V型斜视的手术治疗

目的 探讨V型斜视的手术方法及疗效。方法 28例V型斜视手术治疗患者，按术式分为两组：水平直肌垂直移位组(Ⅰ组)5例，下斜肌切断或部分切除术组(Ⅱ组)23例。结果 28例V型斜视患者中，23例行下斜肌切断或部分切除术，5例行水平直肌垂直移位术，术后观察效果良好。结论 下斜肌亢进是V型斜视主要原因。下斜肌减弱术及水平直肌垂直移位术是矫正V型斜视的有效手术方式。在有下斜肌功能亢进的情况下，前者为首选。     

V型外斜视的临床特征和手术治疗

目的:探讨V型外斜视的临床特点和手术方法及疗效方法:分析2003-01/2007-07在我院行手术治疗的93例V型外斜视患者,其中男51例,女42例,年龄4～27(平均13.2)岁,术后随访时间为6mo～4a,V征向上向下注视的斜视度之差最小为15△,最大相差100△,其中15～50△者85例,>50△者8例,第一眼位斜视角在-20～-110△,术前行同视机检查有双眼单视功能者18例。手术根据有无斜肌异常和V征的程度,在水平斜视矫正的同时,选择下斜肌切断或部分切除,直肌附着点垂直移位、及下斜肌部分切除并水平直肌垂直移位三种术式。结果:采用下斜肌断腱或部分切除术和水平直肌附着点移位均取得满意效果,下斜肌断腱或部分切除术适应于下斜肌亢进的外斜V型,垂直肌移位术适应因无下斜肌亢进的外斜V征,术后第一眼位正位者84例,V征消失者87例,双眼视功能恢复者达49例。结论:V型外斜视是一种常见的斜视类型,常合并水平斜视,发病原因以斜肌功能异常为主,可根据病因选择不同手术方式,手术不仅可以矫正眼位,而且有利用双眼单视功能的建立。     

V型斜视的疗效观察

目的探讨V型斜视的手术方法及术后双眼单视功能的状况。方法31例V型斜视伴有斜肌功能亢进的22例行斜肌断腱+水平肌后徙、缩短+水平肌止点垂直移位术;不伴斜肌功能亢进9例行水平肌后徙、缩短+水平肌止点垂直移位术;术后对无双眼单视功能的病例用同视机进行双眼单视功能训练。结果31例中V征矫正满意25例(80.6%),欠矫6例(19.4%),欠矫者术前V征斜视度差值均>35△。术前无双眼单视功能的28例术后经同视机训练21例年龄在17岁以下的病例获得双眼单视功能,Ⅰ级2例,Ⅱ级4例,Ⅲ例15例。结论V征产生原因是多因素的,可根据有无斜肌功能亢进选择术式,对有斜肌功能异常的行斜肌断腱+水平肌后徙、缩短+水平肌止点垂直移位术疗效满意。术后进行双眼单视功能训练,超过视觉发育敏感期的病例仍有部分能获得良好的双眼单视功能。     

V型斜视的手术治疗

目的探讨V型斜视的手术治疗效果及术后双眼单视功能状况。方法对48例V型斜视按下斜肌功能状况分为四组:Ⅰ组V型外斜视伴有下斜视肌功能亢进17例;Ⅱ组V型外斜视无明显下斜肌功能亢进10例; Ⅲ组V型内斜视伴下斜肌功能亢进14例;Ⅳ组V型内斜视无明显下斜肌亢进7例;对Ⅰ组和Ⅲ组行内外斜视矫正同时行单(双)侧下斜肌后徙术,对Ⅱ和Ⅳ组行内外斜视矫正同时行水平直肌附着点垂直移位术。结果Ⅰ组患者术后原在位眼位-8△-+3△向上与向下注视时斜视角差≤4△。Ⅱ组原在位眼位-10△-+5△向上与向下注视时斜视角差≤8△。Ⅲ组原在位眼位-4△-+6△向上与向下注视时斜视角≤4△。Ⅳ组原在位眼位-5△-+10△,向上与向下斜视角差为7△。结论采用两种术式矫正V型斜视疗效确切,下斜肌后徙较水平直肌附着点垂直移位效果明显,并且有希望建立双眼单视功能。     

