调整缝线在急性共同性内斜视术中的应用

急性共同性内斜视者多因复视及内斜视就诊,且经保守治疗半年～1年后复视不消失或内斜视者采用手术治疗,手术治疗的目的是使复视消失,部分患者术后可获得一定程度的立体视[1]。对儿童行全麻下急性共同性内斜视手术矫正时,手术量精度要求高,而采用术中放置调整缝线,可弥补手术量偏差,提高手术的成功率。本文2例急性共同性内斜视均在全麻下行双眼内直肌后徙术,术中一眼置调整缝线,术后应用调整缝线调整眼位,矫正效果满意。临床资料例1　患儿,男,7岁,突发复视并内斜视2年,2年前左眼被他人踢伤,院外经保守治疗1年余,复视不消失。收入院后经儿科及…     

成人急性共同性内斜视的临床观察

目的 对成人急性共同性内斜视进行回顾性研究，获取诊断、治疗的共性。方法 对成人急性共同性内斜视病人15例进行内直肌徙后的调整缝线手术，术后常规进行1～2周同视机训练，收集资料，进行数据统计、分析。结果 （1）看远斜度大于看近。（2）实际手术量比共同性内斜大。（3）术后双眼视功能恢复好。（4）大部分病人复视消失。（5）内直肌止端靠前。结论 急性共同性内斜视大部分可通过手术矫正达到复视消失、功能治愈的目的，手术量的计算与其他共同性内斜视不同。     

急性共同性内斜视的手术治疗

目的 探讨急性共同性内斜视的手术治疗及效果.方法 对29例急性共同性内斜视患者进行回顾性研究,手术采用单眼或双眼内直肌后徙、单眼内直肌后徙加外直肌截除、双眼内直肌后徙加单眼或双眼外直肌截除,手术量较普通内斜视略大.同视机及颜氏立体图检查术前及术后双眼视觉和立体视.结果 29例患者术后眼位矫正满意,患者复视消失.双眼单视功能改善,术后1个月融合范围平均20.57°± 3.93°,与术前比较差异有显著统计学意义(t=3.396,P<0.01);术后1 a融合范围平均26.91°±4.09°,与术后1个月比较差异有统计学意义(t=1.971,P<0.05).结论 急性共同性内斜视在保守治疗3～6个月后尽早实行手术治疗,达到斜视和复视消失及功能治愈目的 .[眼科新进展2009;29(6).466-167]     

急性共同性内斜视的手术探讨

目的探讨急性共同性内斜视的有效治疗方法。方法回顾分析8例急性共同性内斜视手术治疗患者的手术效果。用同视机测定视远双眼单视功能,用Titmus立体图谱测定近立体视锐度。结果术后眼位正位6例,恢复双眼单视;两例欠矫5°,术后获同视机Ⅰ～Ⅲ级功能。结论全矫手术是治疗急性共同性内斜视的合理有效的治疗方式。     

急性共同性内斜视的手术治疗

目的探讨急性共同性内斜视的手术治疗效果.方法采用单眼内直肌后徙加外直肌截除,或双眼内直肌后徙加单眼或双眼外直肌截除,手术量比普通内斜视略加大的手术方法治疗急性共同性内斜视.结果13例术后眼位得到满意矫正,并且消除了复视,改善了双眼单视功能.结论对于复视干扰明显,斜视度大的急性共同性内斜病例,在发病6个月后尽快施行手术治疗,能有效矫正眼位,消除复视,保全或改善双眼单视功能.     

急性共同性内斜视的早期治疗效果探讨

目的 探讨急性共同性内斜视早期进行安全有效处理的方法.方法 选取2010年4月至2011年3月在眼肌科门诊就诊的急性共同性内斜视患者6例.平均年龄24.5岁,平均病程10周.治疗前三棱镜+马氏杆检查内斜视度数平均为+25△(33 cm,),远、近距离内斜视角度基本相等.同视机检查融合范围较正常小,平均为-3.3°～+9.2°.排除中枢神经系统、内分泌系统异常及其它疾病后,在外科手术显微镜下使用我们自创的眼表微创注射法将肉毒毒素注入眼外肌肌腹.结果 6例患者随访时间6～18个月.一次注射后5例眼位正,自觉复视症状消失,融合范围不同程度增加,且病情稳定未见复视再次发生.另1例在注射后3个月复视再次出现,再次行该药物注射.此患者在发病后11个月因内斜视和复视的反复发作而行内斜矫正手术.药物注射后6例患者均未发生外斜视和上睑下垂等并发症.结论 急性共同性内斜视发病早期行眼外肌肉毒杆菌类毒素注射治疗,可以达到有效地消除和缓解复视和斜视的作用,对大多数患者可以达到治愈目的.     

