分离性垂直斜视手术

目的 探讨分离性垂直斜视(DVD)的最有效的手术方法.方法 对36例(56眼)DVD根据不同情况设计手术.双眼DVD不伴有下斜肌功能亢进者,且上斜程度相等者行双眼上直肌等量后徙术;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;伴有下斜肌功能亢进者行下斜肌断腱并转位术合并上直肌后徙术;单眼DVD仅行单眼手术;单眼弱视明显先行弱视眼手术.合并水平斜视者尽可能同时完成,否则先矫正水平斜视,6个月后矫正DVD.结果 47眼疗效良好(83.92%),8眼好转(14.28%),1眼无效(1.78%).结论 对不同类型的DVD采用不同的手术方法均收到比较好的疗效.     

伴下斜肌亢进的分离性垂直偏斜的手术治疗

目的探讨伴下斜肌亢进的分离性垂直偏斜（DVD）的手术方式及效果分析。方法回顾性分析28例合并下斜肌亢进DVD手术方式,原在位垂直斜度较小选择单纯下斜肌转位术;大度数垂直斜视行下斜肌后徙联合同侧上直肌后徙术。三棱镜加遮盖法检查垂直斜度,反复检查3次,取平均值;下斜肌亢进分＋1～＋4;术后随访1个月至3年。结果术前下斜肌亢进28例（41只眼）,其中双眼13例;亢进＋1,4只眼;＋2,20只眼;＋3,16只眼;＋4,1只眼。下斜肌亢进均得到矫正。单纯下斜肌转位22例（30只眼）,单眼14例,双眼8例。近期满意率85．71％。远期满意率71．42％。下斜肌后徙＋同侧上直肌后徙术6例（15只眼）,双眼5例,单眼1例;双眼5例中4例满意,1例好转,其中2例术后出现轻度上转受限;单眼1例,效果满意,但术眼出现轻度上转受限,睑裂变小。结论伴有下斜肌亢进DVD垂直斜度较小时下斜肌转位术效果良好;垂直斜度较大需行下斜肌减弱＋同侧上直肌后徙术,上转肌同时减弱术,双眼手术比单眼安全。     

分离性垂直性斜视的诊断及手术

目的 探讨分离性垂直性斜视(dissociated venical divergence,DVD)的手术方法及效果.方法 28例(40眼)DVD者中双眼上斜视度不相等者做双眼不等量上直肌后退;单眼DVD做单跟上直肌后退.后退最大量8 mm.合并下斜肌亢进者做下斜肌转位术,伴有的水平斜视也同时矫正.结果 12例单眼上直肌后退,术后观察3～5周,出现对侧眼上斜视6例,上斜视度在10△左右.8例行不等量上直肌后退,效果较好,外观改善,被遮盖眼无明显上漂.6例下斜肌亢进,行下斜肌转位.经半年以上观察,手术效果好.结论 采用同视机和三棱镜检查为手术提供依据,做不等量上直肌后退.     

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。     

下斜肌后徙转位术治疗分离性垂直斜视

目的探索伴有下斜肌亢进的分离性垂直偏斜的有效手术方式。方法对54例95眼伴有下斜肌亢进的DVD患者应用下斜肌后徒转位法。依据上斜程度确定下斜肌新附着点的位置。上斜小于6△16眼转位到下直肌止端水平后1mm;上斜7～11△45眼,转位到下直肌止端水平;上斜大于11△34眼,前移到下直肌止端前1mm或2mm(1mm25眼,2mm9眼)其中1例单眼上斜50～80△者联合同侧上直肌后徙6mm,对合并水平斜视者,则采用水平直肌后徙和缩短术同时矫正水平斜视。结果术后满意者93眼(97.89%),好转者2眼(2.11%),无1例无效者。95眼术后下斜肌亢进均消失,无1例上转受限者。结论下斜肌后徒转位术是治疗伴有下斜肌亢进分离性垂直斜视的有效手术方式。     

