Incidence, risk factors and management of intractable diplopia
Incidence, risk factors and management of intractable diplopia
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DOI：
10.1136/bjophthalmol-2017-310454
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发表时间：
2018-03-01
影响因子：
4.1
通讯作者：
Harrad, Richard A.
中科院分区：
文献类型：
--
作者：
Newsham, David;O'Connor, Anna R.;Harrad, Richard A.
目的关于顽固性复视的文献很少。本研究的目的是确定英国难治性复视的发病率，确定原因和任何相关的危险因素，确定如何处理病例，以及治疗是否成功和耐受。方法通过英国眼科监测单位（BOSU）进行为期1年的前瞻性观察研究。这涉及到报告机制的实施，随后触发事件调查问卷的分发，以了解每个病例的临床细节，并在6个月后进行随访调查问卷，以了解病例的处理情况。结果顽固性复视发生率为53例/年。最常见的既往事件是斜视手术（32%），无已知既往事件，即自发性（25%），严重头部创伤（8%），白内障手术（6%）和玻璃体切除术（6%）。在7岁及以上的高危年龄组中，斜视手术后顽固性复视的发生率为1 / 494 （95% CI; 1 / 296 - 790）。总共使用了九种不同的治疗方法，许多患者接受了两到四种不同的治疗方法。总体成功率较低，但最有效的是不透明人工晶体（iol）（86%）和不透明隐形眼镜（50%）。结论顽固性复视是一种较为罕见但重要的疾病。主要的危险因素是先前存在的斜视，当没有明显的双眼功能的患者计划手术矫正时，需要仔细的咨询。使用不透明人工晶状体治疗顽固性复视的成功率很高，尽管有额外的风险，但通过其他方法很难成功根除复视的效果往往令人失望。
Aims There is a paucity of literature concerning intractable diplopia. The aims of this study were to determine the incidence of intractable diplopia in the UK, identify the causes and any associated risk factors, establish how cases are managed and if the treatment is successful and tolerated.Methods A 1-year prospective observational study was undertaken via the British Ophthalmological Surveillance Unit (BOSU). This involved implementation of a reporting mechanism, which then triggered distribution of an incident questionnaire to explore clinical details concerning each case and a follow-up questionnaire 6months later to explore how the case had been managed.Results The incidence of intractable diplopia was 53 cases per year. The most common preceding events were strabismus surgery (32%), no known preceding event, that is,spontaneous (25%), severe head trauma (8%), cataract surgery (6%) and vitrectomy (6%). In the at-risk age group of 7years and above, the incidence of intractable diplopia following strabismus surgery is 1 in 494 (95% CI; 1 in 296 to 790) cases. A total of nine different treatments were used in the management, with many patients receiving between two and four different methods. The overall success rate was poor, but most effective were opaque intraocular lenses (IOLs) (86%) and opaque contact lenses (50%).Conclusion Intractable diplopia is a relatively rare but important condition. The main risk factor is a pre-existing strabismus, and careful counselling is needed when planning surgical correction in patients with no demonstrable binocular function. Treatment success of intractable diplopia is high when using opaque IOLs, although with additional risk, but is often disappointing via other methods where it can be difficult to eradicate the diplopia successfully.