Sutureless closure of the conjunctiva with a commercial fibrin sealant in extraocular muscle surgery for strabismus

PURPOSE: Suturing is a time-consuming process and patients may suffer from sutures because of discomfort and tearing. This prospective study was done to determine the efficacy of an available commercial fibrin sealant for conjunctival wound closure following extraocular muscle surgery for strabismus. METHODS: Fibrin sealant (Beriplast) was used in 48 conjunctival wounds of 25 patients with strabismus during the period February 2004 to May 2005. There were 12 males and 13 females, whose mean age was 9.3 years. RESULTS: No allergic reactions, chemosis or infections were seen, but suturing was necessary a day after surgery in 3 wounds of 2 cases (3/48 eyes, 6%). All conjunctival wounds were healed at the end of the second week. CONCLUSION: The use of Beriplast for conjunctival wound closure is an effective method that is easy to apply and should be considered a solution in strabismus surgical practice.     

Bacterial contamination of ocular surface and needles in patients undergoing intravitreal injections

PURPOSE: To evaluate potential sources of bacterial contamination during intravitreal (IVT) injection procedures. METHODS: Patients scheduled for IVT injection were asked to enroll in the study at the California Vitreoretinal Center (Menlo Park, CA) and the Vantage Eye Center (Salinas, CA) between October 2004 and April 2005. A total of 104 patients participated in the study, with a total of 118 IVT injection procedures performed on 107 eyes. Standard microbiological techniques were used to culture, identify, and quantify bacterial contamination of injection needles and the bulbar conjunctiva at the injection site in patients undergoing IVT injections. The main outcomes measured were type and quantity of bacterial isolates. RESULTS: Two (2%) of 114 needles collected were contaminated with bacteria. The prevalence of bacterial contamination of the injection site on the bulbar conjunctiva was 43% before prophylaxis on the day of the injection with topical antibiotics and povidone-iodine, with a statistically significant reduction to 13% after prophylaxis (P < 0.0001). Coagulase-negative Staphylococcus, the most common bacterium isolated from the ocular surface, was isolated from both culture-positive needles. CONCLUSIONS: IVT injection needles became contaminated with bacteria during the injection procedure. Although the contamination rate was low, this supports a mechanism of postinjection endophthalmitis in which there is direct inoculation of ocular surface flora into the vitreous cavity by the injection needle.     

Strabismus surgery among aged medicare beneficiaries

OBJECTIVES: The purpose of this study was to investigate the incidence of strabismus surgery among aged patients in the United States. METHODS: The Medicare Part B claims experience (physician professional fee billing) for 1995 was reviewed for the number of times each strabismus surgical procedure recognized in Physicians' Current Procedural Terminology (CPT) was performed. To determine the indications for the procedures that were performed, a 5% sample of claims was reviewed for the pertinent International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic codes. RESULTS: There were 27 million aged Medicare beneficiaries eligible for Part B benefits in 1995 in a fee-for-service setting. During that year physicians reported 9497 strabismus physician services. These represented 6585 separate procedures (CPT codes 67311 to 67343) and 277 botulinum toxin (Botox) injections for strabismus (CPT 67345) performed during 1995. Sixty-nine percent of the surgical procedures were for horizontal correction and 28% were for vertical correction. Adjustable sutures were used for only 1240 cases (1 9%). The add-on procedural code for reoperation surgery or surgery in the presence of restriction of the extraocular muscles was used in just 930 cases (14%). The most common diagnosis for horizontal surgery was exotropia. Paralytic strabismus and thyroid disease were identified for 17% of cases. Three percent of the diagnoses were inappropriate for the procedures performed and may have been reported in error. CONCLUSIONS: These data confirm a very low incidence of strabismus surgical procedures (2/10,000) and injections (1/100,000) among aged Medicare beneficiaries. The strabismus surgery was most often performed to repair a horizontal deviation. The adjustable suture technique was used infrequently. These data may be extrapolated into the future to aid in determining the strabismus services that will be needed early in the next century.     

