共同性水平斜视的再次手术

目的 探讨共同性水平斜视手术后施行再次斜视手术的临床特点及手术处理的特殊性.方法 共同性水平斜视手术后施行再次斜视手术的55例患者进行了回顾性临床分析,手术前后进行眼位检查、眼球运动,Titmus立体视检查双眼视觉功能.手术方法:手术前做全麻下或局麻下行牵拉试验.手术方式选择原则:依据视近和视远斜视角的不同,眼球运动受限制的受累肌肉和牵拉试验结果选择术式.术后追踪观察1～8年,平均2年.结果 (1)内斜视术后继发外斜视13例中,除即刻过矫3例在手术后48h内施行内直肌探查术外,其余施行原后徙内直肌完全复位或部分复位术,联合外直肌截除.治愈率76.9%.外斜视术后继发内斜视11例,施行原后徙外直肌完全复位或部分复位术,联合内直肌截除.治愈率81.8%.伴有V型斜视和垂直性斜视者联合水平直肌移位或斜肌减弱术.(2)内斜视欠矫15例中,8例施行内直肌边缘切开联合外直肌截除术;选择单纯在同一眼上外直肌截除术2例;伴有斜肌异常患者,则选择对侧眼内直肌后徙联合外直肌截除并下斜肌后徙5例.术后正位率86.7%.外斜视欠矫16例中:6例施行原外直肌后徙眼边缘切开联合内直肌截除术;2例Ⅴ型外斜视联合双下斜肌后徙,4例外直肌周围瘢痕松解术,4例联合调整缝线.术后正位率87.5%.结论 (1)水平斜视过矫伴有受累肌运动障碍,结合看近与看远斜视角的差别,选择内直肌或外直肌复位术.(2)调整术后缝线可将再次斜视手术的非预期结果降低到最小程度.

The surgical treatment of consecutive strabismus following concomitant horizontal strabismus surgery

Objective To investigate the results and techniques of surgical treatment of consecutive strabismus following concomitant horizontal strabismus surgery. Methods Fifty-five patients operated on for consecutive strabismus following their first surgical treatment of concomitant horizontal deviation were analyzed retrospectively. Preoperative visual acuity, deviation, mobility evaluation, stereoacuity with Titmus test and traction test were performed as well as post-operative residual deviation and binocular function. The mean postoperative follow-up time was 2years. Results Thirteen patients with consecutive exotropia due to overcorrection for primary concomitant esotropia were managed with exploratory operation (3 patients) or treated with unilateral lateral rectus muscle recession combined with medial rectus muscle advancement (10 patients),in which 10 patients (76.9%) achieved satisfactory alignment at final follow-up. Eleven patients with consecutive esotropia due to overcorrection for primary concomitant exotropia underwent medial rectus muscle resection and lateral rectus muscle complete of partial advancement to the original insertion and 9 patients in which achieved long-term satisfactory alignment. Fifteen patients with undercorrection for concomitant esotropia were treated with medial rectus marginal myotomy combined with lateral rectus muscle recession (8 patients), unilateral lateral rectus muscle recession (2 patients) or medial rectus recession and lateral rectus resection combined with inferior oblique muscle recession in fellow eye (5 patients with Oblique muscle abnormal), and postoperative orthophoria rate was 86.7%. Sixteen patients with undercorrection for concomitant exotropia were treated with lateral rectus muscle recession and medial rectus muscle resection (6 patients) or combined with inferior oblique muscle recession (2 patients with V-exotropia), cicatricotomy for lateral rectus muscle (4 patients) or adjusted of releasable sutures (4 patients), in which postoperative orthophoria rate was 87.5%. Conclusions The reversal of unilateral medial rectus and lateral rectus recession or resection is an effective alternative for treating postoperative consecutive exotropia due to overcorrection of concomitant horizontal strabismus. Adjusting of releasable sutures provide more stable expections of the results achieved by the re-operation.