先天性内斜视手术治疗的远期效果观察

目的观察先天性内斜视手术治疗后眼位和双眼单视功能的变化。方法追踪观察60例先天性内斜视手术治疗后眼位和双眼单视功能的变化，并进行分析。结果先天性内斜视手术治疗后远期眼正位率明显低于术后近期正位率，4岁前手术组患者术后双眼单视功能明显优于4岁后手术组。结论先天性内斜视患者手术时机以在4岁前为宜，术后随访观察眼位变化并进行相应处理。     

283例手术治疗共同性内斜视临床特点分析

目的探讨共同性内斜视各类型分布、不同类型及手术年龄对双眼单视功能的影响。方法回顾分析手术治疗的共同性内斜视283例,统计各类型内斜视的分布。重点分析婴儿内斜视、非调节性内斜视和部分调节性内斜视三种类型及其手术年龄对双眼单视功能的影响。结果 283例共同性内斜视患者中,婴儿内斜视136例(48.57%)、非调节性内斜视77例(27.21%)、部分调节性内斜视44例(15.55%)、残余性内斜视18例(6.36%)、知觉性内斜视4例(1.41%)、连续性内斜视4例(1.41%)。部分调节性内斜视存在融合功能和远近立体视的比率均高于婴儿内斜视和非调节性内斜视,P<0.05;而婴儿内斜视和非调节性内斜视远近立体视差别不大,P>0.05;<2岁患儿融合及近立体视存在率高于2～9岁和>9岁患儿,P<0.05。结论在手术治疗的共同性内斜视中,婴儿内斜视占首位。部分调节性内斜视对双眼单视功能影响最小。手术年龄小有助于双眼单视功能的改善。     

手术治疗先天性内斜视临床探讨

目的：探讨先天性内斜视的临床特点、手术时机、手术方法及疗效。方法回顾分析43例施行手术的先天性内斜视病例的治疗结果。结果正位36例,正位率83.72%,欠矫5例,占11.63%,过矫2例,占4.65%,随访2~4年,部分病例经过二次手术,术后进行弱视治疗及双眼单视功能训练,最终获得正位率41例,占93.02%,弱视治愈率92.11%,23.26%病人恢复双眼单视功能。结论先天性内斜视的患者应早期手术治疗,术后弱视治疗及双眼单视功能训练,对远期眼位正位,弱视的治愈及双眼单视功能的重建非常重要。     

Results of early treatment of congenital strabismus]

The authors analyse the results obtained after very early treatment of Esotropia in 38 children. These children were divided into 4 groups according to their age at the time of treatment. At the age of 30 months, they studied binocular vision, manifest latent nystagmus (NML) and dissociated vertical deviation (DVD). In groups 1 and 2, treatment was instituted before the age of 6 weeks (13 children) no DVD was noted, only one NML and 11 children have binocular vision. In groups 3 and 4, treatment was instituted after the age of 3 months (25 children) 4 cases of DVD and 10 of NML are noted, and only 9 children have binocular vision. In case of congenital esotropia, the authors recommend treatment before 2 months old to obtain a possibility of binocular vision and to decrease the risk of NML and DVD.     

先天性内斜视手术治疗后眼位的远期观察

目的:观察先天性内斜视的临床特点和治疗,随访手术治疗后眼位的变化,探讨早期治疗的意义。方法:追踪观察40例先天性内斜视手术治疗后眼位的变化,并进行分析。手术以双侧内直肌后徙术为主,少数年长且斜视角较大者采用双侧内直肌后徙加单侧外直肌截除术。结果:先天性内斜视手术治疗后远期眼正位率明显低于术后近期正位率,4岁前手术组患者双眼单视功能明显优于4岁后手术组。结论:先天性内斜视患者在视力发育敏感期内得到正确的手术治疗,功能治愈率良好。     

Unexplained head tilt following surgical treatment of congenital esotropia: a postural manifestation of dissociated vertical divergence