急性共同性内斜视手术治疗探讨

目的 探讨急性共同性内斜视的诊断及处理.方法 选取2003～2009年经治疗的12例5～12岁诉有复视、斜视度为25△～60△、双眼存在立体视觉的急性共同性内斜视病人先排除了神经系统疾病后,行常规内斜矫正术并作回顾性分析.结果 术后随访6～18个月,所有病人眼位被矫正,复视消失,立 体视觉维持并改善到40".结论 急性...     

非对称性手术矫正共同性斜视的临床分析

目的:观察非对称性手术矫正共同性斜视的疗效。方法:选择138例共同性斜视患者,其中包括共同性外斜视88例,共同性内斜视50例,合并垂直斜视度<7△的20例,合并轻度眼球隐性震颤的4例。其中外斜视平均斜视度30△～65△,内斜视平均斜视度30△～70△。所有患者均经过屈光矫正,弱视治疗视力提高至0.8以上,或双眼视力平衡0.6以上,同视机检查视功能,内斜患者戴镜矫正6mo以上。三棱镜检查33cm和5m斜视度差值≤15△的基本型斜视患者,斜视度在30△～70△的行单眼水平肌肉后徙加缩短的非对称性手术。术后1wk年龄在6～14岁的做10d同视机功能训练。结果:术后1mo复查:矫正正位126例,欠矫8例,过矫2例,垂直斜视度变化不大,复视2例。术后3mo复查:矫正正位128例,欠矫8例,过矫1例,复视1例。同视机检查三级功能:术后做过功能训练的Ⅰ,Ⅱ,Ⅲ级视功能建立,Ⅰ级视功能建立35例,Ⅱ级视功能建立58例,Ⅲ级视功能建立45例。结论:非对称性手术矫正共同性斜视效果满意,儿童术后行功能训练有助于早日恢复视功能。     

白内障术中局部注射麻醉导致的术后斜视及治疗

目的 在白内障手术中因球后或球周麻醉时药物可能导致眼外肌毒性而产生术后斜视及治疗.方法 对5例局部麻醉白内障术后患者,均于术后第一天去除眼罩时发现复视.于白内障术后3个月后在全麻下行受累肌肉的后徙及可调节缝线手术.结果 白内障术中局部注射布比卡因导致的眼肌麻痹于术后即发复视并持续存在.在观察病例中2例上直肌受累、3例下直肌受累.4例左眼,1例右眼.在受累肌肉行足量的肌肉后徙并可调节缝线,术后大部分注视方向复视消失,眼位调正.结论 白内障术后斜视应当注意到术中局麻药物肌肉毒性所致的斜视.早期由于肌肉麻痹产生复视,后期由于肌肉纤维化和(或)肥大产生与初始复视相反方向的复视.对受累肌肉的足量后徙和可调节缝线可以获得满意的术后效果.     

甲状腺相关眼病眼眶减压术后继发内斜视伴复视的手术疗效观察

目的探讨甲状腺相关眼病(TAO)眼眶减压术后继发内斜视伴复视的斜视矫正手术治疗效果。方法回顾性系列病例研究。选取2016年3月至2018年10月在天津市眼科医院因TAO行眼眶减压术后继发内斜视伴复视行斜视矫正手术治疗的11例患者资料。斜视矫正手术前、后检查患者斜视度数、眼球运动,观察复视情况。手术均在监护下麻醉联合局部麻醉下进行,术中采用被动牵拉试验结合调整缝线方法,调整至第一眼位复视消失。术后定期随访。结果11例患者中男性1例,女性10例;年龄26~42岁;均为单纯内斜视伴复视;内斜视度数10~98三棱镜度;眼眶CT提示患者内直肌不同程度增厚,外直肌增厚程度较内直肌轻。2例患者行单眼内直肌后徙术,2例行双眼内直肌后徙术,2例行单眼内直肌后徙联合外直肌缩短术,另外5例行双眼内直肌后徙联合单眼外直肌缩短术。11例患者术中内直肌后徙量为3.5~7.5 mm,7例联合外直肌缩短术患者外直肌缩短量为2.0~6.0 mm。全部患者术后复视消除,第一眼位正位,均达到治愈标准。眼球运动术前外转受限分级为(-1.91±1.04)级,术后外转受限分级为(-0.64±0.81)级。11例患者均对手术结果满意,术后随访6~24个月,效果稳定,未发现远期过矫患者。结论应用术中调整缝线技术,斜视矫正手术可以有效治疗TAO眼眶减压术后继发的内斜视伴复视。     

