V型斜视的手术治疗

目的探讨V型斜视不同术式的治疗效果。方法采用直肌附着点垂直移位及下斜肌部分切除两种方法治疗V型斜视。结果V型外斜视12例采用直肌垂直移位术,术后原在位平均-5°,向上平均-15△,向下平均-8△,采用下斜肌部分肌除术8例,术后原在位平均-5°,向上平均-10△,向下平均-5△。V型内斜视8例采用下斜肌部分切除术,术后原在位平均+5°,向上平均+8△,向下平均+16△,采用直肌垂直移位术,术后原在位平均+10°,向上平均+8△,向下平均+10△。结论V型斜视采用下斜肌部分切除术和直肌附着点移位术均能取得较好的治疗效果。     

Clinical Features of Strabismus in Patients with Congenital Optic Disc Anomaly

PurposeTo investigate the clinical features of strabismus in patients with congenital optic disc anomaly and compare and analyze the characteristics of patients who showed changes in the strabismus pattern with those who did not.MethodsMedical records of the patients who were diagnosed with both strabismus and congenital optic disc anomaly and followed-up for ≥1 year were reviewed retrospectively. Clinical characteristics and ophthalmic features at the initial visit and final follow-up were assessed. Patients with a change in the direction of strabismus or a difference of >10 prism diopters in the deviation angle during the follow-up period were allocated to the changed group. The remaining patients were assigned to the unchanged group. The clinical characteristics of the two groups were compared.ResultsTwenty-eight patients (15 boys) were included (mean age, 39.0 months; range, 5–150 months). Three (10.7%) patients were born preterm and four (14.3%) had other underlying systemic disease. Sixteen (57.1%) patients had exotropia, and 12 (42.9%) had esotropia. Concurrent vertical strabismus was present in three (10.7%) patients. Strabismus features changed in 14 (50.0%, changed group) patients and remained unchanged in 14 (50.0%, unchanged group) patients. Age, sex, and laterality did not differ between groups. Preterm birth history (n = 3) and combined systemic disease (n = 4) were only observed in the changed group (p = 0.111 and p = 0.049, respectively).ConclusionsConsidering the possibility of changes in strabismic features, close monitoring of patients with strabismus combined with congenital disc anomaly is essential, particularly in those with preterm birth history or underlying systemic conditions.     

Analysis of Postoperative Outcomes in Patients with Intermittent Exotropia According to Preoperative Change of Angle of Deviation

PurposeThe correlation between the existence of the preoperative condition of ≥10 prism diopters (PD) in patients with basic type of intermittent exotropia (IXT) and postoperative outcomes was analyzed.MethodsThe medical records of patients that underwent surgery for IXT were analyzed retrospectively. The analysis was conducted by dividing the patients into a group with change of <10 PD (group 1) and ≥10 PD (group 2) before the time of the surgery. Patients who received at least 6 months of follow-up after surgery were included. The age, sex, angle of deviation and stereoacuity of the patients were studied. Surgical success was defined as exodeviation of <10 PD or esodeviation of <4 PD at the final visit after the surgery. The correlation between clinical factors and surgical success rate was analyzed by using correlative analysis.ResultsA total of 129 patients participated in the study. There were 108 (83.7%) and 21 (16.3%) patients in groups 1 and 2, respectively. There were 89 (82.4%) and 17 (80.1%) patients with surgical successes in groups 1 and 2, respectively (p = 0.18). Moreover, 13 (12.0%) patients in group 1 and three (14.3%) patients in group 2 required reoperation, showing no significant difference (p = 0.12). There was no statistically significant correlation between surgical success and preoperative change of angle of deviation <10 PD (odds ratio, 1.78; p = 0.17).ConclusionsAmong the patients with basic type of IXT subjected to the analysis, 16.3% had a change of ≥10 PD before surgery, and there was no significant correlation between surgical success and preoperative change of angle of deviation.     

