内直肌截除联合外直肌后徙术治疗集合不足型间歇性外斜视效果观察

目的：观察单眼内直肌截除术联合外直肌后徙术治疗集合不足型间歇性外斜视（Convergenceinsuficency-type?intermittent?exotropia,CI-IXT）矫治效果。方法：回顾性分析2018年1月-2021年1月笔者医院收治的104例CI-IXT患者的临床资料,根据手术方式不同分为对照组（n=52）和观察组（n=52）,对照组采用双眼外直肌后徙术治疗,观察组采用单眼内直肌截除联合外直肌后徙术治疗,比较两组患者术后6个月眼位矫正效果,并统计手术前后视远度、视近度、平均斜视度及视功能、融合功能、并发症发生率和复发率。结果：观察组术后1周、术后3个月的正位率均高于对照组,过矫率低于对照组（P <0.05）,两组欠矫率比较,差异无统计学意义（P>0.05）。且两组术后6个月的正位率、过矫率及欠矫率比较,差异无统计学意义（P>0.05）。术后6个月,两组视远度、视近度及平均斜视度均降低,且观察组视远度、视近度及平均斜视度均显著低于对照组（P<0.05）。术后6个月,两组无、Ⅰ级视功能阳性率均降低,Ⅲ级视功能阳性率均升高（P<0.05）,...     

超常量上直肌徙后术治疗下直肌缺如性上、内斜视一例报告

目的:观察超常量上直肌徙后术治疗下直股缺如性上、内斜视的疗效.方法:对1例下直肌缺如性上、内斜视患者施行超常量上直肌徙后术.结果:随访时间四月,患者斜视角度明显改善.结论:超常量上直肌徙后术是治疗下直肌缺如性上、内斜视的一种有效方法.     

改良双眼外直肌后徙手术对大角度外斜视矫正的效果研究

目的:探究改良双眼外直肌后徙术对大角度外斜视的矫正效果,为患者的治疗提供新型手术支持。方法:选择2015年7月-2018年7月笔者医院收治的160例大角度外斜视患者作为研究对象。按照入院先后顺序,将其均分为观察组和对照组。对照组实行双眼外直肌等量后徙术,观察组则在此基础上对术式进行改良,适当增加了外直肌后徙量。比较分析治疗前后两组患者的斜视度、眼位矫正情况、眼球内转受限情况以及双眼视觉功能。结果:治疗后1个月、3个月和6个月,观察组患者的斜视度均明显优于对照组,差异有统计学意义(P0.05);治疗后6个月,观察组眼位正位率为92.50%,明显高于对照组的73.75%,其欠矫率和过矫率均显著低于对照组,同时其眼球内转受限率(3.75%)也明显低于对照组(13.75%),组间比较差异有统计学意义(P0.05);观察组患者的立体视恢复率和融合功能恢复率分别为91.25%、98.75%,均明显高于对照组(71.25%、91.25%),差异有统计学意义(P0.05)。结论:改良双眼外直肌后徙术在矫治大角度外斜视上效果显著,能够有效纠正大角度外斜视患者的眼位和斜视度,其效果较好,有利于患者视觉功能的改善和恢复。     

双眼外直肌后徙术与常规疗法治疗斜视临床疗效比较

目的:比较双眼外直肌后徙术与常规疗法治疗斜视的临床疗效。方法:选取2016年6月-2017年6月笔者医院收治的128例斜视患者,按治疗方式不同分成对照组和研究组,每组各64例。其中对照组患者行常规单眼外直肌后徙联合内直肌缩短术(R&R),研究组患者行双眼外直肌后徙术(BLR-rec)。术后对患者随访1年,观察术后眼位正位率、欠矫率、过矫率,视觉功能恢复情况以及并发症发生率。结果:研究组患者正位率为89.06%高于对照组的68.75%,差异有统计学意义(P<0.05)。术前,对照组和研究组患者视近度、视远度和平均斜视度比较,两组患者融合功能和立体视功能占比比较,差异均无统计学意义(P>0.05)。术后,两组患者的斜视度较治疗前均出现了明显下降(P<0.05),且研究组治疗后斜视度下降幅度明显大于对照组(P<0.05);两组患者视觉功能恢复率均明显增加(P<0.05),且研究组恢复率明显大于对照组(P<0.05)。研究组并发症发生率明显低于对照组(P<0.05)。结论:双眼外直肌后徙术较单眼外直肌后徙联合内直肌缩短术有更好地临床效果,且安全性更高,值得临床推广。     

