双眼外直肌后徙矫正大角度外斜视

本文报告２０例大角度（≥６０△）外斜视，施行双眼外直肌同时等量后徙（多数患者采用超常量后徙）及非注视眼内直肌切除术。一次手术正位率９０％。外转有轻度不足现象，但不影响其外观及向前方注视。避免了双眼分次手术，维持了双眼对称性运动。     

集合不足型外斜视外直肌斜向后徙

目的　评价集合不足型外斜视外直肌斜向后徙的效果。方法　研究组 2 2例 ,对照组 8例 ,看近斜视角大于看远斜视角至少 15PD ,研究组 2 2例行外直肌斜向后徙术 ,对照组 8例行标准的外直肌后徙术。结果　研究组 18/2 2术后看近外斜度≤ 10PD ,2 2 /2 2术后看远外斜度≤ 10PD ,看近看远外斜角平均差值由术前 2 5± 8 11PD减少到术后 5 2 3± 4 0 3PD。对照组仅 3 /8术后看近外斜度≤10PD ,6/8术后看远外斜度≤ 10PD。结论　集合不足型外斜视外直肌斜向后徙术效果优于标准的外直肌后徙术。     

间歇性外斜视患者交叉视差和非交叉视差的临床观察

目的　了解间歇性外斜视患者交叉视差和非交叉视差的临床变化。方法　对 5 5例间歇性外斜视患者 ,术前应用颜少明的《立体视觉检查图》检测其近零视差、交叉视差及非交叉视差 ,并根据检测情况分为 3组进行分析。结果　第 1组 2 5例 ,近零视差立体视锐度正常者占 4 8 0 % ,其交叉视差和非交叉视差立体感知度检测值均不在正常范围 ,交叉视差者的立体感知度检测值比非交叉视差者大 ,差异有显著意义 (t =84 3 5 ,P <0 0 0 0 1)。第 2组 2 6例 ,近零视差立体视锐度正常者占30 8% ,其交叉视差立体感知度检测值不在正常范围 ,未见有非交叉视差者。第 3组 4例 ,为仅查到不正常的近零视差立体视锐度者。 5 5例中 ,无近零视差仅和非交叉视差共存者 ,也无交叉视差和非交叉视差各自独立存在者 ,亦无交叉视差和非交叉视差两者共存者。结论　 (1)本组间歇性外斜视患者近零视差立体视锐度及交叉视差和非交叉视差立体感知度不健全 ;(2 )间歇性外斜视患者视差的损害顺序依次为非交叉视差、交叉视差、近零视差。 (3)双眼黄斑颞侧视网膜对应的是交叉视差 ,双眼黄斑鼻侧视网膜对应的是非交叉视差     

同视机训练对间歇性外斜视术后眼球回退影响的远期疗效观察

目的探讨同视机训练对间歇性外斜视术后患者眼球回退的影响。方法对80例间歇性外斜视术后患者,随机分为治疗组和对照组进行观察,治疗组应用同视机进行融合功能训练,观察术后7、30、180、540天的斜视度、融合功能、立体视并比较分析。结果同视机治疗组与对照组在术后540天的比较,治疗组眼位回退率为15．00％,低于对照组的35．00％(P<0．05);融合功能恢复率达87．50％,高于对照组的60．00％(P<0．05); 立体视功能恢复率达80．00％,明显高于对照组的57．50％(P<0．05),有显著性差异。结论应用同视机对间歇性外斜视术后的患者进行融合功能训练能提高融合功能恢复并减少眼球回退的发生。     

外直肌悬吊-后退术治疗共同性外斜视疗效观察

目的观察外直肌悬吊-后退术治疗共同性外斜视的效果。方法56例共同性外斜视患者在局部麻醉下进行单眼或双眼的外直肌悬吊-后退术，手术量是依据远距离的外斜视度数，术中对后退量调整，术后6周后用三棱镜测量看远的斜视角，对所有患者的手术结果进行分析。结果48例患者治愈，7例好转，1例出现内斜。结论外直肌悬吊．后退术安全、有效，可代替常规的外直肌后徙术治疗共同性外斜视。     

大度数外斜过矫治疗与回退量的前瞻性研究

目的探讨大度数外斜术后外斜回退量及外直肌超常量后退过矫治疗远期疗效。方法以统计学方法分析超常规组和过桥组外斜回退量、远期疗效及外转不足等。结果平均回退量每限为6．67°、每1外斜度为0．17°.远期治愈率过矫组与对照组比较P＜0．05。过矫可增加外转不足，且无外观不满意。结论外直肌超常量后退加过矫是抵销外斜回退、提高疗效的安全方法，过矫量初步拟为5～7mm。     

