下斜肌转位术与下斜肌切断术治疗斜视V征的比较

目的 比较下斜肌转位术(AT)与下斜肌切断术在治疗下斜肌功能亢进引起的斜视V征的作用.方法 回顾性分析行下斜肌转位术治疗的伴有下斜肌功能亢进,同时合并分离垂直性斜视(DVD)的28例斜视V征患者,术前下斜肌功能亢进程度为+1～+3,V征差值不超过30PD,根据双眼下斜肌功能亢进对称性以及双眼或单眼行下斜肌转位术,分为双眼AT组(15例)和单眼AT组(13例),与历史同期行下斜肌切断术治疗的伴有下斜肌功能亢进,不合并DVD的28例斜视V征患者进行非随机埘照研究,对照组根据下斜肌功能亢进对称性及双眼行对称或非对称下斜肌切断术,相应地分为对照1组(15例)和对照2组(13例),分别测最手术前后V征筹值,比较手术矫正V征差值并进行统计学分析.结果 双眼AT组平均矫正V征差值(15.67±4.03)三棱镜度(PD),对照1组平均矫正(15.20±3.51)PD,两组差异无统计学意义(t=0.338,P＞0.05);单眼AT组平均矫正v征差值(14.69±3.71)PD,对照2组平均矫正(14.00±3.94)PD,两组差异无统计学意义(t=0.462,P＞0.05).结论 下斜肌转位术与下斜肌切断术治疗下斜肌功能亢进引起的V征斜视疗效无差别.     

下斜肌后固定手术的临床效果

目的：探讨下斜肌后固定术在下斜肌亢进合并小角度上斜视以及V型斜视中的应用效果。方法：回 顾性系列病例研究。收集2017年10月至2018年10月在天津市眼科医院行下斜肌后固定手术的患者 资料16例（22眼）,8例为单眼上斜肌麻痹合并下斜肌亢进,2例为水平斜视合并原发单眼下斜肌亢进 +,6例为V型斜视（3例外斜V征,3例内斜V征）合并原发双眼下斜肌亢进（+～++）。10例患者原在 位轻度上斜视（≤5 PD）。合并水平斜视者均同期予以矫正。术后随访3～6个月。对比分析手术前 后原在位垂直斜视度,V征程度以及眼底客观旋转状态的改变。数据采用配对t检验进行统计分析。 结果：10例上斜视患者术前原在位垂直斜视度为4.9△±1.0△,术后原在位垂直斜视度为0.1△±0.3△, 差异有统计学意义（t=19.24,P<0.001）。V征合并双眼下斜肌亢进组术前上转25º和下转25º斜视度 差值为18.3△±3.2△,术后上转25º和下转25º斜视度差值为1.7△±2.3△,减小了16.6△±2.1△;6例V 征患者术前黄斑中心凹-视盘中心夹角度数（FDA）为13.1°±4.3°,术后FDA为5.4°±3.4°,减小了 7.7°±0.9°。上斜肌麻痹组术前FDA为10.6°±4.2°,术后FDA为4.4°±2.4°,差异有统计学意义（t=5.80, P<0.001）。术前下斜肌亢进程度为1.5（+）±0.5（+）,术后下斜肌亢进程度为0.1（+）±0.4（+）。结论： 单眼下斜肌后固定术可以减弱下斜肌亢进并矫正小度数上斜视,双眼下斜肌后固定术可以矫正轻中 度下斜肌亢进并改善V征。     

改良下斜肌切断术治疗伴下斜肌功能亢进的V型斜视

目的：探讨改良下斜肌切断术治疗伴下斜肌功能亢进的 V 型斜视的疗效。方法对68例（106眼）伴下斜肌功能亢进的 V 型斜视行改良下斜肌切除联合水平直肌后退及（或）缩短术,术后观察评价下斜肌功能、眼位及双眼单视功能。结果术后100眼（94.3%）下斜肌功能亢进消失、6眼（5.6%）下斜肌亢进、无下斜肌功能不足者。术前水平斜视角平均64.5△,术后9.2△,术前垂直斜视角平均15.8△,术后随访为2.2△,平均降低13.6△。术前7例（12.5%）有双眼单视功能,术后47例（73.5%）有不同程度的双眼单视功能。结论改良下斜肌切断术是伴下斜肌功能亢进的 V 型斜视的有效术式。     

V型斜视69例的手术疗效分析

目的：探讨伴有下斜肌功能亢进的V型斜视的临床特征及手术效果。 方法：对2009-02/2010-12我院收治的69例伴有下斜肌功能亢进的V型斜视患者行下斜肌减弱联合水平肌手术,观察手术前后眼位及斜肌功能的变化。 结果：术后眼位正位者65例（94.20%）,V征消失64例（92.75%）,19例（27.54%）伴代偿头位者均得到改善,15例（21.74%）患者术后行同视机训练后恢复双眼单视功能。 结论：下斜肌功能亢进是V型斜视发病的主要原因,下斜肌减弱术是治疗V型斜视的有效手术方式。     