外直肌麻痹显微手术的临床观察

目的 观察外直肌麻痹显微手术治疗的临床疗效。 方法 26例在手术显微镜下操作分离上、下直肌颞侧端睫状血管并施行直肌联结联合内直肌后徙手术,术后随访3～24个月观察手术效果。 结果 26例中,22例术后原在位眼位小于+10△,代偿头位消失,占84.62％;好转4例,占15.38％。平均外转过中线12°,外转功能有不同程度改善。未发现眼前节缺血等并发症。 结论 应用显微外科技术行直肌联结联合内直肌后徙术治疗外直肌麻痹临床效果良好。     

显微镜下改良直肌后徙术治疗儿童斜视的疗效观察

目的:探讨显微镜下改良直肌后徙术治疗儿童水平共同性斜视的临床疗效。方法:回顾性分析笔者医院2010年1月-2017年8月收治的293例水平共同性斜视患儿,均采用显微镜下改良直肌后徙术,观察术中出血及手术时间、术后眼部刺激症状、术后眼位、结膜切口恢复情况及并发症发生情况。结果:显微镜下改良直肌后徙术术中出血少,手术时间短,术眼周围刺激症状较轻,球结膜创口愈合较好,且无明显手术瘢痕。术后随访6～12个月,眼位矫正治愈率88.39%(259/293),所有患者的眼球运动均为正常,且均未出现严重并发症。结论:显微镜下改良直肌后徙术治疗水平共同性斜视,疗效确切,效果令人满意,且术后并发症少,值得在临床上使用。     

单侧内直肌后徙术与双侧内直肌后徙术治疗青少年急性共同性内斜视的疗效对比

目的：探讨单侧内直肌后徙术与双侧内直肌后徙术对内斜视青少年视功能、斜视度及眼外肌、血清中胰岛素样生长因子-1(Insulin like growth factor 1,IGF-1)水平的影响。方法：选取笔者医院2020年1月-2022年1月收治的60例急性共同性内斜视（Adolescent patients with acute concomitant esotropia,AACE）青少年患者作为研究对象,按照随机数字表法分为观察组（30例,采用单侧内直肌后徙术治疗）和对照组（30例,采用双侧内直肌后徙术治疗）,术后随访半年。观察两组患者治疗效果、Base-out恢复点参数、视功能、斜视度（N-D值）,眼外肌、血清中IGF-1水平。结果：术后6个月,观察组患者正位率高于对照组患者,过矫率低于对照组患者（P<0.05）。术后6个月,观察组患者Base-out恢复点参数与Base-in(BI)恢复点与对照组比较差异无统计学意义（P>0.05）。术后6个月,观察组患者正常视近立体视比例高于对照组患者（P<0.05）。术后6个月,观察组患者斜视度与对照组比较差异无统计学意义（...     

成人共同性外斜视的临床特点与手术疗效影响因素分析

目的探讨成人共同性外斜视的临床特点和影响手术疗效的主要因素。方法采用前瞻性研究方法,将2003年1月-2005年1月在我院就诊,需要手术治疗的成人共同性外斜视患者完善各项检查后予以手术治疗。随访观察1～5年后,结合患者的临床特征分析影响手术疗效的因素。结果本研究共纳入120名患者,研究发现成人外斜视患者手术时年龄、性别、术前视力、斜视的类型、有无弱视及A、V征以及双眼单视的存在与否等对手术预后（眼正位）影响不大（P〉0．05）。术前大角度斜视（r^2=0．26,P〈0．01）、屈光不正等值球镜度数趋向正视化（r^2=0．04,P〈0．05）与术后眼位矫正效果不佳相关。结论成人共同性外斜患者,由于具有术前斜视度偏大,多无双眼视等临床特点,在决定实施手术之前,应该充分考虑术前斜视度的大小、屈光不正等因素,选择正确的手术术式及手术量,方能获得良好的矫正效果。     