A-V型斜视的手术治疗

目的探讨A-V型斜视的特点和手术治疗。方法分析74例A-V型斜视临床疗效。本组74例中,V型斜视51例,A型斜视23例,手术前后采用三棱镜加交替遮盖法测量33cm和5m处眼球原位斜视角,并分别检测向上注视25°和向下注视25°斜视度数,根据斜肌功能亢进的程度选择不同的手术方式。术后观察眼位和视觉功能状况,随访时间为4～24周。结果 74例中术后眼位达正位65例,占87.83%。其中4例合并DVD二期行单眼的上直肌后徙,3例再次手术施行斜肌断腱,2例未行二次手术。21例术后获得双眼单视功能。伴有下斜肌亢进且合并眼底相外旋的V型斜视33例（61眼）,行下斜肌断腱或下斜肌前转位术,下斜肌亢进消除59眼,缓解2眼。无下斜肌功能亢进和下斜肌亢进＋1且眼底相无外旋的18例行水平直肌水平移位术,术后正位16例,2例V型斜视未消除。伴有上斜肌亢进且合并眼底相内旋的A型斜视10例（20眼）,施行上斜肌断腱术;13例则施行水平直肌移位术。A型斜视2例未消除。结论 A-V型斜视手术治疗矫正原在位水平斜视的同时,根据斜肌亢进的程度,眼底相旋转情况及双眼视功能的情况来选择不同的手术方式,手术效果良好。     

40例V型斜视的临床分析

目的探讨V型斜视的临床特征,手术矫正效果及手术方式。方法总结顺义区医院小儿眼科40例V型斜视,行水平肌垂直移位术,下斜肌部分切除 水平肌手术,下斜肌后徙 转位术 水平肌矫正术,观察术后眼位,下斜肌功能。结果下斜肌部分切除 水平肌手术对V型斜视疗效满意。结论斜肌功能亢进是V型斜视发病的主要原因,V型斜视手术方式主要是下斜肌部分切除 水平肌手术。     

水平直肌移位术在斜视治疗中作用

目的 探讨斜视手术中施行水平直肌垂直移位术和转位术的作用.方法 手术前后采用三棱镜遮盖法测定62例斜视患者各诊断眼位的斜视角及眼球运动等,并通过同视机检查和眼底照相评估主客观旋转斜视.手术年龄5～33岁,平均14岁.术后随访1～34个月,平均6个月.结果 (1)不伴有斜肌功能异常V型斜视26例,施行双侧水平直肌同方向垂直移位术或施行单眼水平直肌反方向垂直移位术,分别矫正垂直非共同性10～30△和8-25△,并未发现旋转斜视. (2)伴有斜肌功能异常A型斜视25例,单纯施行水平直肌垂直移位术,可矫正垂直非共同性8～30△,原在位与向下注视之间残留斜视角5～25△,而联合双侧上斜肌减弱术组,残留斜视角2～8△. (3)治疗共同性水平斜视伴有小角度垂直斜视8例,双侧水平直肌的向下或向上移位术矫正上斜视2～8△,残余上斜视2～5△. (4)治疗单眼先天性双上转肌麻痹3例,施行水平直肌垂直转位至上直肌肌止端两侧,矫正垂直斜视角25～30△,残余垂直斜视角5△,眼球双上转运动均明显改善.结论 水平直肌垂直移位术能有效地矫正下斜肌功能无异常V型斜视垂直非共同性,联合双侧上斜肌减弱术能更有效解决A型斜视向下注视的斜视角,而治疗共同性垂直斜视的作用则有一定的局限性;转位术治疗单眼先天性双上转肌麻痹疗效较好.     

V型斜视伴下斜肌功能过强的治疗

目的探讨V型斜视伴下斜肌功能过强的治疗。方法水平斜视手术合并下斜肌断腱术治疗V型斜视伴下斜肌功能过强，其中V型外斜7例，V型内斜2例。结果术后第一眼位正位（≤10△），V型斜视矫正7例，欠矫2例。下斜肌功能过强改善，术后无明显并发症。结论一次施行双眼多条肌肉手术矫正V型斜视伴下斜肌功能过强是完全有效的术式。     