非对称性分离性垂直斜视的手术治疗探讨

目的 探讨非对称性分离性垂直偏斜(DVD)的手术治疗效果.方法 对15例因非对称性分离性垂直斜视行手术治疗的患者进行回顾性总结分析,观察患者性别、年龄、斜视类型、临床表现、手术方式和效果,并随访3个月到2年.结果 单纯DVD患者6例,合并其他类型斜视患者9例;单眼受累5例,其中3例采用上直肌后徙,2例采用下斜肌部分切除加转位;双眼受累10例,6例采用不等量的上直肌后徙,后徙量为3.5～10 mm,4例采用下斜肌部分切除加前转位,根据垂直斜度及下斜肌亢进程度的不同,分别将下斜肌离断并切除一定量后转位于下直肌颞侧水平前1 mm至下直肌颞侧水平后1 mm不等.术后12例患者眼位正位,遮盖后无上斜视出现,外观满意,1例行单眼手术者对侧眼出现DVD,1只眼行下斜肌转位后患者出现上转受限.结论 非对称性分离性垂直斜视选择非对称性手术效果较好,对于无下斜肌亢进的患者首选上直肌不等量后徙,对于伴有下斜肌功能亢进的患者采用下斜肌部分切除加前转位.     

上斜肌麻痹合并分离性垂直斜视的手术治疗

目的探讨上斜肌麻痹合并分离性垂直斜视（DVD）的手术治疗方法。方法对24例27眼DVD根据双眼视力状况、上斜程度及合并其他类型斜视进行综合分析设计手术,均先行下斜肌后徙转位术,术后半年9眼二次行上直肌后徙术。结果治疗效果23眼满意（85．19％）,4眼好转（14．81％）,术后双眼单视功能明显改善。结论下斜肌后徙转位术联合上直肌大量后徙术分次治疗是矫正上斜肌麻痹合并DVD的一种有效方法。     

分离性垂直性偏斜手术疗效分析

目的为讨论分离性垂直性偏斜(dissociated Vertical deviationDVD)手术治疗方法对15例(25眼)第一诊断为DVD患者，手术治疗方案进行经验总结。方法单纯DVD做上直肌后徙术，DVD合并下斜肌亢进者做下斜肌断腱加转位至下直肌附着点颞侧，DVD合并水平斜视同时联合水平斜视矫正术。结果1．DVD疗效标准：痊愈：垂直斜视消失或小于10^△；好转：垂直斜视较术前减少10^△以上；无效：垂直斜视无改善或改善小于10^△。2．治疗结果：痊愈12例(80％)，好转2例(13％)，无效l例(7％)。结论DVD患者双眼虽然分离不相等，但尽量行双眼等量手术，如果双眼分离相差10^△以上做双眼上直肌不等量后徙手术，如伴有下斜肌亢进应做下斜肌断腱加转位术。     

分离性垂直斜视手术治疗的临床观察

探讨分离性垂直斜视有效的手术治疗方法。 方法:回顾性分析38例61眼分离性垂直斜视患者行上直肌大量后徙,合并下斜肌亢进者同时行下斜肌后徙转位术的临床资料。观察术后效果。 结果:术后满意46眼,满意率75%,术后改善14眼,改善率23%,无效1眼。 结论:上直肌大量后徙术和下斜肌后徙转位术是治疗分离性垂直斜视的有效方法。合并有下斜肌亢进者,首选下斜肌后徙转位术,无下斜肌亢进者,首选上直肌后徙术。     

67例V型斜视的手术探讨

目的 探讨V型斜视的临床特征及不同手术方法及效果.方法 回顾性分析了67例V型斜视的手术治疗.其中外斜V征46例,内斜V征21例,依据是否伴有下斜肌功能亢进及亢进程度,行下斜肌减弱术或水平直肌垂直移位术,所有患者按原在位水平偏斜度常规矫正水平斜视.观察手术前后的眼位、斜肌功能和双眼视觉.结果 67例手术中,49例行下斜肌后徙术或后徙转位术,术后43例上、中、下均正位,V征消失;术前无下斜肌功能亢进或下斜肌功能亢进"+"者13例,行水平直肌垂直移位术后11例正位,V征消失.67例患者术后19例恢复双眼视.结论 下斜肌后徙,后徙转位术适用于下斜肌功能亢进(++)-(+++)的V征,水平直肌垂直移位术适用于无下斜肌功能亢进或下斜肌功能亢进+的V征,应根据下斜肌功能亢进程度选择手术方式.     

Combined bilateral superior rectus muscle recession and inferior oblique muscle weakening for dissociated vertical deviation.

