Bupivacaine Injection to Treat Exotropia and Esotropia

Purpose: To report the results of bupivacaine injection into the extraocular muscles to treat horizontal strabismus, both exotropia and esotropia.

Methods: Bupivacaine, 4.5?ml of a 0.50% solution, was injected into the medial rectus muscle in each of 14 exotropic patients and into the lateral rectus muscle in each of 6 esotropic patients with electromyographic control. The measures of alignment were made before the procedure and 1, 3, 6, and 12 months after injection.

Results: Of 20 patients, 15 had improved ocular alignment with the average change of 8.46, 8.2, 8.33 and 9 prism diopters (PD) at 1,3, 6 and 12 months, respectively. Two of 5 (40%) incomitant strabismus patients and 13 of 15 (86.66%) comitant strabismus patients had improvement in ocular alignment. Eleven of 14 exotropic patient and 4 of 6 esotropic patients had improvement in ocular alignment, averaging 9.73, 9.36, 9.54 and 6 PD in the exotropic group and 5, 5, 5, and 10.5 PD in the esotropic group. There was no serious complication from the injections.

Conclusions: Bupivacaine injection improved ocular alignment in some patients. Denervated extraocular muscle did not respond well to bupivacaine. Bupivacaine improved ocular alignment equally in esotropic and exotropic patients.     

知觉性内/外斜视与视力障碍发病年龄关系的研究

目的 研究知觉性内斜视或外斜视的发生与视力障碍发病年龄的关系。方法 回顾性分析169例知觉性斜视的临床资料,包括视力障碍的发病年龄、病因和知觉性斜视的类型等。结果 169例知觉性斜视中34例先天性视力障碍(20％),其中20例(59％)发生知觉性内斜视,14例(41％)发生知觉性外斜视;135例(80％)获得性视力障碍,其中21例(16％)发生知觉性内斜视;114例(84％)发生知觉性外斜视。两组间有显著性差异,x~2=27.67,P<0.01。86例视力障碍(51％)因白内障所致,其中无晶状体者64例(74％)。结论 先天性视力障碍(发病年龄≤6个月)主要发生知觉性内斜视,获得性视力障碍(发病年龄>6个月)主要发生知觉性外斜视。白内障是导致知觉性斜视最常见的原因。     

布比卡因在斜视治疗中应用的研究进展

布比卡因是长效酰胺类钠通道阻滞剂,除麻醉作用外,肌注后还能导致局部骨骼肌细胞变性、坏死、再生,使肌肉增粗、肌力增强,有研究者提出可以利用这一特性治疗斜视.目前,已有研究者对以共同性水平斜视为主的患者进行试治疗,大多数患者的眼位得到不同程度的改善,同时,亦有学者在病理学、分子生物学及细胞生物学等方面对布比卡因的作用机制进行研究.本文将对布比卡因在斜视领域的试用现状及可能的作用机制进行综述,以探讨未来的研究方向.     

伊朗亚兹德小儿斜视的流行与手术结果的调查研究

目的: 对伊朗亚兹德不同类型斜视的发病率及术后效果的调查。方法: 在此描述性研究中,对年龄低于 16 岁患斜视人群的医疗记录进行回顾性分析。收集术后效果及并发症的问卷数据,对其进行统计学分析。卡方检验用于定性分析,曼-惠特尼 U 检验用于定量分析。结果: 11a 间有 685 例儿童性斜视确诊。斜视类型如下:307 例 ( 44. 8% ) 外斜视,294 例 ( 42. 9% ) 内斜视,84 例( 12. 2%) 水平斜视合并垂直斜视。术后 280 例( 73. 9%)调整到正常水平( 水平偏差范围< 8Δ) 。结论: 研究中最常见的类型为外斜视。术后效果与已发表文献具有可比性。但仍需较长时间随访以评估手术效果。     

知觉性斜视的临床特点及手术效果

目的：分析知觉性斜视的临床特点及手术效果。方法：分析2012－01／2013－06我科收治的178例知觉性斜视患者的临床资料,包括知觉性斜视的类型,斜视眼视力障碍的病因,斜视度数分布,观察术后眼位及复视现象。结果：知觉性斜视178例中知觉性外斜视123例（69．1％）,知觉性内斜视55例（30．9％）,知觉性斜视中109例为屈光参差性弱视,123例知觉性外斜视的平均斜视度为69．32△,其中78例合并垂直斜视,55例知觉性内斜视的平均斜视度为56．45△,其中26例合并垂直斜视。术毕6例患者出现复视,均于2wk内消失。手术设计按内斜欠矫10△左右,外斜过矫10△左右,术后眼位±10△内为正位,所有患者均行斜视眼手术,超过60△者按超常量一截一退手术设计,术后1a随访,178例斜视患者中138例术后眼位达到正位。结论：知觉性外斜视较知觉性内斜视更为常见,知觉性斜视最常见的病因为屈光参差性弱视,通常斜视度数较大,且常合并垂直斜视,知觉性斜视手术可以较好的改善斜视外观,提高患者生活质量。     