不同术式治疗垂直分离性斜视的临床疗效分析

目的探讨治疗垂直分离性斜视（DVD）的最佳手术方式。方法对43例（72眼）DVD根据不同的术前检查结果选择不同的术式。有下斜肌亢进者首选下斜肌切断加转位,根据亢进程度不同决定下斜肌在转位之前的截除量。无下斜肌亢进者首选上直肌后退术。双眼DVD不伴有下斜肌功能亢进者,且上斜程度相等者行双跟上直肌等量后徙术;双眼上斜程度不等者行双眼上直肌不等量后徙,或先行上斜明显眼手术,改期行另眼手术;合并水平斜视者尽可能同时完成,否则先矫正水平斜视,半年后矫正DVD。结果52眼疗效良好（72．22％）,16眼好转（22．22％）,4眼（5．56％）无效,1眼（1．38％）退上直肌和双眼外直肌后出现继发内斜视和对侧眼下斜肌亢进。结论对不同类型的DVD采用不同的术式可获得良好的疗效。     

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.     

Intraoperative adjustable suture strabismus surgery under topical and subconjunctival anesthesia

BACKGROUND AND OBJECTIVE: To assess the postoperative surgical results of intraoperative adjustable suture strabismus surgery under topical and subconjunctival anesthesia. PATIENTS AND METHODS: For 44 patients who had undergone intraoperative adjustable suture technique under topical anesthesia, the deviations were measured preoperatively, at 1 day, 1 month, and 3 months postoperatively, and at the last postoperative follow-up visit. The mean follow-up period was 7.8 months. RESULTS: Thirty-three patients had exotropia and 11 had esotropia. Mean age was 28.8 years. The success rates for exotropia and esotropia at the last follow-up visit were 81.8%. CONCLUSION: Intraoperative adjustable suture strabismus surgery under topical and subconjunctival anesthesia is the recommended surgical technique due to the successful results and various advantages compared with non-adjustable surgery, including the decreased rates of overcorrection or undercorrection that appear immediately after surgery and reoperation. Postoperative "drift" toward the original deviation was observed under longer follow-up periods than other studies.     

复杂性斜视手术显微镜下眼外肌调整缝线式手术的效果

目的:观察手术显微镜下眼外肌调整缝线式手术治疗复杂性斜视的效果。方法:回顾性分析郑州市第二人民医院2015年1月至2018年12月就诊的191例复杂性斜视的临床资料。所有患者均在全麻下行手术显微镜下眼外肌调整缝线手术矫正斜视,其中83例为超长量手术。全麻苏醒后或次日观察眼位及有无复视或复视是否消失,如需调整缝线则在局麻或全麻下进行调整。随访观察6个月。结果:术后全部眼位矫正良好、复视消失,未出现肌肉滑脱等并发症。结论:对复杂性斜视行手术显微镜下眼外肌调整缝线斜视矫正术,手术成功率较高,手术反应少。     

儿童部分调节性内斜视的治疗及调整缝线在手术中的应用

目的 探讨儿童部分调节性内斜视的术前治疗、手术时机与手术量以及调整缝线在治疗中的应用。设计 回顾性病例系列。研究对象 北京儿童医院眼科接受手术治疗的部分调节性内斜视患者30例。方法 对手术治疗的部分调节性内斜视患者的临床资料进行回顾性分析。患儿术前矫正屈光异常,观察斜视度稳定,并予适当弱视治疗,在双眼视力相当的情况下进行手术,按照裸眼和戴镜斜视度的平均值设计手术量。术中常规使用调整缝线技术,术后早期依据眼位情况决定是否需要调整。术后随访6~15个月。观察眼位及双眼视功能。主要指标 术后眼位、双眼视功能、眼位调整情况。结果 有3例患儿进行了眼位调整,均为过矫,避免了二次手术。末次随访时30例患者中26例（87%）眼位在正位~+8△之间,4例（13%）眼位+10△~+15△。术前能合作行双眼视功能检查者19例,有双眼视功能者2例（11%）。末次随访时能合作双眼视功能检查者21例,有双眼视功能者15例（71%）。结论  内斜视伴有调节因素时应及时全矫配镜,在残余斜视度稳定、双眼矫正视力基本相当后应尽早手术。手术设计根据戴镜与裸眼视近的平均斜视度,调整缝线有助于保证术后早期的眼位满意,降低了二次手术的风险。（眼科, 2013,22: 121-123）     