PURPOSE: Dissociated vertical deviation (DVD) is a common disorder that is often difficult to treat satisfactorily with extraocular muscle surgery. Weakening both elevators in a single eye is uncommonly performed because of possible severe upgaze deficiency or chin-up head posture postoperatively. METHODS: A retrospective review of medical records was performed that yielded 14 patients who had undergone bilateral superior rectus muscle recessions (mean 8.1 mm, range 5-10 mm) and bilateral inferior oblique muscle recession, myectomy, or anterior transposition in the treatment of DVD. Three additional patients with asymmetric inferior oblique muscle overaction or true hypertropia in primary gaze position were identified who had bilateral superior rectus muscle recessions combined with unilateral inferior oblique muscle weakening. RESULTS: Mild-to-moderate elevation deficiencies were common postoperatively but never exceeded -2 up-gaze limitation (scale 0 to -4) except in the immediate postoperative period and were not associated with persistent chin-up head posturing. Cosmetically objectionable upper eyelid retraction occurred in one patient after re-recession of a superior rectus muscle but before inferior oblique muscle surgery. Only three patients undergoing four vertical muscle surgeries had residual DVD >10 PD in primary gaze position, and none exhibited manifest dissociated strabismus warranting further treatment. CONCLUSION: Bilateral superior rectus muscle recession of up to 10 mm combined with inferior oblique muscle weakening appears to be a safe surgical approach in the management of patients with large angle or recurrent DVD. Our data further suggest that simultaneous four vertical muscle surgery may be preferred in some patients to weakening the superior rectus or inferior oblique muscles alone.     

Helveston综合征的手术治疗

目的：探讨 Helveston 综合征的手术治疗方法。
　　方法：回顾分析我院手术治疗且资料完整的15例30眼Helveston 综合征病例,根据患者上斜肌亢进及分离性垂直偏斜(dissociated vertical deviation,DVD)程度的不同选择不同的手术方式。
　　结果：患者8例16眼行双眼上斜肌鞘内断腱术,术后随访1~3a,A 征均消失,其中3例6眼 DVD 消失,5例10眼DVD 减轻,均未再次行 DVD 矫正手术;患者4例8眼行双眼上直肌后徙联合双眼外直肌后徙并垂直移位术,术后随访1~3a,眼位正位,A 征消失,1例2眼 DVD 消失,3例6眼 DVD 减轻,未再行二次手术;患者3例6眼行双眼水平直肌后徙联合垂直移位术,术后随访6mo,眼位正位,A 征消失,DVD 减轻,未再次行二次手术。
　　结论：Helveston 综合征可根据患者上斜肌亢进及 DVD 程度的不同选择不同的手术方式。     

下斜肌前置移位治疗伴有下斜肌亢进的分离性垂直偏斜

目的:观察下斜肌前置移位治疗伴有下斜肌亢进的分离性垂直偏斜(dissociated vertical deviation,DVD)。方法:下斜肌前置移位于下直肌附着点颞侧前2mm或下直肌附着点颞侧成一直线处,同时矫正水平斜视。结果:患者8例11眼中,术前6眼DVD程度是1+,术后DVD消失;术前3眼DVD程度是2+,术后2眼垂直斜视消失,1眼DVD程度为1+;术前2眼DVD程度是3+,术后1眼DVD程度为1+,1眼为2+。所有患者下斜肌均不亢进。结论:下斜肌前置移位是治疗伴有下斜肌亢进的DVD的有效方式,无明显副作用。     

The effect of graded recession and anteriorization on unilateral superior oblique palsy

PURPOSE: We wanted to examine the effect of graded recession and anteriorization of the inferior oblique muscle on patients suffering from unilateral superior oblique palsy. METHODS: Inferior oblique muscle graded recession and anteriorization were performed on twenty-two patients (22 eyes) with unilateral superior oblique palsy. The recession and anteriorization were matched to the degree of inferior oblique overaction and hypertropia. The inferior oblique muscle was attached 4 mm posterior to the temporal border of the inferior rectus muscle in six eyes, 3 mm posterior in five eyes, 2 mm posterior in five eyes, 1 mm posterior in five eyes, and parallel to the temporal border in one eye. RESULTS: The average angle of vertical deviation prior to surgery was 11.3 +/- 3.9 prism diopters (PD). The total average correction in the angle of vertical deviation after surgery was 10.8 +/- 3.8 PD. In the parallel group, the average reduction was 14 PD. After surgery, normal inferior oblique muscle action was seen in eighteen of twenty-two eyes (81.8%). CONCLUSIONS: Graded recession and anteriorization of the inferior oblique muscle is thought to be an effective surgical method to treat unilateral superior oblique palsy of less than 15 PD.     

