高度近视合并固定性内斜视的手术治疗探讨

目的探讨外直肌外眦眶骨膜悬吊联合内直肌断腱术治疗固定性斜视的疗效。方法回顾分析我院近两年来收治的高度近视合并固定性内斜视患者10例（16只眼）,对其斜视度数、眼球运动状态、手术效果进行了总结,平均随访时间4.8个月。结果术后正位者10眼,残余内斜10°～15°者4眼,过矫5°～10°者2眼。随访中轻度回退4眼,回退度数不超过7°。结论采用内直肌断腱联合外直肌外眦眶骨膜悬吊是治疗固定性内斜视的有效手术方式,且具有手术方法简单易于操作的优点。     

外直肌折叠眶骨膜固定术治疗固定性内斜视

目的 探讨固定性内斜视的手术治疗方法及手术效果.方法 对10例12只眼固定性内斜视采用内直肌完全断腱,外直肌折叠眶骨膜固定术治疗固定性内斜视.结果 术后第2～4天,12只眼水平位斜视完全矫正,1只眼残余下斜视约5°.术后随访3月至5年,患者9只眼正位,3只眼残余水平斜视5°～10°,其中2只眼同时残余下斜视5°～10°.10例患者外观明显改善,术眼视物功能部分恢复.结论 采用内直肌完全断腱,外直肌折叠眶骨膜固定术治疗固定性内斜视,手术操作简单、安全、创伤小,效果较满意,是对其治疗方法的一种有益改进.

Abstract：

Objective To investigate surgical methods and treatment effect for esotropia fixus.Methods Ten cases of 12 eyes with esotropia fixus were treated by severing of medial rectus muscle, folding of lateral rectus muscle combined orbital periosteum fixation and made the eye overcorrection for 5-10. Results Followed-up 3 months to 5 years, 9 eyes gained normotopia and 3 eyes were undercorrection. All patients' visual function and appearance obtained amelioration. Conclusions Severance of medial rectus muscle, foldback of lateral rectus muscle and orbital periosteum fixation can make satisfied result in most patients of esotropia fixus.     

Lateral rectus muscle disinsertion and reattachment to the lateral orbital wall

BACKGROUND/AIMS: Surgical correction of ocular alignment in patients with third cranial nerve paralysis is challenging, as the unopposed lateral rectus muscle often pulls the eye back to exotropia following surgery. The authors present a simple surgical approach to overcome this difficulty. This approach is also applicable to removal of unwanted overactivity of the lateral rectus in Duane syndrome. METHODS: A review was made of the records of four patients with third cranial nerve paralysis and one with Duane syndrome with exotropia in which the lateral rectus muscle was removed from its scleral insertion and reattached to the orbital wall. Additional surgery to bring the eye to the midline included medial rectus resection, medial transposition of the vertical recti, and passive suturing of the eye to the medial orbit wall. RESULTS: All patients achieved satisfactory ocular alignment following surgery. Ocular ductions were limited. These results were stable for 1.5-4 years of follow up. No major complications occurred. CONCLUSION: Lateral rectus muscle disinsertion and reattachment to the orbital wall to absorb its force and thus remove abduction torque was a simple and safe surgical procedure for restoring ocular alignment in four patients with third cranial nerve paralysis and in one patient with Duane syndrome with severe exotropia.     

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.     

固定性斜视的研究及治疗进展

固定性斜视是高度近视引起的一种伴有眼球内转及上转功能障碍的进行性内下斜视.传统的手术方式不能很好解决患者的眼位及眼球运动问题,且术后容易复发.随着眼眶结缔组织与肌肉关系研究的深入,固定性斜视的发病机制逐渐被认识,针对发病机制的手术治疗方式效果肯定.本文就固定性斜视的发病机制及手术治疗进展做一综述.     

