联合调整缝线的直肌后徙术矫正间歇性外斜视疗效观察

目的探讨间歇性外斜视的手术时机,观察调整缝线的直肌后徙术的应用效果。方法对47例间歇性外斜视患者施行联合调整缝线的直肌后徙术。结果术后随访3～12个月,44例患者术后获得正常眼位,3例欠矫者经集合训练后得到改善。结论联合调整缝线的直肌后徙术是矫正间歇性外斜视简便而有效的手术方式,可减少再次手术。     

直肌调整缝线在间歇性外斜视术中的应用

目的 探讨间歇性外斜视的手术时机,观察直肌可调整缝线在其术中的应用效果.方法 对51例间歇性外斜视施行联合直肌可调整缝线的直肌后徙术.结果 随访3～12个月,48例达正常眼位,3例欠矫者经集合训练后得到改善.结论 联合直肌可调整缝线的直肌后徙术是矫正间歇性外斜视简便而有效的手术方式,减少再次手术.     

改良眼外肌定量调整术治疗儿童斜视

目的 探讨儿童改良式眼外肌定量调整缝线术治疗斜视的临床效果.方法 采用改良式眼外肌定量调整术,对275例1.3～14岁斜视患儿行斜视矫正.球结膜作PARK切口,强生6-0可吸收缝线作肌肉调整缝合线,剪断肌肉后,将调整缝线呈八字于肌肉附着点下穿出,再将缝线穿出球结膜,以5-0丝线在相应部位扎活动结,以双极射频镊关闭结膜伤口.结果 275例患者术后第1天均可正常睁开双眼,正常注视玩耍或配合检查,其中有87例患儿于术后第1天或第2天在表面麻醉下分别作了不同程度的调整,调整率31.6%,其中过矫57例,欠矫30例,所有患儿均可正常接受术后调整的操作,调整后眼位基本满意.结论 该术式术后患儿反应轻,术后瘢痕小;患儿基本能接受术后表面麻醉下调整,可作为儿童斜视手术首选术式.     

外直肌超长量后徙术治疗大角度外斜视的疗效评价

背景 临床上矫正超过50Δ的大角度外斜视时往往需对3条或4条水平直肌进行手术,以避免因外直肌超长量后徙(＞7 mm)引起的眼球外转受限.但研究表明,超长量外直肌后徙可有效矫正大角度外斜视,且术后并不出现眼球明显外转受限.这个结果仍有待临床上进行验证. 目的 观察双眼外直肌超长量后徙或合并非主导眼内直肌缩短对大角度外斜视的矫正效果. 方法 采用系列病例观察法对2013年5月至2014年10月在天津市眼科医院行双眼外直肌超常量后徙术或合并非主导眼内直肌缩短术的间歇性或恒定性大角度外斜视患者51例的治疗效果进行分析,其中29例为间歇性外斜视,22例为恒定性外斜视.所有患者均接受术前及术后眼前节、眼底、眼球运动和双眼视功能检查,采用三棱镜加遮盖法测量斜视角大小.依据病史、眼球运动、知觉状态和斜视角度数对患者行个体化手术治疗,术中结合可调整缝线技术,行双眼外直肌超长量后徙术或合并非主导眼内直肌缩短术.术后随访时间均超过6个月,比较术眼术前和术后眼位变化、眼球运动情况以及双眼知觉功能.结果 行双眼外直肌超长量后徙术者33例,双眼外直肌超长量后徙术合并非主导眼内直肌缩短术者18例.术前患者视远(5 m)斜视度为-52Δ～-120Δ,平均(-70.57±16.46)Δ;视近(33 cm)斜视度为-55Δ～-130Δ,平均(-75.65±16.14)Δ.左眼外直肌后徙8～15 mm,平均(11.17±1.67)mm,右眼外直肌后徙9～15 mm,平均(11.28±1.62) rnm,非主导眼内直肌缩短3～6 mm.末次随访时患者视远斜视度为+4Δ ～-14Δ,平均(-3.45±4.20)Δ;视近斜视度为+4Δ～-14Δ,平均(-5.49±3.96)Δ,其中41例术后眼球正位,占80.4％,10例欠矫,未发现过矫者.32例患者术后立体视较术前改善,其中术前无立体视的27例中18例术后获得不同程度的立体视.无一例患者出现眼球运动障碍.结论 双眼外直肌超长量后徙术或合并非主导眼内直肌缩短术可有效治疗大角度外斜视,可减少需要手术的眼外肌数目,术后未发现眼球运动障碍.     

