| Amblyopia and strabismus are the most common eye diseases in children that affect the binocular visual function and visual development. The dysfunction of binocular visual, wearing glasses, patching and strabismus surgery(strabotomy) bring much inconvenience to children and the influence of psychological health are considerable, such as social anxiety, loneliness, self-esteem instability, personality change, severe surgically induced stress reactions and poor memory, etc, which have become important manifestations of psychologically unhealthy. The individual characteristics of children(gender, age, the type and level of amblyopia or strabismus), therapies, compliance, family(parents’ education, living condition) social support, and multiple factors that interact comprehensively affect the mental health development of amblyopia and strabismus children. Therefore, we focus on the medical psychological treatment which is mental and physical factors affecting the system research in strabismus and amblyopia of children, discuss the disease for the promotion of mental health and unfavorable factors and intervention effects on psychological health, establish effective interventions and improve children’s quality of life, provide powerful scientific guidance to reasonable use the intervention treatment of medical and psychological.Objective:The purpose of this study was to investigate the effects of psychological characteristics and influencing factors, to reveal the mental health impact on characteristics by using medical interventions and psychological support therapy on amblyopia children and analyze the psychological characteristics of strabismus children and the influence of different preoperative interventions in perioperative period.Methods: 1. Patients selection: 171 children between 3-13 years of age with a confirmed diagnosis of strabismus and amblyopia, including 140 of strabismus and amblyopia(91 of strabotomy), 31 of healthy participants in our department between 2011~2012. In addition, all participants were further devided by the type of amblyopia with strabismic, anisometropic, both strabismus and anisometropia, the level with mild, moderate and severe, the type of strabismus with esotropia, exotropia and special types of strabismus, the strabismus angle with ≤30△ group and >30△ group, the age groups with 7~8 years old, 9~10 years old and 11~13 years old. All participants rule out other systemic diseases. 2. Main outcome measurements: The visual acuity(Snellen chart), ocular motility examination, binocular vision, cycloplegic refraction(1% atropine sulfate and retinoscopy) and ocular examinations. Cases were followed every 1 month or 2 months, and measured the refraction each year cycloplegiccally. Therapies: ⑴ With spectacle for the BCVA. ⑵ Occlusion therapy: fellow eye with part-time(4~6h/d) and full-time(>6h/d) patching regimens, respectively. ⑶ Strabotomy. 3. Intervention treatment 3.1. Intervene for amblyopia: refraction group, refraction with patching group. 3.2. Intervene for preoperative of strabotomy: midazolam group, psychological intervention group and control group. 4. Outcome measures 4.1. Psychological scale for amblyopia and strabismus, including SASC, SES, CLS and EPQ-Junior. 4.2. Psychological scale preoperative period, including m YALE, ICC, PAED, PHBQ, STA-I and Measuring for memory. 5. Statistical analysis: All data was analyzed using SPSS version 17.0(SPSS Inc., Chicago, IL), including descriptive statistics, paired t test, one-way ANOVA, LSD test. P values ≤ 0.05 were considered significant.Results Part I: Assessment the difference of psychological scale index between three diagnosis groups, the statistically significant differences were found(p=0.001, p=0.003) in SASC and EPQ-E. SASC of control group(3.45±2.93) was differed low index than that of strabismus group(6.10±3.01, p=0.001), amblyopic group(4.33±3.23, p=0.01) and the S&A group(6.02±2.39, p=0.001), but the S&A group was highly index than that of the amblyopic group(p=0.003). EPQ-E of strabismus group(16.22±4.36) and S&A group(15.72±4.34) was differed low index significantly than that of the control group(19.06±4.47, p=0.003, p=0.001), but the amblyopic group(17.96±4.13) was highly index than that of the S&A group(p=0.04). Part Ⅱ: 1. Intervention of medical therapy and psychology support therapy on amblyopia children Amblyopia children in the intervention of medical treatment and psychological support therapy period, who had best compliance for patching about 100%, the 23 cases of 4-6h/d patching had good compliance(100%), in the 7 cases of >6 h/d patching group, 5 cases had good compliance and 7 cases had poor compliance. ⑴ After intervention treatment: Index of CLS(8.83±5.62, p=0.001) and CSES(5.00±3.21, p=0.001) had notable decreasing, The index of EPQ-P(-0.88±0.71) was increasing(p=0.001). ⑵ After intervention of refractive error correction: Index of CLS(8.67±7.14, p=0.001), CSES(6.35±11.66, p=0.005) and SASC(2.03±2.49, p=0.001) had notable decreasing. The index of EPQ-P(-0.58±1.45) was increasing(p=0.001). After intervention of refractive error correction and patching: the index of CLS(9.00±3.46) was increasing(p=0.001). The index of SASC(-1.31±2.63, p=0.01), EPQ-P(-1.24±1.92, p=0.002) had notable decreasing. ⑶ The CSES and SASC of the refractive error correction and patching group were highly index than that of the refractive error correction group(97.66±10.03 vs. 90.42±11.19, p=0.01; 6.41±2.39 vs. 3.55±1.31, p=0.001). 