改良的Yokoyama术治疗高度近视眼限制性内下斜视

目的 评价改良的Yokoyama术治疗高度近视眼限制性斜视的手术疗效.方法 临床病例研究.分析5例(7只眼)高度近视眼性斜视患者的临床、影像学及手术资料.眼轴长应用A超检查.斜视角度应用Krimsky加三棱镜方法检查.根据眼球运动情况行受限程度分级.手术前后均行眼眶MRI和CT检查,并分析眼外肌和眼球位置的改变.手术方式为改良的Yokoyama术,并联合内直肌后徙术.结果 5例(7只眼)患者的平均眼轴长为32.62 mm( SD l.84).术前平均内斜视角度为82.86 PD( SD 37.62),平均垂直斜视角度为20 PD(SD 7.91).7只手术眼均存在明显的眼球外转和上转运动受限.术前眼眶MRI和CT检查显示,上直肌鼻侧偏位,外直肌下偏位,眼球从肌锥的颞上方疝出,眼球的后部与外侧骨壁的空间变窄.术后第1天术眼眼位均正位,眼球外转和上转均能过中线,随时间推移眼球运动又进一步改善.术后MRI显示,外直肌和上直肌联结后,脱位的眼球被还纳至肌锥内,上直肌与外直肌止点位置偏移恢复正常.平均随访时间5个月,患者的术后情况保持稳定.结论 通过改良的Yokoyama术可有效矫正高度近视眼限制性内下斜视,还纳脱出的眼球至肌锥内,并改善眼外肌走行及眼球运动功能.

Surgical treatment of myopic strabismus fixus by modified Yokoyama's surgery

Objective To evaluate the surgical results of modified Yokoyama's procedure for treating myopic strabismus fixus.Methods Retrospective analysis of records of 5 patients (7 eyes) with high myopic strabismus.Pre- and postoperative orthoptic measurements were recorded and analyzed.Anatomic relationships between the muscle cone and globe were analyzed using MRI or CT scan.The surgical procedure is a modification of Yokoyama's technique and medial rectus muscle was also recessed.Results The average axis length of 7 eyes was 32.62 mm( SD1.84).The mean preoperative horizontal deviation was 82.86 PD (SD 37.62)esotropia and mean vertical deviation was 20 PD( SD 7.91 )hypotropia.All patients had marked limitation of elevation and abduction.Displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by CT or MRI scan of the orbits and by observation during surgery.After surgery,the supertemporal dislocation of globe was improved.Both the horizontal and vertical deviations decreased significantly,and the abduction and sursumduction motility were also improved gradually.The average follow-up was 5 months,all patients achieved satisfactory results and remained stable.Conclusions In high myopic patients,if the deviant paths of the LR and SR muscles were demonstrated by MRI or CT scan,the surgical procedure to restore the dislocated globe back into the muscle cone by uniting muscle bellies of the superior rectus and lateral rectus muscles is effective and recommended.