间歇性外斜视的手术治疗

我们用 Rice 等介绍的方法手术治疗间歇性外斜视100例。术后近期随访治愈率(≤±9~△)为92.0%,双眼视功能恢复率为21.0%。文章讨论了影响手术效果的因素、手术量、评价标准和远期疗效的界限等问题。     

新型睫状前血管保留术在常规显微斜视手术中的应用

目的探讨新型睫状前血管分离并保留术在常规显微斜视手术中的应用。方法2016年4月-2017年4月,征集共同性水平斜视患者100例,采用改良的斜视手术器械在显微镜下进行眼内、外直肌的后退/缩短术,术中采用新型睫状前血管分离器械对睫状前血管进行分离并保留,术毕,观察血管的完整和通畅情况。术后定期随访。结果在新型血管分离器械的辅助下,分离单条肌肉的血管仅需(52.2±18.3)s,在保留血管的情况下,1条肌肉后徙或缩短的操作时间为(13.1±4.6)min,眼外直肌和内直肌血管保留成功率分别为98.1%和93.4%。所有患者术后术眼无不良反应,均随访6个月~2年,术后远期正位率达97%。结论采用新型的睫状前血管分离并保留术,操作简单,分离效率高,值得在常规显微斜视手术中推广。     

Surgical treatment of combined vertical tropias: dissociated vertical deviation and primary hyperfunction of the inferior oblique ocular muscles

We have treated 27 children with DVD and primary overaction of the inferior oblique muscles in the same time. In all of them we have done recession of the inferior oblique muscles (for 4, 6, 8 or 10 mm). In only seven of them we did recession of the superior recti (for 7, 8 or 9 mm) simultaneously. DVD doesn't need to be operated in every child. Large recession of the superior rectus muscles very significantly and adequately ameliorate the DVD in 79% of children. Hypocorrection of the DVD we have in another 21% of the operated eyes. We get valid results one month after the surgery. They were constant after six months too.     

Infantile exotropia in healthy children

Constant exotropia is uncommon during the first year of life. We retrospectively identified 13 patients with large, constant exotropia during the first year of life which required surgery. Bilateral lateral rectus muscle recessions were done in all 13 cases. Only two patients have required reoperation. The clinical characteristics and management of this unusual condition are similar to those of infantile esotropia.     

Surgical treatment of exotropia after surgically produced pseudoparalysis of the medial rectus muscle.

The characteristic clinical findings of pseudoparalysis of the medial rectus muscle include exotropia in primary position, widened medial fissure on the affected side, limitation of adduction on the affected side, an A-pattern exotropia, and a paradoxical forced-traction test. We have devised a surgical technique to restore good movement of the eye in adduction. The priniciple behind the technique is that all adhesions between Tenon's capsule covering the muscle and conjunctiva, and between muscle and sclera must be found and cut posterior to the fornix. This will allow the muscle to be brought forward easily so that it can be resected and advanced for restoration of function.     

The Gass hook as an aid in inferior oblique recession

We describe how use of the Gass hook allows safer placement of the lateral rectus stay suture for inferior rectus recession through an inferotemporal cul-de-sac incision.     

Enhancing surgery for acquired esotropia

In acquired esotropia, operating only on the non-accommodative angle often results in undercorrection. To decrease the frequency of this outcome, we enhanced surgery in a preliminary study by operating for a target angle equal to half the sum of the distant non-accommodative angle (minimum 12 prism diopters) plus the distant angle measured without correction. The mean augmentation in 12 patients undergoing bimedial rectus recession was 0.8 +/- 0.2 mm, and in eight patients who had a previous bimedial rectus recession and were undergoing a bilateral rectus resection it was 1.7 +/- 0.8 mm. With a mean follow-up of 26 +/- 20 months, 13 patients were within 10 prism diopters of orthotropia and four were undercorrected. Three overcorrected patients were orthophoric after reducing the hyperopic correction. All 17 patients old enough to cooperate had stereopsis or a positive Worth four-dot test at some point postoperatively.     