下斜肌亢进的手术治疗

目的　探讨下斜肌亢进的手术方法及疗效。方法　下斜肌亢进 80例 ,根据垂直斜视度亢进程度及并发症不同 ,将下斜肌手术方式分为 3类 (3组 ) :截除组 48例 ,鞘内断腱组 16例 ,转位组 16例。结果　 80例随访平均 6月 ,截除组治愈44例 (91 67% ) ;鞘内断腱组治愈 14例 (87 5% ) ;转位组治愈 10例 (62 5% )。下斜肌截除组效果最好 ,经统计学处理 ,3组间治愈率差异无显著性意义 (P >0 0 5)。结论　下斜肌亢进没有固定的手术模式 ,根据术前垂直斜视角大小、下斜肌亢进程度及是否合并垂直分离性斜视 (DVD) ,选择不同的手术方式均能取得满意疗效。     

不同下斜肌术式在V征治疗的临床观察

目的 对比观察下斜肌断腱术和下斜肌部分切除术在V征治疗中的效果.方法 取伴有下斜肌亢进的V征患者35例.使用三棱镜交替遮盖法测量视近时第一眼位及上下转25°时的水平斜视度.对下斜肌功能亢进程度进行分级.随机分为2组,分别行下斜肌断腱术和下斜肌部分切除术,观察术后3个月的上下转斜视度差值和下斜肌功能变化.结果 术后3个月时下斜肌断腱术组上下转斜视度差值平均为(5.6 4±5.4)△,下斜肌部分切除术组上下转斜视度差值平均为(4.7±4.3)△,两组相比无显著性差异(P>0.05).下斜肌断腱术组下斜肌功能+2级2只眼,+1级7只眼,0级21只眼.下斜肌部分切除术组下斜肌功能+2级1只眼,+1级5只眼,0级22只眼.两组相比无显著性差异(P>0.05).结论 下斜肌断腱术和下斜肌部分切除术都有效的解决了下斜肌亢进的V征问题,消除了垂直非共同性.     

水平肌移位术治疗水平斜视并伴垂直斜视的临床效果观察

目的探讨水平肌移位术治疗水平斜视并伴垂直斜视的临床效果。方法选取我院2009年2月至2011年2月收治的诊断为水平斜视并伴垂直斜视的患者56例（83只眼）,对其临床病历资料进行回顾性分析,均采取水平肌移位术治疗,选择行内外直肌止端的上下移位量〈3 mm的患者为观察组A,共32例（51只眼）;选择行内外直肌止端的上下移位量为5～7 mm的患者为观察组B,共24例（32只眼）,再选择10例（12只眼）无进行内外直肌移位术的患者设为对照组,观察对比三组患者的视力矫正效果。结果观察组A平均矫正的垂直斜视度数为1.76°±0.45°;观察组B平均矫正的垂直斜视度数为4.57°±0.79°;对照组平均矫正的垂直斜视度数为1.24°±0.36°,3组患者平均矫正垂直斜视度数对比存在明显差异（P〈0.05）,具有统计学意义。结论水平肌移位术治疗水平斜视并伴垂直斜视的临床效果显著,水平肌的移位量均在5mm以上,平均矫正垂直斜视度数最为明显,安全可靠。     

Effect of aging on human rectus extraocular muscle paths demonstrated by magnetic resonance imaging

PURPOSE: To compare normal functional anatomy of rectus extraocular muscles (EOMs) and pulleys in normal older humans with previously reported findings in younger subjects. DESIGN: Experimental study of the orbits of normal healthy older volunteers by magnetic resonance imaging (MRI). METHODS: In planes perpendicular to the orbital axis, contiguous MRI images spanned the anteroposterior extents of 22 orbits in 12 older adults with an average age of 65.2 years (range, 56-74). Images were obtained in central gaze in all subjects and repeated in supraduction, infraduction, abduction, and adduction in some subjects. Mean EOM cross-sectional area centroids were normalized to an oculocentric coordinate system and plotted over the length of each EOM to determine paths. RESULTS: Compared with images obtained using identical technique in 12 younger subjects (average age, 28.5 years, range 21-33), the horizontal rectus EOMs in the 12 older subjects were significantly displaced inferiorly throughout the anteroposterior extent of the orbit. The vertical rectus EOM was positioned identically to those of younger subjects. Inflections in EOM paths produced by the connective tissue pulleys could not be determined in most older subjects, because of difficulties in maintaining extreme eccentric gaze. For one subject who was able to do this, the anteroposterior location of the medial rectus pulley inferred from path inflection was similar to that of younger subjects. CONCLUSIONS: The horizontal rectus EOMs are displaced inferiorly in the elderly relative to the globe center. This displacement presumably reflects an inferior location of the corresponding pulleys, partially converting horizontal rectus EOM force to depression. This may contribute to the observed impairment of elevation in older people and predispose them to a characteristic pattern of incomitant strabismus.     