Bacterial contamination of anterior chamber during IOL surgery

PURPOSE: To study the nature and frequency of bacterial contamination during cataract surgery. METHODS: The preoperative smears from the conjunctiva and anterior chamber (AC) fluid aspirates during extra-capsular cataract surgery (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in 40 eyes were analysed for aerobic and anaerobic bacteria. Any change in the bacterial strains isolated before and after cataract surgery was also studied. RESULTS: AC fluid aspirates were positive for bacteria in 15 eyes (37.5%). Coagulase-negative Staphylococcus was the most common aerobe (39.4%) and Propionibacterium acnes the most common anaerobe. Of the 15 cases with positive AC fluid cultures, 6 showed an organism in the AC aspirate different from the conjunctival smear. CONCLUSION: Clinically there was no endophthalmitis in any of the eyes. Factors such as preoperative antibiotic use, the antibacterial properties of aqueous, or low inoculum size could explain this. The preoperative conjunctival smear may not be useful in predicting the AC fluid contamination or outcome of cataract surgery.     

Amniotic membrane transplantation for the repair of severe conjunctival dehiscence after strabismus surgery with adjustable sutures

PURPOSE: To evaluate the outcome of amniotic membrane transplantation (AMT) for the repair of severe conjunctival dehiscence that occurred during or after fornix-incision strabismus surgery with adjustable sutures. DESIGN: Retrospective, interventional case series. METHODS: Four patients in whom severe conjunctival dehiscence developed during or after strabismus surgery were treated with amniotic membrane grafts. The extent of conjunctival reepithelization over sclera, range of ocular motility, and patient comfort were evaluated immediately after the surgery and at 1, 2, and 4 weeks. RESULTS: The mean follow-up period was 16 weeks (range 4 to 28 weeks). Conjunctival dehiscence was detected 0 to 14 days after surgery. AMT was performed 0 to 14 days later. The conjunctival defect was reepithelized in all patients by the fourth postoperative week without evidence of scarring or restriction of motility. CONCLUSIONS: In the treatment of large conjunctival defects that may follow strabismus surgery, AMT may be an alternative to conservative management or primary conjunctival closure.     

Timing of postoperative adjustment in adjustable suture strabismus surgery.

PURPOSE: The use of adjustable sutures in strabismus surgery has increased the rate of surgical success. Little data are available on the optimum timing for postoperative adjustment after strabismus surgery. We wanted to compare 2 common practices of adjustable suture technique after strabismus surgery. METHODS: Two comparable groups of 40 patients each, who had strabismus surgery with adjustable suture technique, were prospectively studied. Group A had early adjustment the same day of the surgery about 6 hours after the operation, and group B had late adjustment the next day about 24 hours after the operation. Subjective scoring tables were used to evaluate the pain felt by the patient before, during, and after the adjustment and any difficulties of the adjustment process. Requirements of postoperative pain medications and final alignment 6 weeks after surgery were also compared. RESULTS: Despite adequate statistical power, no significant differences were found between the groups regarding pain before, during, and after adjustment, difficulties performing the adjustment, and final alignment after 6 weeks (P > .05). Both adjustment schedules were equally associated with mild to moderate pain before, during, and after the adjustment. In the first 24 hours after surgery, no overall difference in the use of pain medications was found. Nausea and vomiting in the first 24 postoperative hours were more common in the early adjustment group (P = .02). CONCLUSION: The surgeon can feel free to choose the timing for postoperative adjustment. However, when performing an early adjustment, the surgeon should be especially prepared to control nausea and vomiting.     

