单眼水平直肌后徙联合缩短术与内直肌斜向缩短术治疗集合不足型外斜视的疗效对比

目的：比较单眼水平直肌后徙联合缩短手术与内直肌斜向缩短术对集合不足型外斜视的治疗效果。方法：前瞻性研究。对2016年9月到2017年2月在郑州大学第一附属医院就诊的36例集合不足型外斜视患者行手术治疗,随访时间≥6个月。根据手术方式不同分为3组：单眼水平直肌后徙联合缩短手术组（A组,16例）、单眼内直肌斜向缩短术组（B组,9例）和双眼内直肌斜向缩短术组（C组,11例）。A组中外直肌按照看远斜视度数后徙,内直肌按照看近斜视度数缩短。B组和C组中内直肌肌止端上端按照看远斜视度数缩短,肌止端下端按照看近斜视度数缩短。术后正位的评价标准为看远斜视度在±10 △ 以内。采用Fisher精确概率检验、重复测量方差分析进行数据分析。结果：随访期末,A组正位占比为14/16例,显著高于B组（2/9例）和C组（4/11例）,差异具有统计学意义（均P < 0.05）。A组看近和看远斜视度均小于其他2组,差异具有统计学意义（均P < 0.05）。3组间手术后看近和看远斜视度的差异无统计学意义。结论：单眼水平直肌后徙联合缩短手术中外直肌按照看远斜视度数后徙,内直肌按照看近斜视度数缩短设计术式,可以有效治疗集合不足型外斜视,优于内直肌斜向缩短手术。     

双眼外直肌倾斜后徙术治疗集合不足型间歇性外斜视的疗效

目的：探讨双眼外直肌倾斜后徙术治疗集合不足型间歇性外斜视的疗效及安全性。

方法：选取2017-10/2019-11在我院就诊的集合不足型间歇性外斜视患者29例行双眼外直肌倾斜后徙术治疗,术后随访6mo,观察斜视度的变化、手术正位率、双眼视功能及并发症情况。

结果：本组患者术前看近斜视度-41.72±3.35PD,看远斜视度-23.28±9.75PD,看近-看远斜视度差值16.90±2.47PD,术后6mo分别为-5.97±4.85、-2.66±4.78、3.28±1.10PD,手术总体正位率76%。术后6mo,Ⅰ、Ⅱ级视功能恢复比例均较术前提高(P<0.05),远立体视、近立体视恢复较术前均无显著差异(P>0.05)。所有患者术后均未出现A-V综合征、眼球运动受限、限制性斜视、垂直斜视、旋转复视等并发症,部分患者术后出现短暂水平复视,均在术后2～3wk内消失。

结论：双眼外直肌倾斜后徙术能减少看近、看远斜视度及看近-看远斜视度差值,未发现明显并发症,是一种安全有效的治疗集合不足型间歇性外斜视的手术方式。     

集合不足型外斜视手术治疗及双眼视觉重建的相关研究

目的:观察集合不足型外斜视术后双眼视功能的恢复及眼位回退情况。方法:对83例行单眼外直肌后徙联合内直肌缩短的集合不足型外斜视患者手术前后的眼位、双眼视功能、进行回顾性总结和分析。斜视手术以单眼外直肌后徙联合内直肌缩短为主设计。术前有一级视功能患者如术后欠矫则进一步在同视机下行双眼融合功能训练。术后随访6～12(平均8)mo。结果:术前视远平均外斜度为-35.6△(-15△～80△),视近平均外斜度为-56.5△(-30△～-95△);术后视远平均外斜度为-6.5△(+11△～-19△),视近平均外斜度为-13.2△(+9△～-20△),术后视远视近斜视度与术前视远视近斜视度的比较差异有统计学意义(P=0.000),术前双眼视功能和术后双眼视功能比较差异有显著性,术后远期视远视近外斜度的差值明显降低,平均斜视度差值从术前的19△下降到术后的5.5△(P=0.000)。结论:集合不足型外斜视患者行单眼外直肌后徙联合内直肌缩短;术后如双眼视功能进一步恢复则术后远期效果较好,回退率较低。     

单纯与双内直肌后徙联合Faden术矫正集合过强型内斜视的比较分析

目的 比较单纯双内直肌后徙与双内直肌后徙联合Faden术在矫正集合过强型内斜视中的作用。方法 28例集合过强型内斜视,远近斜视角相差在15△以上,AC/A值〈6,看近斜视角为45～80△,看远25～45△,一组12例行单纯双内直肌后徙,另一组16例行双内直肌后徙联合Faden术。结果 12例行单纯双内直肌后徙组中9例视近仍残余＞10△内斜视。16例行双内直肌后徙联合Faden术组14例视近时基本正位,2例视近仍残余＞10△内斜视,2例视远过矫。结论 双内直肌后徙联合Faden术较单纯双内直肌后徙可有效矫正集合过强型内斜视,但需要注意防止过矫。     