单眼外退-内截手术矫正间歇性外斜视效果分析

目的 对比分析间歇性外斜视单眼外退-内截手术效果、外退-内截各1 mm平均矫正量、视远视近矫正效果的差异. 方法 对96例间歇性外斜视患者行单眼外退-内截手术,对术后远期眼位、平均矫正量和视近视远手术效果差异进行统计学分析. 结果 功能治愈58例(60.42%),临床治愈89例(92.71%);基本型、集合不足型及外展过强型外斜视患者手术后视远视近斜视角差异较手术前视远视近斜视角差异明显减小,差异有统计学意义(P<0.05).平均矫正效果与术前斜视度呈负相关(P<0.05);平均矫正效果与手术量呈正相关(P<0.05);与手术年龄、发病年龄无相关性. 结论 间歇性外斜视单眼外退-内截手术设计应考虑术前斜视度对平均矫正量的影响,外退-内截手术可以较好的矫正远近斜视度的差异.     

Traction Sutures in the Management of Long-Standing Third Nerve Palsy

PURPOSE: To determine the results of surgical exploration soon after orbital trauma in comparison with surgery half a year or longer after trauma. METHODS: A retrospective study was done on 41 patients with motility disorders after trauma. Full ophthalmologic and orthoptic investigation was done in all patients. CT-scans and/or X-ray photographs were also made. The 41 patients were divided into two groups. One group of 13 patients did not need surgical repair. One group of 28 patients needed an operation. RESULTS: In 13 patients there was an orbital fracture but no surgical repair was needed. In 28 patients surgical repair was done. In 8 patients the operation was performed half a year or longer after trauma, 15 patients underwent surgery within two weeks after trauma, and 5 patients within two months. CONCLUSION: The best final results were obtained when the operation was done soon after trauma; however, the results in the patients who were operated late were fairly good too.     

Contemplation of the surgical normogram of lateral rectus recession for exotropia associated with superior oblique palsy

Purpose

To suggest a surgical normogram for lateral rectus recession in exotropia associated with unilateral or bilateral superior oblique muscle palsy (SOP).

Methods

We retrospectively reviewed the charts of 71 patients with exotropia who were successfully corrected over one year. Each patient had undergone unilateral or bilateral rectus recession associated with uni- or bilateral inferior oblique (IO) 14 mm recession, using a modified surgical normogram for lateral rectus (LR) recession, which resulted in 1 to 2 mm of reduction of LR recession. We divided all patients into 2 groups, the 34 patients who had undergone LR recession with unilateral IO (UIO) recession group and the remaining 37 patients who had undergone LR recession with bilateral IO (BIO) recession group. Lateral incomitancy was defined when the exoangle was reduced by more than 20% compared to the primary gaze angle. The surgical effects (prism diopters [PD]/mm) of LR recession were compared between the two groups using the previous surgical normogram as a reference (Parks'' normogram).

Results

The mean preoperative exodeviation was 20.4 PD in the UIO group and 26.4 PD in the BIO group. The recession amount of the lateral rectus muscle ranged from 4 to 8.5 mm in the UIO group and 5 to 9 mm in the BIO group. Lateral incomitancy was noted as 36.4% and 70.3% in both groups, respectively (p = 0.02). The effect of LR recession was 3.23 ± 0.84 PD/mm in the UIO group and 2.98 ± 0.62 PD/mm in the BIO group and there was no statistically significant difference between two the groups (p = 0.15).

Conclusions

Reduction of the LR recession by about 1 to 2 mm was successful and safe to prevent overcorrection when using on IO weakening procedure, irrespective of the laterality of SOP.     

外斜弱视的多导VEP研究

对20例恒定性外斜(简称恒斜)弱视和16例间歇性外斜(简称间斜)弱视进行了多导VEP研究。结果表明,所有36例病人在刺激弱视眼所引起的VEP振幅,均明显低于健眼,而且潜伏期亦延长,当以全视野刺激双眼所引起的VEP与刺激单(健)眼相比,恒斜弱视组不存在VEP总和现象,而间斜弱视组则有较弱的VEP总和。分别以半视野刺激时,部分间斜弱视病人的弱视眼、健眼以及恒斜弱视的健眼均出现颞侧视网膜抑制现象,而恒斜弱视眼的这种半侧视网膜抑制现象则不明显。