Prognostic factors for strabismus surgery after cataract surgery

PURPOSE: To evaluate the clinical features of strabismus that present after cataract surgery and determine the motor and sensory results after surgical correction of the strabismus. SETTING: Department of Ophthalmology, the Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. METHODS: Thirty-one patients who had strabismus surgery after cataract surgery between January 1996 and June 2004 were included in the study. The clinical features of strabismus and the factors contributing to successful strabismus surgery results were retrospectively analyzed. Sensory functional tests were performed postoperatively. RESULTS: Fifteen patients (48.4%) had exotropia. The types of cataract included traumatic (35.5%), congenital (32.3%), and senile (25.8%). Prolonged deviation was the statistically significant factor contributing to final alignment (P = .023). Fourteen of 31 patients had stereoacuity measurement; all achieved a stereoacuity of 3000 seconds of arc. Five of the 14 patients (35.7%) had better than 200 seconds of arc. CONCLUSIONS: The anatomical results and sensory function of the patients were generally good. When appropriate, surgical intervention to treat strabismus after cataract surgery should be offered, and this is important for restoration of fusion.     

Intraocular pressure fluctuations during strabismus operations and the postoperative period

PURPOSE: To evaluate the intraocular pressure (IOP) variations which occur during and after strabismus surgery. METHOD: We measured the IOP in 34 eyes of 20 pediatric patients undergoing primary strabismus surgery under general anesthesia. Measurements were performed by the Tono-Pen (Mentor O&Q Inc. Norwell, MA) prior to surgery, immediately after suturing of the conjunctive, and 1 week and 4 weeks after surgery. All patients received the same local antibiotics and steroid solutions postoperatively. RESULTS: IOP decreased from baseline to the end of surgery by a mean of 8.26 +/- 1.8 mmHg and increased from baseline to 4 weeks after surgery by a mean of 3.6 +/- 1.8 mmHg. Thirty-eight percent of the eyes had an IOP of 21 mmHg or more during the postoperative period. CONCLUSION: IOP variations are prevalent during and after strabismus surgery. Careful postoperative measurements are recommended in order to identify individuals who may be prone to iatrogenically increased IOP.     

The immediate postoperative adjustment of sutures in strabismus surgery with comaintenance of anesthesia using propofol and midazolam.

PURPOSE: Adjustable suture techniques are used to reduce the reoperation rate in strabismus surgery, but traditionally require that final adjustments be made between 1 to 24 hours after surgery. The purpose of this study was to evaluate a new anesthetic technique that would allow immediate postoperative adjustment of sutures in strabismus surgery, thereby improving patient convenience and comfort. METHODS: This was a prospective study of strabismus patients who were judged to be appropriate candidates for adjustable sutures. Comaintenance of anesthesia was accomplished using a stepped-down infusion of propofol with midazolam. Final suture adjustments were performed in the operating room immediately upon completion of strabismus surgery. Patient satisfaction was assessed 24 hours later. Patients were followed for 6 weeks postoperatively. RESULTS: A total of 16 patients were studied, with 8 patients having horizontal muscle surgery, 7 patients with vertical muscle surgery, and 1 patient undergoing both horizontal and vertical muscle surgery. The change in deviation after 6 weeks of follow-up was 8 PD or less horizontally in all patients and 4 PD or less vertically in 87% of patients when compared with the alignment in the operating room. Diplopia, if present, resolved in 85% of patients. One patient (6.7%) required a second surgery. The mean drift at 2 weeks horizontally was 1.87 PD esotropic (range, -6 PD exophoric to 18 PD esotropic) and vertically 0.94 PD (range, -4 PD hypotropic to 4 PD hypertropic). The mean drift at 6 weeks horizontally was -0.27 PD exotropic (range, -8 PD exophoric to 8 PD esotropic) and vertically 0.6 PD (range, -6 PD hypotropic to 10 PD hypertropic). CONCLUSION: The immediate postoperative adjustment of sutures in strabismus surgery may be accurately performed using this new anesthetic technique.     

Scleral penetrations and perforations in strabismus surgery and associated risk factors.