合并小度数垂直斜视的共同性外斜视眼外直肌MRI研究

目的观察共同性外斜视合并小度数垂直斜视患者眼外4条直肌Pulley位置、肌肉体积及水平直肌上、下两部分肌肉体积比值的特点。方法横断面研究。收集2018年1月至2019年12月在天津市眼科医院确诊为共同性外斜视患者,其中第一眼位不合并垂直斜视的患者为A组,第一眼位合并小角度垂直斜视(<5三棱镜度)的患者为B组;健康志愿者为C组。采用MRI冠状位扫描观察各组眼外4条直肌Pulley位置及体积的差异,同时计算比较水平直肌上、下两部分肌肉比值的差异。采用单因素方差分析及Kruskal-Wallis检验进行统计学分析。结果收集A组患者19例(38只眼),男性10例,女性9例,平均年龄30岁;B组患者10例(20只眼),男性4例,女性6例,平均年龄27岁;C组健康志愿者20名(40只眼),3个组间年龄和性别分布匹配(均P>0.05)。3个组间眼外4条直肌Pulley位置差异均无统计学意义(均P>0.05)。A组内直肌肌肉体积为(358.6±44.9)mm³,B组内直肌肌肉体积为(334.7±35.6)mm³,C组内直肌肌肉体积为(437.5±49.3)mm³,A组、B组内直肌肌肉体积均小于C组,差异均有统计学意义(t=6.405,6.025;均P<0.01);除内直肌外,其他直肌肌肉体积在3个组间差异均无统计学意义(均P>0.05)。3个组内直肌及外直肌上、下两部分肌肉体积比值差异均无统计学意义(均P>0.05);与A组和C组比,B组患者体积比值更分散。结论共同性外斜视合并小度数垂直斜视患者眼外4条直肌Pulley位置变化不明显,内直肌体积明显减小,水平直肌上、下两部分肌肉体积比值分布较分散可能与小度数垂直斜视有关。(中华眼科杂志,2021,57:223-227)     

外斜视儿童多导视觉诱发电位的研究

目的探讨不伴有弱视的恒定性外斜视儿童的多导视觉诱发电位（ｖｉｓｕａｌｅｖｏｋｅｄｐｏｔｅｎ－ｔｉａｌｓ,ＶＥＰｓ）的临床意义及外斜视的发病机理。方法采用１４个盘状作用电极行全视野及半视野棋盘格翻转刺激,记录正常对照组与不伴有弱视的恒定性外斜组儿童的视觉诱发电位。结果斜视组全视野刺激所记录的双眼与单眼ＶＥＰｓ潜伏期（ＬＰ１）、振幅（ＡＮ１Ｐ１）比较,差异无显著性（Ｐ＞０．０５）,此结果与正常对照组不同;斜视组主眼和非主眼ＬＰ１较正常对照组延长（Ｐ＜０．０１）,斜视组非主眼ＡＮ１Ｐ１较正常对照组下降（Ｐ＜０．０１）;斜视组鼻、颞侧视网膜ＬＰ１、ＡＮ１Ｐ１比较,差异无显著性（Ｐ＞０．０５）。结论ＶＥＰｓ检测可为恒定性外斜视者的双眼视功能异常提供客观依据;恒定性外斜视者视力虽正常但ＶＥＰｓ并非正常,提示有初级视皮层功能障碍存在;不伴有弱视的恒定性外斜视者在单眼半视野刺激条件下,无颞侧视网膜抑制现象。     

长眼轴的共同性外斜视手术量探讨

目的 :探讨长眼轴的共同性外斜视的矫正手术量。方法 :行双侧外直肌对称性后徙术共同性外斜视 74例 ,术前采用A/B型超声波测量眼轴。分为正常眼轴组 (眼轴长 2 2 75± 1 0 0mm)和长眼轴组 (眼轴长>2 3 75mm)。正常眼轴组按外直肌常规后徙量手术 ,长眼轴组按外直肌加大后徒量手术。结果 :近期随访(术后 1周 )正位率 ,正常眼轴组为 87 50 % ,长眼轴组为 82 77% ,两组差异无显著性 (P >0 0 5) ;长期随访(术后≥ 6周 )正位率 ,正常眼轴组为 80 0 0 % ,长眼轴组为 76 92 % ,两组差异无显著性 (P >0 0 5)。结论 :对长眼轴的共同性外斜视加大其外直肌后徙手术量 ,可获得与正常眼轴的共同性外斜视行常规外直肌后徙术相同的效果。     

A型肉毒毒素治疗儿童间歇性外斜视的临床观察

目的 观察A型肉毒毒素(BTXA)治疗儿童间歇性外斜视的临床疗效.方法 采用前瞻性非随机对照临床试验,将60例年龄于4～12岁的间歇性外斜视患儿分为2组,分别接受常规手术治疗(双外直肌后退或外直肌后退联合内直肌缩短术)和BTXA双外直肌注射治疗.治疗6个月后比较两组患儿的眼位矫正情况及双眼视觉功能改善情况.两组之间年龄分布及治疗前斜视度数分布比较采用两独立样本t检验和秩合检验.两组之间正位率比较采用四格表卡方检验.结果 注射组患儿治疗前平均斜视度数(-41.33±12.17)△,注射6个月后平均斜视度数(-6.23±9.80)△,7例低矫,正位率为76.67%.手术组患儿治疗前平均斜视度数(-42.83±11.72)△,手术6个月后平均斜视度数为(2.67±5.21)△,1例低矫,2例过矫,正位率为90.00%.两组患儿的治疗后眼位比较差异无统计学意义(P=0.177).两组患儿正位率的差异无统计学意义(x2=0.42,P=0.166).治疗后两组均有患儿重建了融合功能,获得了远立体视觉,近立体视觉也得到明显改善.结论 BTXA注射作为一种简便、创伤性小的治疗方式,其临床疗效可能接近手术治疗.