Surgical treatment of myopic strabismus fixus: a graded approach

Background  Surgical treatment of myopic strabismus fixus is challenging. Options for its correction range from conventional combined recession-resection surgery to innovative surgical procedures aiming to correct the deviated muscle paths. In this report we review our experience and compare the results of various surgical options for treatment of strabismus fixus. Methods  We report the surgical outcomes of nine adults with acquired strabismus fixus due to myopia with a follow-up of 1 year. Patients were enrolled between May 2003 and April 2007 in this retrospective study. The surgical procedure was determined depending on the angle of deviation and extent of motility impairment. A new transposition technique was performed in one patient who had an extreme variant of strabismus fixus. Results  Combined recession-resection surgery was performed in four patients with resulting small-angle esotropia. In patients with both esotropia and hypotropia due to muscle alignment, we performed an additional upward displacement of both horizontal recti muscles combined with a myopexy of the lateral rectus muscle. The results were satisfying; in particular in one patient who had a transposition procedure a significant improvement was achieved. Conclusions  For treatment of myopic strabismus fixus, a graded approach seems advisable. Combined recession-resection surgery yields good results for smaller deviations with mildly impaired motility, additional fixation techniques need to be applied once the horizontal muscle paths are deviated, and in extreme cases, a transposition procedure is required.     

肌腹下眶-球硅管连接术治疗固定性斜视

目的探讨在麻痹肌肌腹下行眶-球硅管连接术治疗固定性斜视的疗效。方法收集23例（23只眼）固定性斜视患者,其中内斜视22例,外斜视1例;11例为全固定性斜视,12例为亚固定性斜视（9例斜视眼可转动,但无法达到正视位,3例斜视眼转动可达到正视位）。行拮抗肌后退术后,用直径为1mm的硅管经麻痹肌腹下连接眦部眶骨膜和麻痹肌止端前巩膜。术后随访12～36个月,观察眼位和眼球运动情况。结果23例患者术后眼位均恢复至正视位。术眼可向麻痹肌侧转动达25％、50％及75％正常幅度者分别为5例、2例及3例。结论肌腹下眶-球硅管连接术借用硅胶的弹性,起到被动牵拉作用以矫正斜视,是治疗固定性斜视的可行方法,同时该手术具有硅胶不外露的优点。（中华眼科杂志,2005,41：817-820）     

Traumatic disinsertion of the superior rectus

The authors report the findings and management of traumatic disinsertion of the superior rectus occurring in a 55-year-old woman.     

Activated satellite cells in medial rectus muscles of patients with strabismus

PURPOSE: The goal of this study was to determine whether the medial rectus muscles of patients with a history of medial rectus underaction or overaction show alterations in the process of satellite cell activation when compared with normal age-matched control muscles. METHODS: Medial rectus muscles were obtained with consent from adult patients undergoing surgical resection due to medial rectus underaction or overaction and were prepared for histologic examination by fixation and paraffin embedding. Control muscles were obtained from cornea donor eyes of adults who had no history of strabismus or neuromuscular disease. Cross sections were obtained and stained immunohistochemically for the presence of activated satellite cells, as identified by MyoD immunoreactivity, and the presence of the total satellite cell population, as identified by Pax7 immunoreactivity. The percentages of MyoD- and Pax7-positive satellite cells per 100 myofibers in cross section were calculated. RESULTS: As predicted from results in the literature, MyoD-positive satellite cells, indicative of activation, were present in both the control and resected muscles. In the underacting medial rectus muscles, the percentages of MyoD- and Pax7-positive satellite cells, based on the number of myofibers, were approximately twofold higher than the percentages in the control muscles. In the overacting medial rectus muscles, the percentage of MyoD-positive satellite cells was twofold less than in the control muscles, whereas the percentage of Pax7-positive satellite cells significantly increased compared with that in the control specimens. CONCLUSIONS: The presence of an increased number of activated satellite cells in the resected underacting medial rectus muscles and the decreased numbers of activated satellite cells in the overacting muscles was unexpected. The upregulation in the number of MyoD-positive satellite cells in underacting muscles suggests that there is potential for successful upregulation of size in these muscles, as the cellular machinery for muscle repair and regeneration, the satellite cells, is retained and active in patients with medial rectus underaction. The decreased number of activated satellite cells in overacting MR muscle suggests that factors as yet unknown in these overacting muscles are able to affect the number of satellite cells and/or their responsiveness compared with normal age-matched control muscles. These hypotheses are currently being tested.