OBJECTIVE: To evaluate the incidence and identify associated risk factors of scleral penetrations and perforations resulting from strabismus surgery. METHODS: A prospective observational study of patients undergoing strabismus surgery by residents or fellows was conducted. The surgical techniques employed included recessions, resections, advancements, posterior fixation sutures, and transpositions. Indirect ophthalmoscopy was performed on each operated eye following surgery to identify any retinal changes indicative of a penetration or perforation. RESULTS: Of the 144 patients and 217 operated eyes, 11 sustained penetrations (5.1%), and 6 perforations (2.8%). On a per muscle procedure basis, the incidence of penetrations was 4.3% and of perforations 1.9%. The mean age at surgery for patients who experienced perforations was 4.8 years (+/- 5.3), which was less than those with penetrations or those without any complications (P = .016). The surgeon's experience was not related to the frequency of these complications. Penetrations or perforations were more likely to occur with rectus muscle recessions than resections (P = .0067). Horizontal rectus muscles were most frequently associated with penetrations and perforations when compared to vertical rectus and oblique muscles (P = .003). The S-24 needle was more frequently involved in the penetrations and perforations than other needles (P = .027). CONCLUSIONS: In order to reduce the risk of scleral penetrations or perforations, surgeons should exercise caution when performing strabismus surgery in younger patients, when using S-24 needles, and when performing rectus muscle recessions. This study has demonstrated, for the first time with statistical significance, that recessions are more often associated with penetrations and perforations than other types of strabismus procedures.     

The effect of topical tetracaine eye drops on emergence behavior and pain relief after strabismus surgery.

INTRODUCTION: Pediatric strabismus surgery may be associated with postoperative nausea, vomiting, and emergence agitation (restlessness, thrashing, crying, moaning, disorientation). We hypothesize that emergence agitation after strabismus surgery is in part related to pain and that topical tetracaine ophthalmic drops can decrease the intensity and incidence of postoperative pain and emergence agitation. METHODS: Eighty-eight subjects aged 1 to 12 years scheduled for strabismus surgery were enrolled in a double-masked randomized control trial. The patients were randomized to one of three groups: Group A received normal saline drops before and after surgery; Group B received normal saline drops before and tetracaine 1% drops after surgery; Group C received tetracaine 1% drops before and after surgery. An observer masked to group assignment assessed each patient in the postanesthesia care unit (PACU) using both a behavior scale and a modified behavioral pain scale. RESULTS: Patients in Group A were found to be in significantly more pain than Groups B or C at 5 minutes after arrival to the PACU (p < 0.013). Using the behavior scale, a significantly greater proportion of patients in Group A were crying or crying and thrashing at 5, 15, and 30 minutes after arrival to the PACU (5 minutes, p < 0.019; 15 minutes, p < 0.041; 30 minutes, p < 0.021). There was no significant difference between groups in total PACU time, PACU vomiting, PACU morphine use, or pain at home. CONCLUSIONS: Postoperative strabismus surgery pain was improved by the use of preoperative, and pre- and postoperative, tetracaine drops. Emergence agitation was not fully evaluated by the behavioral scale, and therefore, the effect of tetracaine drops on emergence agitation was not clarified. This study suggests that tetracaine drops can lead to a less stressful early postoperative experience for the patient.     

Ramosetron compared with granisetron for the prevention of vomiting following strabismus surgery in children

BACKGROUND/AIMS: Postoperative vomiting occurs frequently after strabismus surgery in children. Granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting following paediatric strabismus surgery. Ramosetron, another new antagonist of 5-hydroxytryptamine type 3 receptor, has more potent and longer acting properties than granisetron against cisplatin induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting following strabismus surgery in children. METHODS: In a randomised, double blinded manner 80 children, aged 4-10 years, received intravenously granisetron 40 microg/kg or ramosetron 6 microg/kg (n=40 each) at the end of surgery. A standard general anaesthetic technique and postoperative analgesia were used. Emetic episodes and safety assessment were performed during the first 24 hours and the next 24 hours after anaesthesia. RESULTS: The percentage of patients who were emesis free during 0-24 hours after anaesthesia was 85% with granisetron and 90% with ramosetron, respectively (p = 0.369); the corresponding rate during 24-48 hours after anaesthesia was 70% and 95% (p = 0.003). No clinically serious adverse events caused by the study drug were observed in any of the groups. CONCLUSION: Prophylactic antiemetic therapy with ramosetron is comparable with granisetron for the prevention of vomiting during 0-24 hours after anaesthesia in children undergoing strabismus surgery. During 24-48 hours after anaesthesia, ramosetron is more effective than granisetron for prophylaxis against postoperative vomiting.     