Predictability of horizontal versus vertical muscle surgery outcomes in thyroid eye disease

Surgical repair of vertical muscles in thyroid eye disease (TED) is believed to yield more unpredictable results than horizontal muscle surgery. The purpose of this study is to determine if the short-term outcomes for strabismus surgery in TED are equally predictable for horizontal and vertical muscle surgery. We retrospectively reviewed the charts of 27 consecutive patients who underwent strabismus surgery for TED from a single surgeon’s practice. Eligibility for inclusion in the study included biochemically stable thyroid disease for at least a year and stable orthoptic measurements for at least 6 months prior to surgery. Nine patients had surgery only on vertical rectus muscles, three only on horizontal, and fifteen on both vertical and horizontal rectus muscles. Mean follow-up was 2.4 ± 5.2 months. In primary gaze at 6 m, a mean horizontal deviation of 16.6 ± 22.3 PD, and a mean vertical deviation of 19.7 ± 14.1 PD were measured pre-operatively. Post-operatively, this measured 2.3 ± 8.4 PD horizontally and 2.1 ± 7.8 PD vertically (p = 0.933). There was no statistically significant difference between post-operative horizontal and vertical deviations in elevation, depression, adduction, and abduction. Nine patients required reoperation to attain satisfactory ocular alignment; seven of these cases involved repeat surgery on vertical muscles, while two cases required operation on both horizontal and vertical muscles. Results suggest that surgical outcomes of both horizontal and vertical muscle surgery are equally predictable in stable TED; however, reoperation rates were higher for vertical muscles compared to horizontal muscles.     

O'Connor's surgical method in abducens nerve paralysis

Eighteen patients who underwent surgery for nervus abducens paresis (NAP), were kept under observation for up to 23 years after the operation. Three patients had paresis of both nerves. The operation, employing O'Connor's method (11 patients) included the grafting of split inferior and superior rectus muscles on to the insertion of the resected lateral rectus muscle. Six patients underwent resection and retroposition of the lateral and medial rectus muscles respectively. O'Connor's method produced functionally and cosmetically better results than surgery on horizontal muscles in congenital NAP (13 patients). In NAP due to organic damage (e.g., trauma) (5 patients) the results obtained with the two methods were similar.     

An approach to the surgical management of total oculomotor nerve palsy

The goal of the procedure was to keep the eyes of patients with total oculomotor palsy in the straight ahead position by means of surgery on the horizontal and inferior rectus muscles in one session, without involving the superior oblique muscles. Six patients underwent surgery for total oculomotor nerve palsy. All of the surgical procedures were carried out on the muscles of the paralytic eye. We performed hemi-hangback recession of the lateral rectus and resection of the medial rectus for exotropia in all patients. Depending on the magnitude of vertical deviation, the insertions of the horizontal rectus muscles were moved upward, alone or in combination with hemi-hangback recession of the inferior rectus. The mean preoperative horizontal deviation was 66.6 PD. Two years after the operation, the horizontal deviation was measured to be 11.6 PD. Similarly, the mean preoperative vertical deviation of 16 PD decreased to 6.6 PD in two years. This procedure did not disturb normally functioning superior oblique and lateral rectus muscles. Subjectively, all of the patients were satisfied with their alignment two years after the operation. We are of the opinion that this technique is a safe, simple and effective procedure and can be regarded as a first-choice operation in total oculomotor palsy. If one fails to maintain the eye position with this procedure, one can still perform a second operation on the superior oblique muscle, which remains untouched in our procedure.     