BACKGROUND: Strabismus surgery for congenital esotropia can be complicated by the development of a postoperative head tilt. PURPOSE: To determine the pathophysiology of acquired head tilting following horizontal realignment of the eyes in children with congenital esotropia. MATERIALS AND METHODS: Retrospective analysis of nine children with congenital esotropia who developed unexplained head tilts following horizontal realignment of the eyes. RESULTS: Shortly after strabismus surgery, each child developed a head tilt in association with asymmetrical dissociated vertical divergence (DVD). Five children maintained a head tilt toward the side of the fixing eye (group 1), which did not serve to control the DVD. Four children maintained a head tilt toward the side of the hyperdeviating eye, which served to control the DVD (group 2). Children in group 2 had earlier horizontal muscle surgery and developed better stereopsis than those in group 1, suggesting that the higher degree of single binocular vision and stereopsis in these children may have led to a compensatory torticollis to control an asymmetrical DVD. CONCLUSIONS: The onset of an unexpected head tilt after congenital esotropia surgery is usually a postural manifestation of asymmetrical DVD. In this setting, a head tilt toward the side of the fixing eye corresponds with a postural manifestation of the underlying central vestibular imbalance that produces DVD, while a head tilt toward the side of the hyperdeviating eye serves to counteract the hyperdeviation and stabilise binocular vision.     

周期性内斜视(附23例报告)

目的 :通过对 2 3例周期性内斜视的临床观察和手术治疗 ,了解周期性内斜视的临床性质和手术治疗效果。方法 :对我院 5年多来诊断治疗的 2 3例周期性内斜视的病史、临床检查和手术治疗进行总结分析。结果 :2 3例病例具有典型的内斜位和正位交替的时间周期 ,所有的病例经内直肌后徙术治疗均获得满意的正位 ,手术越早 ,双眼视功能恢复越好。结论 :周期性内斜视是一种具有生物节律的特殊类型的内斜视 ,并最终转化为恒定内斜 ,发病机制可能有多种因素。尽早的手术治疗不仅有助于手术的正位率 ,并且可使病人恢复正常或接近正常的双眼视     

先天性内斜视术后的双眼单视功能

目的探讨先天性内斜视术后双眼单视功能的发育状况。方法把45例先天性内斜视患儿分≤2岁组,≤5岁两组,≤2岁组12人,≤5岁组33人,术前用同视机和颜少明《立体视觉检查图》检测立体视功能(2岁前组不理解除外)。术后行双眼单视功能训练9月至1年。结果术前≤2岁组未查,≤5岁组术前全部无双眼单视。术后通过训练,≤2岁组中有2例有中心凹立体视觉,4例周边立体视觉,2例Ⅱ级视功能,4例Ⅰ级视功能。≤5岁组无一例有中心凹立体视觉,5例有周边立体视觉,6例周边融合,3例中心融合,11例仅有Ⅰ级视功能,8例无同时知觉。两组相比较有显著性差异(P<0.05)。结论手术年龄对患儿术后的双眼视觉发育至关重要,先天性内斜视2岁前手术可望获得亚正常双眼视觉,2岁后手术者获得较好的双眼视觉可能性极小。     

压贴三棱镜在共同性内斜视的应用

目的探讨压贴三棱镜应用于共同性内斜视的效果。方法对41例共同性内斜视病例,其中屈光性调节性内斜视24例、部分性调节性内斜视6例、继发性内斜视11例,一眼前置底向外的压贴三棱镜4～24月。结果压贴三棱镜前,同视机无同时视17人、Ⅰ级功能5人、Ⅱ级11人、Ⅲ级8人;Titmus〉800″36人（87.8%）。压贴三棱镜4个月,同视机无同时视1人、Ⅰ级功能7人、Ⅱ级17人、Ⅲ级16人,差异有高度显著性,P〈0.001;Titmus〉800″18人（43.9%）,差异有显著性,P〈0.01。结论对暂时不能手术的共同性内斜视病例佩戴压贴三棱镜有利于双眼单视功能。     

儿童部分调节性内斜视117例手术疗效分析

目的 探讨儿童部分调节性内斜视手术时机和疗效。方法 对117例部分调节性内斜视患者行双眼内直肌后徒联合非主导眼外直肌缩短手术。结果 术后治愈率为88％,建立双眼单视功能者占71.8％。结论 儿重部分调节性内斜视应尽早全部矫正屈光不正6个月以上方可进行手术,同时获得双眼单视功能的机会增多。     

Binocular visual function in congenital esotropia after bilateral medial rectus recession with loop suture