腹外斜肌转移肌瓣技术修补腹直肌缺失的临床应用

目的探讨肿瘤或外伤等导致腹直肌缺失的患者使用腹外斜肌转移肌瓣技术行腹壁缺损修补和重建的临床应用效果。 方法2014年12月至2018年12月,浙江大学医学院附属杭州市第一人民医院收治腹直肌缺失患者10例,采用腹外斜肌转移肌瓣技术进行腹壁缺损修补和重建。收集并回顾性分析患者的临床资料。通过问诊、查体和腹壁CT检查评估患者腹壁重建和恢复情况。 结果10例腹直肌缺失患者中,腹直肌肿瘤9例（其中男性1例,女性8例）,腹直肌外伤毁损1例（男性）。平均年龄（46.90±13.25）岁,体质量指数（23.10±3.98）kg/m²。9例腹直肌肿瘤中,原发性肿瘤8例,转移性肿瘤1例,均行腹直肌复合体屏障性切除。腹直肌外伤患者行毁损腹直肌切除。切除后腹壁缺损平均宽度为（11.70±1.89）cm,均采用单侧腹外斜肌转移肌瓣技术进行腹壁缺损修补和功能重建,并采用补片加强修补。补片均为聚丙烯补片,平均大小为（420.00±154.91）cm²。平均手术时间（132.50±38.96）min,平均术中出血量（107.00±74.54）ml,平均住院时间（11.50±4.30）d。术后无腹外斜肌肌瓣缺血坏死,无切口裂开、手术部位感染、肠瘘等并发症。在术后随访行问诊、体格检查及腹壁CT检查,显示患者腹壁完整,功能恢复良好。平均随访时间（35.50±11.35）个月,随访期内未发现肿瘤复发、切口疝形成或腹壁膨出病例。 结论腹外斜肌转移肌瓣修补技术是一种安全有效腹壁缺损修补技术,在腹直肌缺失患者中具有较好的临床效果。     

Differential intraocular pressure as an indirect measure of generated muscle force

Differential intraocular pressure offers a painless, non-invasive, reliable test for evaluating incomitant strabismus. These data can be used in selecting a recess-resect vs. a muscle transfer procedure and, combined with findings of the traction test, can direct the surgeon in doing a full tendon transfer or a rectus muscle union with recession of the antagonist.     

Ipsilateral surgery of primary pterygium, sensory esotropia and conjunctival autotransplantation in a single procedure

The purpose of this study was to find out whether a conjunctival autograft over the recessed bulbomotor muscle can prevent a recidive of an inflammatory internal pterygium associated with strabismus. The fast growing internal pterygium (crossing corneoscleral limbus of the right eye 3-4 mm towards the centre of the cornea) in a 42 years old patient, was removed by superficial keratectomy, while strabismus was corrected by the recession of the internal rectus muscle and covered with an autograft of the upper bulbar conjunctiva. Neither collagen vascular diseases, nor dry eye were present. Horizontal deviation was lessened from +12 to +6, after surgery, and the regrowth of the inflammatory pterygium was not observed during a five years follow up. The risk of the reappearance of pterygium at the site of muscle surgery for strabismus might have been avoided by creating a smooth ocular surface over a thin conjunctival autograft without Tenon's capsule. We believe that conjunctival autograft in such eyes, carrying a higher risk for pterygium regrowth, may help in the avoidance of the use of cytostatic drugs and on their untoward effects.     

Use of the anterior rectus sheath for abdominal wall reconstruction: A study in cadavers

Our aim was to evaluate the amount of tension present after incision and undermining of the anterior rectus sheaths and the external oblique muscles in 20 fresh adult cadavers. Resistance to traction of the anterior and posterior rectus sheaths towards the midline was measured at three stages of dissection: before any aponeurotic undermining; after incision and undermining of the anterior rectus sheaths; and after incision and undermining of the external oblique muscles associated with the previous dissection. Significance of differences was assessed using non-parametric tests. There was a significant reduction in tension in the anterior and posterior sheaths on both levels after each stage of dissection. The incision and undermining of the anterior rectus sheaths and the external oblique muscles promoted a progressive reduction in tension at the aponeurotic edges of the abdominal wall.