超常量后徙联合缝线松弛治疗大度数间歇性外斜视的长期疗效观察

目的:评价双眼外直肌超常量后徙联合缝线松弛治疗大度数间歇性外斜视的安全性及长期疗效。方法:回顾68例大度数间歇性外斜视患者,按遮盖24h后最大手术量设计,双眼外直肌后徙10～14mm包括放松缝线2～4mm。所有患者行详细相关检查。术后随访24mo到3a,分析近期和远期手术效果。结果:术后1wk:41例正位,斜视角为 8△～-8△;有14例轻度过矫。13例明显过矫,其中1例需要再手术。术后3mo,56例正位,斜视角为 8△～-8△;有6例轻度过矫,6例轻度欠矫;术后2～3a,56例正位,斜视度为 8△～-8△,有8例轻度欠矫。4例明显欠矫。眼球运动正常。结论:双眼外直肌超常量后徙联合缝线松弛治疗间歇性外斜视长期手术效果稳定,安全性高。     

直肌后徙可调缝线术在儿童共同性斜视中的应用

目的：观察直肌后徙可调整缝线术治疗儿童共同性斜视的临床效果。方法对34例儿童共同性斜视在全麻下采用直肌后徙调整缝线术治疗,术后1～2 d内进行缝线调整,随访6～24个月,观察手术效果。结果34例儿童共同性斜视患者中,11例达正常眼位,23例因欠矫或过矫需要调整,其中过矫9例及欠矫11例均调至正位,有3例欠矫者经集合训练后得到改善。在6～24个月随访中,未调整的患者中欠矫1例,经过调整的患者中欠矫2例,术后视功能较术前有明显的改善。结论采用可调整缝线治疗儿童共同性斜视是简便而有效的手术方式,可以减少再次手术风险,使儿童全麻斜视矫正手术的成功率获得较大的提高。     

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.     

斜视手术初学者两种结膜切口及术式的比较分析

目的探讨住院医师初学斜视手术时,结膜切口和直肌处理方法对术后并发症及眼位矫正成功率的影响。方法回顾性分析103例斜视手术的切口方式、直肌处理方法与术后并发症及眼位矫正成功率的关系。结果共同性斜视手术103例,采用传统梯形切口,直肌缝合于肌止端后巩膜处45例;穹窿结膜切口,直肌悬吊后徙术58例。两种手术方式最终术后斜视角<10△,欠矫和过矫者无明显差异(χ2=4.672,P>0.05)。传统切口及手术方式组2例行二次手术调整眼位。穹窿结膜切口术后瘢痕小,结膜愈合平整,眼部刺激症状轻。结论穹窿结膜切口愈合美观,可调节后徙缝线法方便对术后眼位的调整,避免二次手术,但操作比传统切口略有难度。     

单条外直肌大量后徙治疗小角度外斜视

目的探讨单条外直肌后徙治疗小角度外斜视的效果.方法25例斜角15～20Δ外斜视病人,施行单条外直肌后徙10～12nm,平均手术量11mm,手术平均年龄8岁,术前平均斜视角18Δ,术后随访至少6个月.结果术后6周眼位:正位或残留小角度外斜≤4Δ,平均矫正斜角16Δ.术后6个月后10例正位,9例-4Δ～-8Δ外斜视,6例外隐斜.结论单条外直肌大量后徙治疗15～20Δ外斜视是有效的,具有安全、简便及全麻时间短等优点.     

改良Parks切口联合外直肌悬吊后徙术治疗大角度外斜视

临床上对大角度外斜视多采用外直肌超常量后徙。但在手术实践中我们感到，在超常量后徙外直肌时，无论是角膜缘结膜梯形切口还是跨肌肉结膜切口，切口较长，结膜损伤多；同时，由于向眼球后方过多分离眼球筋膜、肌间膜，易造成广泛粘连，而且手术操作较困难。有文献报道采用外直肌悬吊后徙术矫治大角度外斜视效果满意，手术操作简便、易行。改良Parks切口则有手术操作简单，术后瘢痕细小、隐蔽、无碍美容等优点。为减少组织损伤，我们在2006年采用改良Parks结膜切口联合外直肌悬吊后徙矫正大角度外斜视20例，取得满意临床效果，现报告如下。     

Use of adjustable sutures: a helpful modification

Adjustable suture surgery helps achieve visual axis alignment in special cases. We describe a modification of adjustable suture surgery that provides better patient comfort and easier assessment of the muscle function at the time of adjustment. These beneficial features are achieved by using the cul-de-sac approach and by delaying final adjustment up to one week postoperatively. We review our experience involving 52 cases and discuss the surgical methods and reasoning behind delayed suture adjustment through the cul-de-sac approach.     

