下斜肌前转位术治疗伴有下斜肌亢进的分离性垂直斜视患儿的疗效

目的：探究下斜肌前转位(anterior transposition of inferior oblique muscle)对伴有下斜肌亢进(inferior oblique overaction，IOOA)的分离性垂直斜视(dissociated vertical deviation，DVD)患儿的治疗效果及双眼不等量下斜肌转位术对伴有IOOA的双眼不对称DVD的疗效，为伴有下斜肌亢进的DVD患者提供更加有效的治疗方案。

方法：随机选取2014-01/2015-12在我院住院治疗的80例120眼伴有下斜肌亢进的DVD患者，均采用下斜肌前转位术对患者进行治疗。术后进行回访，回访时间为1～30mo，将患者手术前后远(5m)、近(33cm)距离原在位垂直斜度及IOOA程度进行比较，并对两者进行相关性分析； 对80例患者中采用双眼不等量下斜肌转位术进行治疗的20例30眼伴有IOOA的双眼不对称DVD患者手术前后远(5m)、近(33cm)距离原在位垂直斜度及IOOA程度进行比较，并观察所有患者下斜肌前转位术后抑制上转综合征(antielevation syndrome，AES)的发病情况。

结果：患者术前5m平均三棱镜度(prism diopters，PD)为19.5±0.15PD，术后平均PD为3.5±0.18PD，5m原在位平均矫正16±0.21PD； 术前33cm平均PD为18.6±0.20PD，术后平均PD为4.5±0.26PD，33cm原在位平均矫正14.1±0.16PD，差异具有统计学意义(P<0.05)。行下斜肌前转位术前下斜肌功能亢进+2和+3者各50眼，+1者20眼，术后有12眼仍表现为下斜肌功能亢进，但是亢进程度为+1。IOOA程度与原在位垂直斜度呈正相关，差异具有统计学意义(33cm：r=0.554，P<0.01； 5m：r=0.454，P<0.01)。20例30眼伴有IOOA的双眼不对称DVD患者原在位DVD垂直斜度差异具有统计学意义(P<0.05)，IOOA程度明显降低。行下斜肌前转位术的患者术后18例24眼出现不同程度的AES，与行双眼不等量下斜肌转位术进行治疗的20例30眼伴有IOOA的双眼不对称DVD患者发生AES比较，差异具有统计学意义(P<0.05)。

结论：下斜肌前转位术对伴有下斜肌亢进的分离性垂直斜视患者具有很好的治疗效果，但是术后AES发生率较高，而行双眼不等量下斜肌转位术进行治疗的患者术后AES发生率能够保持在较低水平。

Effect of modified inferior oblique anterior transposition on dissociated vertical strabismus patients with inferior oblique muscle hyperfunction

AIM: To investigate the effect of anterior transposition of inferior oblique muscle on the treatment of dissociated vertical deviation(DVD)in children with inferior oblique overaction(IOOA)and unequal inferior oblique transposition of the treatment of IOOA with the eyes of the asymmetry of DVD efficacy, associated with the lower oblique hyperfunction DVD patients to provide more effective treatment.

METHODS: Eighty patients with hyperfunction who were treated in our hospital from January 2014 to December 2015 were randomly selected and treated with anterior transposition of inferior oblique muscle. Patients were followed up for 1 to 30mo. We compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations, and the correlation between the two. We also compared the vertical incline at the original incline from far(5m), near(33cm)distance and IOOA degree before and after operations in 30 eyes(20 patients)with bilateral asymmetry DVD and IOOA who received unequal inferior oblique transposition. The incidence of antielevation syndrome(AES)was observed after operations.

RESULTS: The mean prism diopters(PD)at 5m before operations was 19.5±0.15, the average PD after operations was 3.5±0.18, at 5m the original incline was 16±0.21PD. The mean PD at 33cm was 18.6±0.20 before operation, 4.5±0.26 after operations, and 14.1±0.16 at 33cm the original incline, the difference was statistically significant(P<0.05). Preoperatively, inferior oblique muscle hyperfunction +2 and +3 was 50 eyes, + 1 was 20 eyes, and 12 eyes still showed inferior oblique muscle hyperfunction after operation, but the degree of hyperactivity was +1. There was a significant positive correlation between the degree of IOOA and the vertical inclination(33cm: r=0.554, P<0.01; 5m: r=0.454, P <0.01). There were significant differences(P<0.05)in the vertical incline in 20 patients(30 eyes)with bilateral asymmetry DVD and IOOA and the degree of IOOA was significantly lower. In contrast, 18 patients(24 eyes)underwent anterior transposition of the inferior oblique muscle had AES in different degrees, which had statistically significant difference(P<0.05)compared with patients(30 eyes)with IOOA treated with unequal inferior oblique transposition.

CONCLUSION: Anterior transposition of the inferior oblique muscle has a good therapeutic effect on isolated vertical strabismus patients with inferior oblique hyperfunction. While the incidence of postoperative AES is low in patients received unequal inferior oblique muscle transposition.