下斜肌肌腹转位术治疗轻度下斜肌亢进伴小度数垂直斜视

目的：观察下斜肌肌腹转位(IOBT)术在单眼下斜肌轻度亢进伴小度数垂直斜视中的应用效果。

方法：回顾性分析2019-09/2021-08在我院行IOBT术的患者,纳入标准为单眼下斜肌轻度亢进(2+及以下),并伴有轻度非共同性垂直斜视(4～9PD)。水平斜视按照常规手术量和方式设计,同期单侧下斜肌亢进眼行单眼IOBT术。观察手术前后水平斜视度、垂直斜视度、侧方注视位垂直斜视度、黄斑视盘夹角及下斜肌亢进程度等。

结果：纳入病例共16例16眼,年龄4～39岁。1例为先天性内斜视术后5a,单眼上斜肌轻度麻痹继发下斜肌功能亢进,余15例均为原发性下斜肌功能亢进伴水平斜视。随访时间为3～6mo。术前和术后平均下斜肌亢进程度分级分别为+2.00(2.00,2.00)级和0.00(0.00,0.00)级(Z=-3.704,P<0.001),平均改善2.00(1.25,2.00)级; 水平斜视度从术前69.13±25.86PD减少到术后2.75±2.59PD(t=9.929,P<0.001); 第一眼位垂直斜视从术前7.44±1.32PD减少到术后1.00±1.21PD(t=22.335,P<0.001),平均矫正上斜视为6.44±1.15PD; 侧方注视垂直斜视从术前12.44±2.73PD减少到术后3.00±2.13PD,平均矫正9.44±2.73PD(t=13.819,P<0.001)。黄斑中心凹-视盘中心夹角度数(FDA)术前为-8.85°±6.53°,术后为-6.49°±7.01°(t=-2.384,P<0.001),平均减少2.36°。未见术后过矫及下斜肌功能不足等并发症。

结论：IOBT术对矫正单侧轻度下斜肌亢进伴小度数垂直斜视是安全有效的。     

伴有下斜肌功能亢进外斜V征眼外肌myogenin的研究

目的：：观察伴有下斜肌功能亢进的外斜V征患者下斜肌和内直肌中myogenin活性卫星细胞数量的变化,探讨伴有下斜肌功能亢进的外斜V征的可能发病原因。方法：将伴有下斜肌功能亢进外斜V征患者6例中切除的下斜肌及内直肌作为斜视组,行myogenin免疫组织化学染色,统计myogenin阳性染色的卫星细胞核数;角膜移植供体的下斜肌及内直肌(6例)作为对照组。结果：斜视组和对照组下斜肌中myogenin免疫染色阳性肌卫星细胞数占总细胞数比例分别为(22.7±7.03)%和(4.2±0.75)%,具有统计学差异(P<0.05)。斜视组和对照组内直肌中myogenin免疫染色阳性的肌卫星细胞数分别为(2.2±0.75)%和(4.5±1.05)%,具有统计学差异(P<0.05)。结论：首次报道伴有下斜肌功能亢进外斜V征患者眼外肌中表达 myogenin 免疫染色阳性肌卫星细胞的变化。myogenin可能是伴有下斜肌功能亢进外斜 V 征的致病因素。     

眼底照相法在下斜肌亢进诊断和疗效评估中的应用

目的以眼底照相为客观性定量检查方法，结合临床观察下斜肌功能异常（原发性下斜肌亢进，继发于先天性上斜肌麻痹的下斜肌亢进）患者手术前后的客观旋转状态，探讨其在诊断和疗效评估中的作用。方法使用日本Canon眼底照像机拍摄眼底像，使用Auto CAD R14绘图软件测量黄斑中心凹-视盘中心夹角度数（forea-disc angle，FDA）。其中正常人70例（140眼），下斜肌功能亢进患者29例（58眼）。结果本研究中正常人的FDA为：右眼5.24°±2.63°，左眼6.68°±2.86°，双眼总FDA为11.92°±4.24°,双眼之差为3.11°±2.11°。18例先天性上斜肌麻痹患者中16例（占89％）的FDA超出正常值范围，11例原发性下斜肌亢进患者中9例（占82％）的FDA超出正常值范围，表现为外旋转斜视。V征与外旋转有关。斜肌手术后眼底的FDA均趋于正常。下斜肌亢进的程度越强，V现象越明显，眼底照相显示的FDA超出正常值越多，术后改善得越明显。结论眼底照相技术可以客观描述旋转斜视患者的眼球旋转状态，为临床诊断提供了可靠的依据，对手术方式的选择有指导意义，也可对手术效果做出评价。     