2. Effects of perioperative anxiety, memory and psychological characteristics by intervention of medicine and psychological in strabotomy children 2.1. Effects of psychological characteristics by intervention of medicine and psychology in perioperative of strabotomy children ⑴ The m YPAS-T3 of control group(56.43±13.46) was high index than that of themidazolam group(44.13±9.28, p=0.001), psychological intervention group(44.07±8.49, p=0.002), respectively. ⑵ The ICC of control group(2.36±.96) was high index than that of the midazolam group(0.12±0.43, p=0.01), psychological intervention group(1.00±1.48, p=0.001), respectively. ⑶ The PAED of three intervention groups were not significant differences among groups(p>0.05). ⑷ The forgetting-rate of midazolam group(0.74±0.29) was high index than that of the psychological intervention group(0.00±0.00, p=0.001) and the control group(0.00±0.00, p=0.001), respectively. 2.2. The characteristics of m YPAS in perioperative of strabotomy children(Difference value) The index of m YPAS-T2(-8.81±10.52, p=0.001), T3(-16.81±14.39, p=0.001), T4(-8.01±16.93, p=0.001) was increasing compared with T1. The index of m YPAS-T3 group was increasing than that of the T2(8.01±9.45, p=0.001), T4(8.79±15.04, p=0.001). 2.3. The characteristics of STAI-2 of parents during perioperative of strabotomy children ⑴ The index of STA-I was increased(t=7.63, p=0.001), the result had positive correlation(r=0.52, p=0.001). ⑵ The STAI-2 of parents of midazolam group was lower index than that of the control group(64.27±11.83 vs. 73.42±15.60, p=0.007). 2.4.The psychological characteristics after strabotomy of children(Difference value) ⑴ The index of PHBQ-2 was decreasing with PHBQ-1(11.78±7.15, p=0.001). The index of PHBQ-3 group was increasing index than that of the PHBQ-2(11.61±11.24, p=0.001). ⑵ The index of PHBQ-1 of midazolam group was lower index than that of the psychological intervention group(92.14±3.34 vs. 84.36±8.90, p=0.04).Conclusions: Part I. Assessment the difference of psychological scale index in 171 cases, the results showed that social anxiety: S&A>strabismus>amblyopia, EPQ-E(extrovisionintrovision): S&A-strabismus-amblyopia. EPQ-P had notable high in S&A children. The male children had notable high psychoticism index in each groups. ⑴ Strabismus children: The female children had notable high self-esteem index. The non-spectacle of children had marked social anxiety. ⑵ Amblyopic children: The age of 9-10 y, mild amblyopia, and non-patching children had high loneliness index. The moderate amblyopia and patchingchildren had marked social anxiety. The children with spectacle were emotional instability. ⑶ S&A children: The psychoticism show: special types of strabismus>strabismus> amblyopia. The children with esotropia had marked lie index. The mild amblyopia of children showed an extroversion personality. The patching group had high self-esteem index. The non-patching group had high neuroticism index. The children with spectacle had neuroticism personality. Part II. Assessment the differences of psychological scale index in 60 cases of amblyopia and 91 cases of strabismus by intervention treatment. ⑴ Amblyopia treatment combined psychological support therapy: the patching of children had 100% of the compliance rates, the good compliance was 89.2%. Comparation: the comprehensive intervention therapy restrained the children’s loneliness and self-esteem growth, but the psychoticism index was increased. The spectacle & patching therapy restrained the children’s loneliness, but social anxiety and psychoticism index were increased, in this group, children had high self-esteem and seriously social anxiety. ⑵ Strabotomy children: The age of 7-8y children had seriously anxiety before entering the operating room 1 day and on surgery day, and had high anaesthesia emergence delirium index. The children living in the city had high loneliness. The children with strabismus angle >30△, the parents had great anxiety. In surgical history group, the children had high induction compliance index, anaesthesia emergence delirium and anxiety before entering the operating room 1 day. The midazolam and psychological intervention of strabotomy children had good results of preoperative anxiety and induction compliance, especially, the midazolam group had great forgetting-rate(74%). Postoperative, the parents’ anxiety was decreasing, and the midazolam group had greatly decreasing. The children’s behavior had significant changes in postoperative 1 week; the index decreased in 1 month, the behavior had significant decrease in 6 month postoperatively. Moreover, the midazolam group had good behavior changes than psychological intervention group. |
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