调整缝线术用于儿童间歇性外斜视

目的探讨调整缝线技术在儿童间歇性外斜视手术的应用及儿童间歇性外斜视手术设计的特点。方法回顾性分析70例使用调整缝线技术的间歇性外斜视患儿,按术后眼位是否矫正满意（-8^△～＋8^△）将患者分为矫正满意组（46例）和不满意组（24例）。比较二组患者的发病时间、手术年龄、手术是否涉及下斜肌和内直肌等。结果矫正不满意组患者中,欠矫者1例,过矫者23例。比较两组患者的发病时间、手术年龄、性别构成、手术是否涉及下斜肌减弱,差异没有统计学意义（P〉0.05）。比较两组患者手术是否涉及内直肌加强,差异有统计学意义（P〈0.05）。结论儿童间歇性外斜视的手术设计应充分考虑患者的双眼视功能状况,手术涉及内直肌加强时,应适当减少手术量。调整缝线技术应用于儿童间歇性外斜视手术有其独到的优势,不仅可使手术设计更加充分,保证术后早期眼位矫正的满意,更可提供追求远期效果的手段。     

Adjustment of sutures 8 hours vs 24 hours after strabismus surgery

PURPOSE: To compare the postoperative results of adjustable-suture strabismus surgery when suture adjustment was performed 8 hours (group 1) and 24 hours (group 2) after surgery. METHODS: A retrospective clinical study was conducted in two hospitals. Strabismus surgery and muscle adjustment were performed in 90 patients. All patients had horizontal strabismus (40 patients had esotropia and 50 patients had exotropia), and they underwent either primary surgery or reoperation. Mean age of the patients was 29.9 +/- 14.1 (range, 14 to 74) years. The angle of deviation was measured in all patients before surgery, after surgery both before and after adjustment, and at the final follow-up examination. The follow-up period was 6 to 40 months (mean, 19.6 months). RESULTS: Preoperative data were similar in the two groups. The mean angle of deviation immediately after muscle adjustment was 0.6 +/- 6. 1 prism diopters in group 1 and 0.4 +/- 6.3 prism diopters in group 2. This similar deviation in the two groups (P =.9) changed during the follow-up period, and at the final examination the measured angles in groups 1 and 2 were -1.0 +/- 7.9 and -2.5 +/- 10.3 prism diopters, respectively (P =.48). The most considerable outcome measure was the calculated drift values. At the last follow-up these values were -1.6 +/- 5.8 for group 1 and -2.9 +/- 11 prism diopters for group 2 (P =.5). Subdividing the patients on the basis of their deviation before surgery, a postoperative drift toward exotropia was found in most patients of group 1. In group 2, however, a greater tendency toward exotropia was shown only by those patients who had displayed exotropia preoperatively, whereas patients with preoperative esotropia showed a greater tendency toward esotropia after surgery. CONCLUSION: In patients undergoing horizontal extraocular muscle surgery with adjustable sutures, suture adjustment 8 hours or 24 hours after surgery did not produce significantly different results.     

Timing of postoperative adjustment in adjustable suture strabismus surgery.

PURPOSE: The use of adjustable sutures in strabismus surgery has increased the rate of surgical success. Little data are available on the optimum timing for postoperative adjustment after strabismus surgery. We wanted to compare 2 common practices of adjustable suture technique after strabismus surgery. METHODS: Two comparable groups of 40 patients each, who had strabismus surgery with adjustable suture technique, were prospectively studied. Group A had early adjustment the same day of the surgery about 6 hours after the operation, and group B had late adjustment the next day about 24 hours after the operation. Subjective scoring tables were used to evaluate the pain felt by the patient before, during, and after the adjustment and any difficulties of the adjustment process. Requirements of postoperative pain medications and final alignment 6 weeks after surgery were also compared. RESULTS: Despite adequate statistical power, no significant differences were found between the groups regarding pain before, during, and after adjustment, difficulties performing the adjustment, and final alignment after 6 weeks (P > .05). Both adjustment schedules were equally associated with mild to moderate pain before, during, and after the adjustment. In the first 24 hours after surgery, no overall difference in the use of pain medications was found. Nausea and vomiting in the first 24 postoperative hours were more common in the early adjustment group (P = .02). CONCLUSION: The surgeon can feel free to choose the timing for postoperative adjustment. However, when performing an early adjustment, the surgeon should be especially prepared to control nausea and vomiting.     

Outcome of large angle exotropia treated by single stage adjustable strabismus surgery with monitored conscious anesthesia