周期性内斜视的屈光状态与临床治疗

目的 探讨周期性内斜视的屈光状态与治疗方法。方法 对２４例周期性内斜视者用１％阿托品液散瞳验光检验屈光度。斜视日与正位日用三棱镜测量斜视度,用同视机检验双眼立体视觉。手术量按斜视日最大斜视角有设计。结果 轻度、中度远视２３例。斜视日均有复视。正位日均有双眼立体视觉,斜视矫正术后２３例在斜视日与非斜视日眼位均矫正有正常的立体视觉。结果 为获得正常的双眼立体视功能,应在周期性期间及早手术。手术量控斜视     

Long-term results of adjustable suture surgery for strabismus secondary to thyroid ophthalmopathy.

PURPOSE: To review the results of adjustable suture surgery in patients with strabismus secondary to thyroid ophthalmopathy to determine long-term outcome and to identify postoperative complications. METHODS: The records of 1524 patients with thyroid ophthalmopathy were retrospectively reviewed to identify those who required treatment for strabismus in the ocular motility clinic. Treatment consisted of adjustable suture surgery, prisms, or both. Elimination of diplopia in primary and reading positions was used at the criterion for success. RESULTS: Forty-seven patients were treated with adjustable suture surgery, with an average follow-up of 41 months. Results after 1 or more surgeries were: 47% excellent, 26% good, 19% fair, and 9% poor. Significant postoperative complications included eyelid retraction and A-pattern exodeviation. Sixteen of 18 patients with fair or poor outcomes after the initial surgery were recognized within 6 months. Postoperative changes in vertical deviation from primary position to downgaze were predictive of postoperative diplopia in downgaze. Analysis of multiple preoperative characteristics showed no statistically significant associations with outcome. Eight additional patients had adequate relief of diplopia using prisms alone, with an average follow-up of 49 months. CONCLUSIONS: Long-term symptomatic relief of diplopia was obtained in the majority of patients using adjustable suture strabismus surgery, combined occasionally with small amounts of prism postoperatively. Prisms alone provided effective long-term relief in patients with small-to-moderate deviations.     

Advancements in diagnosis and surgical treatment of strabismus in adolescent and adults

PURPOSE: To present complete process of pre-operative strabismus diagnosis, which can be used for prediction of post-operative diplopia in adolescents and adults. MATERIAL AND METHODS: The study involved three patients, who were qualified for the surgical treatment of strabismus. Complete pre-operative diagnosis predicting potential post-operative diplopia was performed in all patients. The prismatic test for diplopia, hyperfunctional muscle botuline toxin injection, and prism correction were performed RESULTS: Regarding the results of tests, two patients were qualified for surgical treatment. None of them suffered from diplopia after this treatment. The third patient in pre-operative tests showed unacceptably high risk of intolerable diplopia. CONCLUSIONS: Post-operative diplopia in adolescents and adults represents a serious problem, especially in susceptible patients. Accurate and complete pre-operative diagnosis allows for risk reduction in post-operative diplopia. The predictive test for post-operative diplopia, botuline toxin injection and prism correction in isolation are not always able, to give a reliable indication, as to the sensory status following strabismus surgery. A combination of the three above mentioned techniques give more reliable diagnosis. For patients, who can possibly suffer from post-operative diplopia, the adjustable suture technique should be applied.     

Surgical treatment in a case of chronic progressive external ophthalmoplegia

PURPOSE/METHODS: The purpose is to discuss the surgical result in a case with chronic progressive external ophthalmoplegia (CPEO) associated with strabismus and diplopia. The authors present a patient with mitochondrial myopathy and CPEO who was treated using adjustable recessions with local anaesthesia. RESULTS/CONCLUSIONS: Five months after surgery improvement in ductions were maintained and there was no diplopia or torticollis. We support operating these cases with CPEO associated with strabismus. The adjustable suture technique allowed us a satisfactory result in immediate postoperative.