外斜V征的手术探讨

目的探讨外斜V征的特征及手术效果。方法外斜V征患者44例,依据是否伴有下斜肌功能亢进及亢进程度,行下斜肌切断/部分切除联合常规水平直肌手术或水平直肌垂直移位术。所有患者常规矫正相应的水平斜度。观察手术前后的眼位、斜肌功能和双眼视觉。结果下斜肌切断/部分切除适用于下斜肌功能亢进＋＋以上的V征,水平直肌垂直移位术适用于无下斜肌功能亢进或下斜肌功能亢进＋的V征。结论下斜肌功能异常是外斜V征的主要原因,应依据是否伴有斜肌功能亢进、亢进程度决定行下斜肌手术或水平直肌垂直移位术。     

外斜Ⅴ征的手术治疗

目的探讨外斜V征不同术式的手术效果。方法48例外斜V征,32例行下斜肌部分切除或后退术,联合外直肌后退及内直肌缩短,16例行水平直肌垂直移位术,联合外直肌后退及内直肌缩短（其中4例联合上直肌肌止端向鼻侧移位）,观察手术前后的眼位、下斜肌功能和双眼视觉的情况。结果术后第一眼位正位者45例,V征消失或缓解者43例,双眼视恢复者17例。结论下斜肌部分切除或后退术适用于下斜肌功能亢进的外斜V征,水平直肌垂直移位术适用于无下斜肌功能亢进的外斜V征。     

外斜V征的手术探讨

目的:探讨外斜V征的手术方法及效果。方法:分析我院2004-01/2008-12收治27例外斜V征患者的手术方法及效果。27例患者中,根据发病原因采取不同的手术方式。18例伴有下斜肌功能亢进的外斜V征患者行下斜肌减弱+外斜视矫正术;9例无下斜肌功能亢进的患者在矫正外斜视的同时行水平肌垂直移位。随访2～41mo。结果:患者27例中25例V征消失;第一眼位正位者24例,欠矫2例,过矫1例;15例患者具有不同程度双眼视功能,其中2例恢复立体视。结论:下斜肌功能亢进是外斜V征发病的主要原因,下斜肌减弱联合外斜视矫正术是有效的治疗方法;对于无下斜肌功能亢进者,在矫正外斜视的同时行水平肌垂直移位也具有确切的效果。     

Surgical stress and cytoskeletal changes in lens epithelial cells following manual and femtosecond laser-assisted capsulotomy

AIM: To study the effect of mechanical stress on the cytoskeleton in lens epithelial cells following conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS). METHODS: The cytoskeleton of the epithelial cells of the anterior lens capsules (ALC) removed by CPS and FLACS was examined by immunohistochemistry. Expression of the intermediate filament, glial fibrillary acidic protein (GFAP), and glutamine synthetase (GS) immunoreactivity were detected. In order to map the actin network of cells, fluorescently labeled phalloidin was used. The samples were examined using confocal laser scanning microscopy. RESULTS: GFAP expression was visible in a larger number of the epithelial cells after CPS compared to FLACS. In CPS sample’s epithelial cells, GFAP immunoreactivity indicated robust morphological change. Regarding the actin filaments, the presence of tubular elements connecting epithelial cells, regular actin pattern and marked cortical network after CPS were found. Following FLACS, the actin cytoskeleton of the epithelial cells remained densely structured, and the tubular elements were undetectable, however, the above-mentioned regular actin pattern and the marked cortical network were visible. CONCLUSION: The conventional removal of the ALC induces more robust changes of the cytoskeleton of the lens epithelial cells.     

Comparison of conventional and Hang-back methods of inferior oblique recession in V-pattern strabismus with inferior oblique overaction