PURPOSE Our aim was to evaluate the binocular visual function in congenital esotropia after bimedial rectus recession with loop suture and to address the factors that could take part in the attainment of binocular function. SUBJECTS AND METHODS Forty children with congenital esotropia who were operated on between 12 and 48 months of age were included in the study group. Postoperative follow-up ranged from 2 to 10 years. In order to determine the factors affecting the sensory results in congenital esotropia, we classified our patients into two groups according to their fusion status. We compared the preoperative and postoperative characteristics of patients in these two groups. RESULTS Twenty-one of 40 patients (52.5%) fused the Worth four-dot at near (Group 1), 19 patients (47.5%) did not (Group 2) at the final examination. No patient showed evidence of stereopsis. We found significant differences between these two groups in respect to the final angle of vertical deviation, the age at surgery, the presence of postoperative inferior oblique overaction, dissociated vertical deviation and abnormal head position. Correlation analysis revealed that early alignment of the eyes and the absence of postoperative vertical deviation were associated with increased incidence of achieving some degree of binocular vision. CONCLUSION In congenital esotropia, not all infants may have the potential for normal binocular function owing to yet unknown constitutional factors. We determined that achieving some degree of binocular function may be related to early alignment of the eyes. Additionally, close follow-up and precise treatment of the accompanying vertical deviation, especially inferior oblique overaction and dissociated vertical deviation,in a timely manner may enhance the attainment of binocular sensory function.     

周期性内斜视手术前后双眼视觉及手术时机的探讨

目的 观察和分析周期性内斜视手术前、后双眼视觉及其手术时机的选择.方法 将30例4～21岁符合标准的内斜视分为2组:周期性内斜视者14例;恒定性内斜视(初诊时为周期性内斜视)16例.同视机测定远双眼视觉级别,颜少明<立体视觉检查图>测定近立体视锐度.观察术前、术后的远双眼视觉,近立体视锐度变化.结果 14例周期性内斜视患者术前正位日及术后远双眼视觉及近立体视锐度与正常人群相比无显著性差异.16例恒定性内斜视(初诊时为周期性内斜视)术前12例(75%)无双眼视觉,术后16例(100%)具有同时知觉能力,16例(100%)可获得融合力,但融合范围低于正常人群.10例(62.5%)获远立体视,8例(50%)获得不同程度近立体视.结论 周期性内斜视应尽量在周期性期间手术,有利于双眼单视功能的恢复,达到功能治愈的目的 .     

Simultaneous horizontal and vertical surgery in esotropia

The vertical syndrome depends on the triple action of the vertical muscles and includes vertical, alphabetical and torsional patterns; this syndrome is of major importance in the diagnosis and treatment of esotropia. We advise routine simultaneous surgery of the horizontal and vertical components. In congenital and early esotropias which occur before one year of age, extensive tests of sensorial evaluation cannot be carried out before three years of age and the vertical syndrome should therefore upon automatically be operated whatever its severity. The advantage of this type of surgery is unquestionable for removal of obstacles preventing recovery of a form of binocular vision. In acquired esotropias when good sensorial conditions (fusion, N.R.C., stereopsis) may be elicited after three years of age and when there is a minor vertical syndrome, vertical surgery might be considered as optional, but as vertical surgery is not dangerous, it can only be regarded as beneficial. With our surgical technique we obtain successful long-term results for horizontal deviation, which improves progressively (83%); vertical and alphabetical patterns improve in similar proportions (65 and 64% respectively). Surgical results depend on which of the following two forms of esotropia is present: in congenital and early esotropias a form of binocular vision with an angle of anomaly occurs almost without exception; in acquired esotropias a form of binocular vision without an angle of anomaly sometimes occurs. Overcorrections require second stage operation, which are simple and nonmutilating when the removal of convex glasses or the use of concave glasses does not reduce secondary exodeviation. Successful results of post-operative fusion confirm the beneficial influence of surgery on the vertical syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comitant strabismus

This review reports on articles written on comitant strabismus during the past year. Congenital esotropia was a recurring theme in these publications. Included in this review are articles that provide an insight into the basis for motor epiphenomena such as optokinetic nystagmus asymmetry and latent nystagmus. The optimum window of opportunity to achieve quality binocular vision by surgical alignment in congenital esotropia is discussed. We also report on articles that address various aspects of the management of comitant strabismus including the amount of medial rectus recession for esotropia, the target angle for best results in accommodative esotropia with high accommodation convergence/accommodation ratio, and issues related to comitant exotropia.     

Results of treatment in congenital esotropia

THE AIM: We analyzed results of the operations in congenital esotropia. MATERIAL AND METHODS: In paediatric ophthalmology department were treated 42 children in age 1.5 to 2.5 years with congenital esotropia. Strabismus angles were from +20 degrees to +45 degrees. After the operations children were controlled in paediatric ophthalmology clinic. The pleoptic-ortoptic therapy was applied when children finished 3.5 years old. RESULTS: 28 children had orthoposition after primary operations and 20 had binocular vision. 6 children had second operation due to excessive functional activity inferior oblique muscle or residual angle. CONCLUSION: The operations of children with congenital esotropia between 1.5 to 2.5 years old provided good functional results.     