手术治疗外斜V征的效果观察

目的探讨外斜v征的手术方法及其效果。方法外斜V征43例中38例行下斜肌切断或部分切除联合常规水平肌手术,另5例行水平直肌垂直移位术。观察术前术后眼位、下斜肌功能和双眼视觉的状况。结果对大多数外斜V征的患者来说,下斜肌减弱术联合常规的水平肌手术矫正效果最好;对无明显下斜肌亢进者,水平直肌的垂直移位术可取得很好的疗效。本组43例外斜V征患者中37例术后眼位上、中、下均为正位,54眼下斜肌功能亢进消失,8眼仍有轻度下斜肌功能亢进,15例有一定程度的双眼视。结论根据外斜V征是否合并下斜肌亢进以及亢进的程度,决定行下斜肌减弱术或水平直肌垂直移位术,同时行常规水平肌手术矫正水平斜视。术后效果良好,患者双眼视觉功能可能有所恢复。     

Recession of both horizontal rectus muscles in Duane syndrome with globe retraction in primary position.

INTRODUCTION: Duane syndrome is characterized by abduction deficiency, narrowing of the palpebral fissure on adduction, and globe retraction,which can be the most prominent aspect of the motility disorder. Recession of both horizontal rectus muscles was investigated for treatment of severe globe retraction. METHODS: Three patients with Duane syndrome were operated on for severe globe retraction. The medial rectus muscles were recessed from between 5.5 to 6.5 mm and the lateral rectus muscles 7.0 to 9.0 mm simultaneously. The recessions were asymmetric, as evidenced by amount of esotropia and face turn. Preoperative Hertel measurements were made in primary gaze, 30-degree left gaze, and 30-degree right gaze. The measurements were repeated at 6 months and 1 year after the operation. RESULTS: All three patients had improvement in globe retraction. The 6-month Hertel readings in primary position were improved by a mean of 3.0 mm (range 2.5 to 3.5 mm) measured in primary gaze. Hertel measurements were stable at 1 year after the operation. No complications were encountered. CONCLUSIONS: Recession of both horizontal rectus muscles is effective in the treatment of significant globe retraction in Duane syndrome.     

垂直斜视75例手术临床分析

目的探讨垂直斜视手术治疗方法,评价疗效。方法回顾分析75例垂直斜视手术患者。根据原在位垂直斜度、下斜肌亢进程度及其合并症不同分别采取下斜肌截断术、下斜肌截除术、下斜肌截除+转位术、下斜肌截除+转位+同侧眼上直肌后徙/或对侧眼下直肌后徙术、伴有水平斜视者按水平斜视矫正原则联合水平斜视矫正术、对无下斜肌亢进者行上直肌和/下直肌后徙术共6种手术方式,并进行平均3年以上的随访。结果 75例患者,通过6种手术方式进行一期手术,治愈57例(76%);好转12例(16%);无效6例(8%),其中欠矫4例(5.3%),过矫2例(2.7%),总有效率为92%。结论垂直斜视临床表现复杂,没有固定的手术模式,需根据术前详细的检查结果制定合理的手术方案,本文6种手术方法对治疗垂直斜视是可行的,绝大部分垂直斜视可通过一期手术获得临床治愈。     

Duane眼球后退综合征13例手术治疗临床分析

目的:探讨Duane眼球后退综合征(DRS)手术治疗的方法和效果。方法:对13例因DRS行手术治疗患者的临床表现、手术治疗方式和效果进行回顾性总结和分析。结果:单眼受累12例,双眼受累1例。Ⅰ型内斜视9例(双眼1例);Ⅱ型外斜视3例;Ⅲ型1例。其中2例外斜视患者合并内转眼急速上射和(或)下射现象。行单眼或双眼水平肌后徙术后代偿头位、眼球后退及睑裂变小体征均得到改善,术后斜视度数≤10△者11例(85%)。行患眼外直肌后徙术,可使内转眼上射和下射现象得到明显改善。结论:水平肌大量后徙可以使原在位的斜视得到矫正,代偿头位消失或得到明显改善,患眼内转的时候,眼球后退、睑裂变小明显减轻,上射和下射的现象减轻或消失。术前牵拉试验及术中彻底消除牵制因素是手术成功的关键。     

非共同性斜视的手术方式和效果分析

目的分析和评价非共同性斜视手术的方式和效果。方法非共同性斜视106例根据术前诊断分别采取斜肌断腱、后徙、并联合水平肌肉手术、上直肌下直肌后徙（缩短）联合水平肌肉手术、水平肌肉移位联合水平肌肉手术等手术方式。结果106例术后均达到治愈标准,异常头位消失。58例恢复了立体视。结论对于非共同性斜视要诊断准确,正确选择手术术式早期治疗。