Bakterielle Kontamination von Injektionskanülen nach intravitrealer operativer Medikamenteneingabe in Paraguay

Purpose

The study was designed to prospectively evaluate the bacterial contamination of needles used for intravitreal injection during surgery.

Material and methods

Between December 2007 and December 2010, 549 eyes of 413 patients were treated with intravitreal injections of 1.25?mg bevacizumab. Of the patients 322 received a single injection and 91 multiple injections. Preoperatively the periorbital skin of all patients was treated with 10% povidone iodine (PVI) and the conjunctival sac was irrigated with 1% PVI. No pre-injection antibiotics were administered. Immediately after the injection the needles were rinsed 3 times in thioglycolate broth which was then cultured at 37°C for 5 days. As a negative control 73 sterile unused needles were treated in the same way.

Results

Out of the 549 needle points tested 8 (1,45%) were found to be contaminated after intravitreal injections. The isolated bacteria were coagulase negative Staphylococcus (n?=?7), Propionibacterium acnes (n?=?1) and Klebsiella pneumoniae (n?=?1) (co-contamination in one case).

Conclusion

Contamination of needles is minimal after prophylactic povidone iodine irrigation before intravitreal injections. Therefore, this prophylaxis technique is recommended before intravitreal injections in order to prevent postoperative infections.     

Use of neuromuscular blocking drugs in strabismus surgery: systematic review and ophthalmology survey study

ObjectiveNondepolarizing neuromuscular blocking drugs have been advocated for accurate forced duction testing (FDT) during strabismus surgery. The purpose of this study was to evaluate the literature on use of muscle relaxants (MRs) in strabismus surgery and to evaluate the current practice of pediatric ophthalmologists.DesignSystematic review and survey study.ParticipantsSeventy-seven pediatric ophthalmologists.MethodsMEDLINE, EMBASE, CENTRAL, Web of Science, and OpenGrey were searched to August 2019. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Primary studies on depolarizing or nondepolarizing MRs in patients undergoing strabismus surgery were included. Primary outcomes included indications and prevalence of use. A 23-question survey was emailed to pediatric ophthalmologists worldwide to collect practice pattern information involving MRs in strabismus surgery.ResultsThree studies were included in the systematic review. MRs were used in 34%–45% of patients undergoing strabismus surgery in one 1999 study for FDT. No evidence exists to support the use of MRs for facilitating FDT. Seven of 77 (9.1%) pediatric ophthalmologists requested MRs for FDT. Those who use MRs were more likely to be practicing outside the United States (p < 0.05) and in academic hospitals or private centres rather than in community settings. Drawbacks appeared to outweigh benefits, with the biggest drawback identified as increased turnover time between surgical cases (44%).ConclusionsInadequate evidence exists in the literature to support the use of nondepolarizing MRs to maintain paralysis of extraocular muscles during strabismus surgery, and this is an uncommon practice among pediatric ophthalmologists.     

