of an augmented reality (AR) plasticity model on the postoperative visual function recovery of children with concomitant exotropia.
UNASSIGNED: Between September 2019 and October 2021, 28 patients with concomitant exotropia who visited Shenzhen Children\'s Hospital (9 male and 19 female) were enrolled in this
study. The average age of the patients was 6.4 ± 1.8 years. Postoperative rehabilitation training was conducted using a personalized AR binocular visual perception plasticity model developed based on the patient\'s examination results. After 1 month, 3 months, and 6 months of training, the patients returned to the hospital for examinations of perceptual eye position, static zero-order stereopsis, dynamic first-order fine stereopsis, and dynamic second-order coarse stereopsis to compare the changes in eye position control and stereovision function.
UNASSIGNED: After 6 months of eye position training, the horizontal perception eye position of the 28 patients was significantly lower than that before training. The difference in eye position at the first and third months compared with that before training was not statistically significant (1st month: z = -2.255, p = 0.024 > 0.017; 3rd month: z = -2.277, p = 0.023 > 0.017; 6th month: z = -3.051, p = 0.002 < 0.017). The difference in vertical perceptual eye position after training compared with that before training was not statistically significant (1st month: z = -0.252, p = 0.801 > 0.017; 3rd month: z = -1.189, p = 0.234 > 0.017; 6th month: z = -2.225, p = 0.026 > 0.017). The difference in 0.8-m static zero-order stereopsis before and after training was not statistically significant (1st month: z = -2.111, p = 0.035 > 0.017; 3rd month: z = -1.097, p = 0.273 > 0.017; 6th month: z = -1.653, p = 0.098 > 0.017). The 1.5-m static zero-order stereopsis was improved after 1 month, 3 months, and 6 months of training compared with that before training (1st month: z = -3.134, p = 0.002 < 0.017; 3rd month: z = -2.835, p = 0.005 < 0.017; 6th month: z = -3.096, p = 0.002 < 0.017). Dynamic first-order fine stereopsis and dynamic second-order coarse stereopsis were measured in the 28 patients before and after training. Patients 1 and 18 had no dynamic first-order fine stereopsis before training, but both regained dynamic stereopsis after 1 month, 3 months, and 6 months of training. Patient 16 had no dynamic first-order fine stereopsis or dynamic second-order coarse stereopsis before training, but first-order and second-order stereopsis had been reconstructed after 1 month, 3 months, and 6 months of training.
UNASSIGNED: Concomitant exotropia surgery improved the basic problem of eye position at the ocular muscle level, but the patient\'s perceptual eye position and visual function defects at the brain visual level remained. This might partly explain the poor postoperative clinical effect. The AR plasticity model can improve patients\' horizontal perceptual eye position and multi-dimensional stereoscopic function, and its clinical effect warrants further
study.