知觉状态与儿童间歇性外斜视术后眼位

间歇性外斜视手术治疗的目的是矫正眼位,恢复双眼视觉。当术后过矫发生连续性内斜视,尤其是视觉发育未成熟的患儿,会导致双眼视觉的严重损害。间歇性外斜视术后早期眼位过矫可通过干预知觉状态以减轻各种集合成分,减少连续性内斜视的发生。（眼科,2013, 22： 292-294）     

Etiology and surgical management of horizontal pontine gaze palsy with ipsilateral esotropia.

INTRODUCTION: An esotropia ipsilateral to a horizontal pontine gaze palsy has been infrequently reported. We discuss the etiology and review the surgical management of this ocular motility defect. METHODS: Four patients with radiographically documented dorsal pontine lesions and persistent horizontal gaze palsy with esotropia ipsilateral to the gaze palsy were treated. In each patient, the esotropia was present in attempted primary gaze, producing symptomatic diplopia. An anomalous face turn was required to attain single binocular vision. RESULTS: All 4 patients underwent surgical correction to alleviate the anomalous head position and diplopia. Bilateral, asymmetric surgery was required to achieve a long-term successful result. Single binocular vision in the primary position with elimination or marked improvement of the compensatory head posture was initially achieved in all 4 patients. One patient, who had not undergone asymmetric strabismus surgery to reconcile incomitance produced by the esotropia, rapidly developed a residual esotropia. CONCLUSIONS: Ophthalmologists should recognize that concurrent esotropia may occur in patients with horizontal pontine gaze palsy. Single binocular vision in the primary position, an expanded binocular visual field, and alleviation of a compensatory head position are achievable with strabismus surgery.     

Surgical results in nystagmus blockage syndrome

Sixty-four patients with nystagmus blockage syndrome (NBS) underwent surgery consisting of unilateral recession-resection, bimedial recession with and without posterior fixation suture, and bimedial recession with resection of one or both lateral recti. The results of the unilateral recession-resection and bimedial recession with or without posterior fixation were comparable. Over- and undercorrections occurred more frequently and the number of reoperations was higher than in a control group of essential infantile esotropia without nystagmus. These unpredictable surgical results in NBS present yet another feature that distinguish this condition from essential infantile esotropia without nystagmus. While restoration of normal binocular vision was not achieved in a single case, a functionally desirable result of subnormal binocular vision or microtropia occurred in 26%. An unusual complication consisting of postoperative asymmetric gaze nystagmus with an anomalous head posture was observed in five patients and required a Kestenbaum-Anderson operation in four to eliminate the head turn.     

调节性内斜视的治疗

目的 探讨调节性内斜视的综合治疗方法.方法 总结分析87例调节性内斜视的治疗情况,所有病例经1%阿托品扩瞳验光后戴镜矫正,弱视眼进行综合训练.戴镜半年后对眼位戴镜不能矫正且双眼视力基本平衡的患儿通过手术干预矫正眼位.结果 经戴镜眼位恢复正位69例(79.31%).戴镜并同时进行弱视训练半年后18例斜视角无法全部矫正的患儿采用手术方法矫正眼位.术后进行双眼单视训练.所有病例恢复正常眼位及双眼单视功能.结论 调节性内斜视的治疗是一个综合性的治疗过程,双眼视力基本平衡时可手术干预残余斜视角.强调双眼单视功能的检查和训练.(中国眼耳鼻喉科杂志,2009,9:33-34)     

间歇性外斜视术后远期疗效及其影响因素分析

目的 探讨间歇性外斜视手术治疗的疗效和术后部分患者斜视回退的可能原因.方法 对120例患者的术后一天眼位、术前有无双眼同时视功能、发病年龄、手术年龄、斜视类型与远期眼位的关系进行分析,寻找影响斜视回退的可能因素.结果 120例随访平均25.34个月(12～50个月).眼位:正位90例(75%),外斜29例(24.17%),内斜1例(0.83%);术后远期眼位只与术后一天眼位和术前有无双眼同时视功能有关,而与发病年龄、手术年龄、斜视类型均无关.结论 间歇性外斜视术后远期眼位与术后一天眼位和术前有无双眼同时视功能有明显相关性,术后一天过矫和术前有双眼同时视功能者可以获得较好的远期眼位.