Strabismus surgery: fibrin glue versus vicryl for conjunctival closure

PURPOSE: The aim of present study was to compare the results of conjunctival closure by fibrin glue with vicryl in strabismus surgery. METHODS: 19 patients undergoing bilateral symmetrical strabismus surgery were included in this study. Conjunctival incisions were closed with 6-0 vicryl in the right eye and fibrin glue in the left eye. RESULTS: On first post-operative day 15 out of 19 eyes (78.9%) had well apposed conjunctiva, 3 out of 19 eyes (15.79%) had 1 mm retraction and one out of 19 eyes (5.26%) had 2 mm retraction, which needed suturing, in cases in which fibrin glue was applied. Increased discomfort and excessive watering was noted during the early postoperative period in 8 out of 19 eyes (42.1%), in eyes in which the conjunctiva was closed with 6-0 vicryl, as compared to none in the fibrin glued eyes (p=0.005). However, the difference disappeared after 21 days. CONCLUSION: Fibrin glue can be used as an alternative to suturing for conjunctival closure following strabismus surgery.     

新鲜羊膜在儿童共同性斜视缝线调整显微手术中的应用

目的：探讨新鲜羊膜在儿童共同性斜视缝线调整显微手术中的应用疗效,为临床治疗提供指导。
　　方法：应用临床随机对照研究方法,依据眼科门诊就诊号将2010-01/2015-10在我科住院并行显微斜视矫正术的60例112眼儿童共同性斜视患者平均分为两组,A组30例58眼行直肌后徙缝线调整联合羊膜移植术, B组30例54眼行单纯直肌后徙缝线调整术,斜视矫正术后随访均≥6 mo。
　　结果：斜视患者27例48眼术后眼位需调整,眼位需调整率为42.9%。术后1mo,眼位可调整18例29眼,其中A组16例26眼,眼位可调整率为44.8%,眼位可调整量平均为2.56±0.64 mm;B 组2例3眼,眼位可调整率为5.6%,眼位可调整量平均为0.52±0.28mm,两组比较眼位可调整率及可调整量差异均有统计学意义(χ2=22.477,P<0.01;t=16.502,P<0.01)。除3例患儿术后不配合眼位调整外,其余均在术后1 mo内行不同程度的眼位调整,眼位调整后, A组27例53眼眼位正位,正位率为91.4%, B 组16例28眼眼位正位,正位率为51.9%,两组比较斜视术后正位率差异有统计学意义(χ2=21.827,P<0.01)。
　　结论：在儿童共同性斜视缝线调整显微手术过程中应用新鲜羊膜效果确切,可明显延长眼位调整时间及增加眼位调整量,提高了儿童斜视手术的可控性和成功率。     

Giant orbital cysts after strabismus surgery

PURPOSE: To describe a rarely reported complication of strabismus surgery. DESIGN: Observational case series. METHODS: A review of four eyes in three patients with orbital cysts following strabismus surgery. RESULTS: Each patient had either a symptomatic strabismus or visible mass that brought them to medical attention many years, often decades after surgery (mean 34 years). All had some degree of incomitancy. During surgery, all cysts were found to be associated with the involved rectus muscle. CONCLUSIONS: Orbital cysts are a rarely recognized complication of strabismus surgery. However, it should be considered in the differential of orbital cysts after strabismus surgery because of the risk of muscle damage during surgical excision.     