AIM: To investigate the regulatory roles of the members of the peroxisome proliferator-activated receptor (PPAR) family in lacrimal gland dysfunction under conditions of desiccating stress or diabetes. METHODS: Quantitative polymerase chain reaction (qPCR) was used to examine the expression of PPARs in the cornea, conjunctiva, meibomian gland, and lacrimal gland in adult rats. The rats were divided into 3 groups: a control group, dry eye group, and diabetic group. The phenol red threads test, tear film break-up time (BUT) test and fluorescein staining were carried out to evaluate the development of dry eye. Based on bioinformatics research, qPCR was used to examine the expression level of PPARγ, tumor necrosis factor-α (TNF-α), interleukin-β (IL-β), interleukin-6 (IL-6), sirtuin 1 (Sirt1), myeloid differentiation factor 88 (MyD88) and transforming growth factor-β (TGF-β) in the lacrimal glands.RESULTS: PPARα and PPARβ/δ were mainly expressed in the conjunctiva and the lacrimal gland, respectively. However, PPARγ was expressed in both the conjunctiva and lacrimal gland, at much higher levels than those measured for PPARα and PPARβ/δ. Dry eye rats and diabetic rats both showed decreased tear secretion, shortened BUT, and increased corneal staining. Significant changes in gene expression were observed compared with the control group. In the lacrimal glands of dry eye rats and diabetic rats, expression of PPARγ decreased (P<0.05), expression of Sirt1 also decreased (P<0.01), whereas expression of TNF-α, IL-β, IL-6, MyD88, and TGF-β increased (P<0.05).CONCLUSION: Among PPARs, PPARγ might play a dominant role in the regulation of metabolic- and inflammatory-signaling pathways on the ocular surfaces and in lacrimal glands. Down-regulation of PPARγ is highly relevant to lacrimal gland dysfunction under desiccating-stress and diabetic conditions. PPARγ, thus, is a potential therapeutic target in the treatment of environment- or diabetes-induced dry eye diseases.     

Effectiveness of modified inferior oblique muscle belly transposition for V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction

AIM: To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction. METHODS: Thirteen cases (23 affected eyes) of V-pattern exotropia with inferior oblique muscle overaction (+ or ++) who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed. The amount of V-pattern, grade of inferior oblique overaction, degree of vertical strabismus, abnormal head posture, and the fovea-disc angle were evaluated before and after surgery. RESULTS: The V-pattern was corrected in all cases, and the amount of V-pattern reduced by 17.85±5.13 prism diopter (PD) on average (t=16.07, P<0.001). The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0% (20/23). The degree of the fovea-disc angle has a mean reduction of 5.45°±2.87° (t=3.95, P=0.003) after surgery. The mean vertical deviation in 5 cases with a small-angle hypertropia (5.23±3.06 PD) in the primary position reduced by 3.15±1.86 PD (t=6.10, P<0.001). No serious complications were observed. CONCLUSION: The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern, which is safe and easy to perform.     

不同下斜肌术式在V征治疗的临床观察

目的 对比观察下斜肌断腱术和下斜肌部分切除术在V征治疗中的效果.方法 取伴有下斜肌亢进的V征患者35例.使用三棱镜交替遮盖法测量视近时第一眼位及上下转25°时的水平斜视度.对下斜肌功能亢进程度进行分级.随机分为2组,分别行下斜肌断腱术和下斜肌部分切除术,观察术后3个月的上下转斜视度差值和下斜肌功能变化.结果 术后3个月时下斜肌断腱术组上下转斜视度差值平均为(5.6 4±5.4)△,下斜肌部分切除术组上下转斜视度差值平均为(4.7±4.3)△,两组相比无显著性差异(P>0.05).下斜肌断腱术组下斜肌功能+2级2只眼,+1级7只眼,0级21只眼.下斜肌部分切除术组下斜肌功能+2级1只眼,+1级5只眼,0级22只眼.两组相比无显著性差异(P>0.05).结论 下斜肌断腱术和下斜肌部分切除术都有效的解决了下斜肌亢进的V征问题,消除了垂直非共同性.     

伴有下斜肌功能亢进外斜V征眼外肌病理学研究

目的:观察伴有下斜肌功能亢进外斜V征患者及正常人下斜肌和内直肌的病理学改变。方法:将伴有下斜肌功能亢进外斜V征患者6例术中切除的下斜肌及内直肌作为斜视组,行HE染色,光镜下观察病理学改变,并测量肌细胞的横截面积;角膜移植供体的下斜肌及内直肌（6例6眼）作为对照组。结果:斜视组下斜肌部分肌纤维轻度肥大增粗,粗细不等,排列紊乱,走形不规则,横纹结构欠清晰;可见部分肌纤维出现核内移现象,玻璃样变性及少量胶原纤维增生。肌纤维平均横截面积为854.1±64.8μm²,与对照组（719.7±80.4μm²）无显著性差异（P>0.05）。斜视组内直肌同样发生了病理改变。除了肌纤维走形不规则,横纹结构欠清晰,部分肌纤维出现核内移现象,玻璃样变性外,主要还表现为肌纤维减少,排列疏松、紊乱,间隙变大,胶原增生较明显。其肌纤维平均横截面积为324.9±63.3μm²,较对照组（690.8±67.3μm²）明显减小（P<0.05）。结论:斜视组功能亢进的下斜肌和弱侧内直肌均发生了明显的病理改变。