Purpose:To evaluate the outcomes of large-angle exotropia by single-stage adjustable strabismus surgery (SSASS) under monitored conscious anesthesia.Methods:A prospective study was done in 33 patients above 14 years with ≥40 prism diopters (PD) of exotropia. All patients underwent SSASS under monitored conscious anesthesia (topical anesthesia plus intravenous sedation). For deviations of ≤55 PD, two horizontal rectus muscles, and for >55 PD, three rectus muscles were operated and a decision on adjustment/operating on an additional rectus muscle was taken after assessing the alignment. Monitored conscious anesthesia allowed us to check our results after surgery and plan further surgery/adjustment to achieve the desired alignment.Results:Mean preoperative deviation for distance was 52 ± 11.1 PD. The target alignment was achieved with the initial surgical plan in 10/21 patients with <55 PD exotropia and 4/12 patients with >55 PD exotropia, and one patient in each group needed adjustment. The remaining patients needed additional rectus muscle surgery. One patient with >55 PD exotropia needed both adjustment and additional rectus surgery. The success rate for distance correction was 85% at 6 months and 1 year. The overall success rate was 71% at 6 months. Percentage of patients with binocular single vision improved from 31% preoperatively to 78% by 6 months. Incidence of oculocardiac reflex was 6.1%.Conclusion:SSASS under monitored conscious anesthesia is a viable option for large-angle strabismus correction with good patient comfort and safety.     

Adjustable suture surgery for correction of various types of strabismus.

BACKGROUND AND OBJECTIVE: This study was conducted to analyze the efficacy of the adjustable suture technique for correction of strabismus in patients with different types of strabismus. PATIENTS AND METHODS: This was an observational case series of patients who underwent the adjustable suture technique for correction of strabismus. A total of 33 adult patients (16 males and 17 females) with a minimum postoperative follow-up period of 6 months were included in the study. Patients were analyzed in three groups (patients with exotropia, esotropia, and vertical deviations). Success criteria determined were percentage change in the angle of deviation for far and near fixation, need for reoperation, and relief of diplopia. RESULTS: The median percentage change in the angle of deviation for far and near fixation was 86.60% and 84%, 92.50% and 94.44%, and 100% and 100% in the exotropia, esotropia, and vertical deviation groups, respectively. There was no need for reoperation, and postoperative adjustment performed 24 hours after surgery was needed in 30.3% of patients due to diplopia. CONCLUSIONS: The adjustable suture technique seems to be an effective method in the correction of various types of strabismus.     

Comparison of the Stability of Postoperative Alignment in Sensory Exotropia: Adjustable Versus Non-Adjustable Surgery

Purpose

To compare the success rates and stabilities of postoperative alignment between adjustable and the non-adjustable surgeries in the treatment of sensory exotropia.

Methods

A retrospective analysis was performed on all patients with sensory exotropia who had undergone unilateral lateral rectus recession and medial rectus resection (R&R) between January 1998 and August 2005. Thirty-four patients underwent conventional R&R, and 20 patients underwent R&R with adjustable suture of the lateral rectus. The surgical results between the two groups were analyzed with regard to the preoperative and post-operative deviation angles and the postoperative drift. The postoperative deviation angle was measured on postoperative day 1 as well as at two weeks, three months, six months and the final visit after surgery.

Results

There were no statistically significant differences in the mean preoperative and postoperative deviation angles between the two groups. In 30 (88%) patients in the non-adjustable group and 15 (75%) patients in the adjustable group, postoperative deviation was less than 15 prism diopters (PD) at the three month follow-up. There was no significant difference in the mean postoperative drift between the two groups.

Conclusions

Strabismus surgery with adjustable sutures did not show a significantly better result than surgery without adjustable sutures in the treatment of sensory exotropia. Considering the amount of postoperative exodrift in both groups, we postulate that the immediate ocular alignment after surgery for sensory exotropia should be orthophoric or 5-6 PD of esodeviation.     

Comparison of the immediate with the 24-hour postoperative prism and cover measurements in adjustable muscle surgery: Is immediate postoperative adjustment reliable?

PURPOSE: Immediate postoperative adjustment after adjustable-suture strabismus surgery has been suggested as a viable alternative to the classic adjustment that is performed, usually within 6 to 24 hours after surgery. The purpose of this study was to compare the immediate postoperative eye measurements with those taken 24 hours postoperatively and to determine whether there was any significant difference between the 2 measurements. METHODS: This was a prospective study of strabismus patients who were candidates for muscle surgery using the adjustable-suture technique. All patients received a total intravenous general anesthesia, which allowed rapid recovery of consciousness. Measurements using the simultaneous prism cover test were obtained in the recovery room immediately after the patients regained consciousness and again 24 hours after surgery. Both measurements were taken before adjustment and were compared. RESULTS: A total of 25 patients were studied. The postoperative alignment changed significantly during the first 24 hours in 84% of our patients. The mean drift in alignment during the first 24 hours measured 7.2 +/- 4.3 prism diopters and was significantly different from 0 ( P < 0.001). CONCLUSION: The immediate postoperative ocular alignment after adjustable strabismus surgery is significantly different from the 24 hours postoperative alignment. This difference was noticed despite using an anesthesia protocol that allowed rapid recovery and full regaining of consciousness shortly after the conclusion of surgery. This early drift should be taken into consideration if adjustment is to be made in the immediate postoperative period.