急性共同性内斜视的临床特征分析和手术 治疗体会

目的：分析101例急性共同性内斜视患者的临床特征、手术方式及治疗效果。方法：回顾性系列病例 研究。连续纳入2018年11月至2020年11月于武汉爱尔眼科医院就诊的急性共同性内斜视患者101例, 其中男71例,女30例,年龄5~76（20.7±11.3）岁。收集患者的临床资料包括患者基本资料、眼部情 况以及头颅影像学检查等。采用配对t检验对看近和看远斜视度及手术前后斜视度进行比较。采用 χ2检验分析不同年龄段、不同性别的患者屈光状态的差异。结果：101例患者中近视81例,远视19例, <12岁组以远视为主,12~30岁组以中高度近视为主,>30岁组以低中度近视为主。发病年龄12~30 岁有71例,占比70.3%（71/101）。其中学生有63例,近距离用眼时长大于8 h的占比46.5%（47/101）。 裸眼看近斜视度（+42.0±18.3） △,裸眼看远斜视度（+43.7±17.2） △,裸眼看远斜视度大于看近斜视 度（t=2.82, P=0.011）;戴镜看近斜视度（+41.6±18.6） △,戴镜看远斜视度（+43.2±17.7） △,戴镜看远 斜视度大于看近斜视度（t=2.61, P=0.007）。裸眼与戴镜看远斜视度数大于看近斜视度数患者占总人 数24.8%,裸眼与戴镜看近斜视度数大于看远斜视度数患者占总人数7.9%。83例内直肌止端距角膜 缘的距离平均为4.74 mm,小于正常值的5.50 mm。最常用的手术方式为内直肌后徙联合外直肌缩 短术,所有患者手术均一次成功,术后患者看近看远的斜视度的均数为0 △。结论：急性共同性内斜 视患者多为青少年和20多岁的年轻人,可能与近距离用眼时长过长有关。不同屈光状态患者均有出 现急性共同性内斜视的可能。内直肌止端前移解剖异常。急性共同性内斜视患者中裸眼和戴镜看远 斜视度数大于看近斜视度数占比高于看近斜视度数大于看远斜视度数。采用内直肌后徙联合外直肌 缩短术治疗的患者术后均有良好的手术效果。     

甲状腺相关眼病限制性斜视手术并发症的临床分析

目的:总结甲状腺相关眼病(thyroid associate dophthalmopathy,TAO)导致的限制性斜视手术并发症的常见原因及应对策略。方法:回顾性分析于2009-01/2012-02在我院就诊的21例眼外肌手术出现并发症的TAO限制性斜视病例,分析手术前病情、手术情况、手术并发症等临床资料。结果:患者21例中术前有6例为限制性上斜视,15例为限制性下斜视。手术中行上直肌断腱1例,后退5例,下直肌后退15例。术中发生巩膜损伤2例,其中1例在断肌止点时损伤巩膜,1例在将肌肉固定于巩膜上时缝穿巩膜;术中预置缝线滑脱3例;术后早期(术后1mo内)发生欠矫6例,过矫5例;术后晚期(术后6mo后)出现过矫15例,包括6例限制性上斜视患者、9例限制性下斜视;下睑退缩8例。结论:TAO限制性斜视手术矫正容易出现过矫,手术中应严格控制肌肉后退量,下直肌后退时应注意下睑退缩发生的可能。     

眼眶骨折伴斜视患者的临床诊治分析

目的 分析眼眶骨折伴斜视患者的斜视性质、眼眶骨折修复的手术时机和术后斜视的变化等.方法 回顾分析2001年1月到2008年12月在中山大学中山眼科中心诊治的眼眶骨折患者.常规作眼眶CT检查、被动转动试验、眼位和眼球运动检查、复像试验,观察眼眶骨折修复前后眼位和眼球运动情况等.结果 共87例90只眼,男性66例,女性21例;年龄3～68岁(平均30.6岁);右眶27例,左眶57例,双眶3例.36%的患者有视力受损.32%为眼眶爆裂性骨折,68%为复合性骨折;以内壁和下壁骨折多见.术前47%的患者有斜视,其中麻痹性41.5%,限制性58.5%;眼眶骨折修复后:35例术前有斜视者(平均随访1年),28.6%斜视消失;17.1%正前方和下方功能位置无斜视,37.1%斜视部分好转或不变;17.1%斜视加莺;1例术前无斜视,术后出现医源性斜视.结论 眼眶骨折伤后患眼斜视的性质包括麻痹性和限制性,骨折修复手术时机存在争论,以下情形需要尽快手术:(1)影像学检查显示有眼外肌断裂;(2)CT扣描和被动转动试验均示有明确的眼外肌嵌顿,保守治疗二周无好转;(3)外壁和上壁的Blow-in骨折.眼眶骨折修复术后其斜视既可消失也可不变或加重;医源性斜视要尽量避免.