分离性垂直偏斜的手术治疗

目的探讨分离性垂直斜视的手术治疗。方法 22例患者（34只眼）,分别采用上直肌大量后徙术和下斜肌后徙转位术,对其疗效进行比较分析。结果 11例（16只眼）行上直肌后徙术,满意14只眼（满意率87.5%）,改善2只眼（改善率12.5%）,11例（18只眼）行下斜肌后徙转位术,满意13只眼（满意率72.2%）,改善5只眼（改善率27.8%）。结论上直肌大量后徙和下斜肌后徙转位均为治疗垂直分离性偏斜的有效手术,合并下斜肌亢进时,可首选下斜肌后徙转位术,无下斜肌亢进时,首选上直肌后徙术。     

Results of anterior transposition of the inferior oblique

Purpose: We present the results of anterior transposition of the inferior oblique in a series of patients with inferior oblique overaction and dissociated vertical deviation (DVD).
Patients and methods: We performed a retrospective study of 37 procedures on 21 patients who had unilateral or bilateral inferior oblique anterior transpositions. Before surgery, patients had +1 to +3 inferior oblique overaction and +1 (< 10 PD) or +2 (10 PD-20 PD) degree of DVD. The inferior oblique insertion was transposed to between 2 mm posterior to and 2 mm anterior to the temporal border of the inferior rectus insertion. Mean follow-up period was 27 months.
Results: Incidence of inferior oblique overaction of +2 or more was reduced from 84% before surgery to 16% at last postoperative assessments. Some 43% of eyes had no inferior oblique overaction and 86% had an improvement in the degree of inferior oblique overaction. At last assessments, 57% of eyes had no evidence of DVD and 68% of eyes had no evidence of DVD or an improvement in the degree of DVD. No patient who had unilateral anterior transposition developed hypotropia in primary position and there was no evidence of inferior oblique underaction in any patient at last assessment. Three patients requiring repeat inferior oblique surgery are discussed, including one patient who developed a large Y-pattern exotropia after bilateral anterior transposition of the inferior obliques.
Conclusions: Inferior oblique anterior transposition has a place in the treatment of coexistent inferior oblique overaction and dissociated vertical deviation.     

外斜V征手术疗效分析

目的探讨外斜V征的手术治疗方法及疗效。方法回顾分析37例外斜V征病例手术前、后眼位和双眼单视功能的变化情况。结果 37例中有31例(56只眼)行下斜肌减弱术联合水平直肌后退或缩短术,6例(12只眼)行水平直肌移位术。手术后30例(81.08%)眼位正位,V征消失,52只眼下斜肌功能亢进消失,4只眼仍有轻度下斜肌功能亢进。手术后25例(67.56%)有不同程度的双眼单视功能。结论外斜V征的患者术前应注意区分有无合并下斜肌亢进及其程度,对于不合并或仅有轻度下斜肌亢进的患者,行水平直肌后退或缩短并止端移位术;对下斜肌明显亢进的外斜V征患者,行下斜肌减弱术并水平直肌后退或缩短术。术后效果良好,患者双眼视觉功能可能有所恢复。     

上直肌后徙联合下斜肌后徙转位治疗分离性垂直斜视

目的观察上直肌后徙联合下斜肌后徙转位术治疗分离性垂直斜视的效果。方法回顾性分析上直肌后徙术联合下斜肌后徙转位术的30例（50眼）分离性垂直斜视的手术效果。结果近期治疗效果满意率为83．33％,远期治疗效果满意率为75．00％。结论上直肌后徙联合下斜肌后徙转位术是治疗分离性垂直斜视的一种有效方法。     

先天性上斜肌麻痹的手术方式分析

目的:探讨先天性上斜肌麻痹的手术治疗方法。方法:对我院2004-10/2005-02收治的39例先天性上斜肌麻痹患者,根据患眼的下斜肌功能亢进程度和垂直斜度大小选择下斜肌后徙、下斜肌切断并部分切除、下斜肌前转位、或联合对侧眼上直肌、下直肌手术。结果:治愈28例(72%),好转10例(26%),无效1例(2%)。结论:先天性上斜肌麻痹的手术方式按减弱直接拮抗肌和配偶肌,加强麻痹肌和间接拮抗肌的原则进行,根据患者下斜肌功能亢进程度和垂直斜视度大小选择不同术式可获得良好的效果。