大角度外斜视手术方法的对比分析

目的探讨大角度外斜视行外直肌悬吊后徙术与外直肌超常量后徙术的比较,观察手术效果。方法两组病例共42例,手术前后均采用角膜映光法、三棱镜遮盖试验测定眼位。一组实施外直肌悬吊后徙术,另一组则行外直肌超常量后徙术。结果两组术前斜视角大小无显著性差异。术后眼位:外直肌悬吊后徙组≤±10~Δ18例,正位率85.71%;外直肌超常量后徙组≤±10~Δ19例,正位率90.48%,两组正位率比较差异无显著性。结论采用外直肌悬吊后徙术矫正大角度外斜视,既可以达到外直肌超常量后徙术的效果,又降低了巩膜意外损伤的危险,具有合理、实用、安全、简便等特点。     

外直肌倾斜后徙术与外直肌后徙术治疗集合不足型外斜视的效果比较

目的：观察外直肌倾斜后徙术（S-LR）与外直肌后徙术（LR）对集合不足型外斜视[CIX（T）]患者的 治疗效果。方法：回顾性研究。收集2017年1月至2019年8月于上海交通大学医学院附属新华医院 由同一术者施行的斜视矫正术的CIX（T）患者101例,根据术式分为双眼外直肌倾斜后徙术（S-BLR） 组44例和双眼外直肌后徙术（BLR）组57例,随访3个月,观察比较行不同术式的患者术后视近斜视 角、视远斜视角及远近斜视角度差（NDD）。使用Mann-Whitney U检验、卡方检验、t检验等进行统 计学分析。结果：术后3个月,NDD较术前的改善量在S-BLR组和BLR组分别为（8.0±3.3）棱镜度（PD） 和（6.1±4.0）PD,S-BLR组较BLR组对NDD的改善更明显（Z=-1.995,P=0.046）。术后3个月,视近 斜视角S-BLR组为（-5.1±5.5）PD,较BLR组的（-8.3±5.8）PD明显减小（Z=-2.882,P=0.004）。视 远斜视角在S-BLR组与BLR组手术前后,差异无统计学意义。术后3个月正位率在S-BLR组为82%, 高于BLR组的53%（χ2 =9.34,P=0.002）。S-LR前后,S-BLR组患者上视及下视斜视角度差及黄斑中 心凹-视盘中心夹角度数差异均无统计学意义。结论：S-LR对CIX（T）的视近斜视角及NDD疗效优 于LR,是一种安全有效的术式。     

高AC/A调节性内斜视治疗效果分析

目的探讨双内直肌后徙术治疗共同性内斜视的适用范围及手术量.方法对28例共同性内斜视患者行双内直肌后徙术,7例行双内直肌后徙后继发外斜视行再矫正术,并行回顾性分析.结果对于高AC/A,非屈光性调节性内斜视,看近大于看远15△以上的中等斜度患者适合行双内直肌后徙术,且手术量应保守些.结论常规量的双内直肌后徙术对中等斜视度,高AC/A内斜视患者矫正效果满意,超常量双内直肌后徙术易致术后过矫.     

发生继发性外斜视的相关因素及治疗

目的研究内斜术后继发外斜视的相关因素及手术治疗。方法我们对1998-2004年在我院住院的23 例内斜术后继发外斜的病人施行手术治疗并观察疗效,探讨发生原因。结果内斜视的发病年龄,是否合并垂直性眼位偏斜,弱视及调节一集合功能(AC/A)减弱是造成继发性外斜视的重要因素。外斜视矫正的效果与术前斜视角及术中眼位矫正清况相关。结论1.内斜术后应该进行长期的随防。2.外直肌后徙联合后徙的内直肌前移是治疗继发性外斜视的有效方式。3.术中5-10 PD 小度数过矫可提高术后的正位率。     

单条外直肌大量后徙治疗小角度外斜视

目的探讨单条外直肌后徙治疗小角度外斜视的效果.方法25例斜角15～20Δ外斜视病人,施行单条外直肌后徙10～12nm,平均手术量11mm,手术平均年龄8岁,术前平均斜视角18Δ,术后随访至少6个月.结果术后6周眼位:正位或残留小角度外斜≤4Δ,平均矫正斜角16Δ.术后6个月后10例正位,9例-4Δ～-8Δ外斜视,6例外隐斜.结论单条外直肌大量后徙治疗15～20Δ外斜视是有效的,具有安全、简便及全麻时间短等优点.     

小角度集合不足型外斜视的手术治疗

目的 探讨小角度集合不足型外斜视的手术方法和疗效.方法 取28例集合不足型外斜视,看远斜视角:正位～-10△,看近斜视角:-15△～ -30△,以看近斜视角为依据行单根内直肌缩短术,定期随访术后眼位.结果 术后正位率,出院时100％,3个月时92.8％,6个月时89.2％,1年时84.2％,2年以后81.8％.术后轻度...     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.