直肌松解后退术联合眶脂肪切除治疗甲状腺相关性眼病限制性斜视

目的：探讨直肌松解后退术联合眶脂肪切除对甲状腺相关性眼病限制性斜视的临床治疗效果。

方法：回顾分析2018-03/2019-06在我科住院的甲状腺相关性眼病限制性斜视病例27例34眼。所有患者均在全身麻醉下行直肌松解后退联合眶脂肪切除术。眶脂肪切除范围根据眼突的程度选择鼻下、颞下、鼻上或颞上等不同象限。25眼行下直肌后退术,5眼行内直肌后退术,4眼行上直肌后退术。术中根据眼球突出程度分别选择切除鼻下、颞下、鼻上或颞上等不同象限肌锥内、外脂肪,根据术前斜视度以及眼外直肌挛缩程度设计直肌手术的后退量,术中估计则依靠被动转动试验抗力的大小。术中切除脂肪量根据术前眼球突度,按切除约1mL脂肪眼球突度后退1mm设计。术后随访时间为每周1次,1mo后每月1次,3mo后不定期随访,所纳入手术患者随访时间在6mo以上。

结果：术中切除脂肪量2.1～3.4(平均2.6)mL。术后1mo视力为0～0.2(平均0.11±0.16),术后6mo视力为0～0.3(平均0.12±0.17),术前术后视力无差异(P>0.05)。术后1mo眼球突出度为13～16(平均14.4±0.8)mm,术后矫正眼球突出度2～4(平均2.4)mm(q=10.737,P<0.01)。术后6mo眼球突出度为13～15.5(平均14.5±0.6)mm,与术后1mo无差异(q=0.624,P=0.173)。术后1mo斜视度为2^△～10^△(平均6.7^△±2.3^△),均为欠矫(q=18.068,P<0.01),术前所有患者第一眼位均有复视,术后1mo第一眼位复视消失,6例患者下转15°眼位残留复视症状。所有患者的代偿头位均得到明显改善。术后6mo患者斜视度(欠矫)0^△～7^△(平均3.4^△±1.2^△),与术后1mo有差异(q=5.385,P=0.015)。术后1mo眼压17.12±1.89mmHg,与术前眼压有差异(q=4.258,P=0.018)。术后6mo眼压17.53±1.67mmHg,与术后1mo无差异(q=0.729,P=0.154)。

结论：眶脂肪切除可改善眼突,并未对限制性斜视的手术设计及效果有明显影响,直肌松解后退术联合眶脂肪切除术治疗甲状腺相关性眼病限制性斜视合并突眼是一种可控的手术方案。     

Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis

ABSTRACT

Purpose: Despite the importance of information on the prevalence of strabismus, which can be effective in planning preventive and curative services, no study has addressed its prevalence comprehensively. In this study, a systematic search was done to estimate the regional and global prevalence of strabismus in different age and sex groups and factors affecting prevalence heterogeneity.

Methods: A comprehensive and systematic search was done in different international databases, including Web of Science, Scopus, PubMed, Embase, etc. to find published articles on the total prevalence of strabismus and the prevalence of exotropia and esotropia. A binomial distribution was used to calculate the prevalence and 95% confidence interval (CI). The Cochran’s Q-test and I² were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The Begg’s test was administered to investigate publication bias and finally, a meta-regression method was applied to determine the factors affecting the heterogeneity among studies.

Results: Of 7980 articles, 56 articles with a total sample size of 229,396 were analyzed. Many of these articles (n = 14) were from the Regional Office for the Americas. The estimated of pooled prevalence (95% CI) of any strabismus, exotropia, and esotropia was 1.93% (1.64–2.21), 1.23% (1.00–1.46), and 0.77% (0.59–0.95), respectively. The heterogeneity in prevalence of strabismus and its subtypes according to I² was above 95% (p value <.001 for all). Age had a direct effect on heterogeneity in the prevalence of exotropia (b: 3.491; p: 0.002). Moreover, WHO region had a significant direct effect on heterogeneity in the prevalence of strabismus (b: 0.482; p < .001) and esotropia (b: 0.168; p: 0.027), and publication year had a significant direct effect on heterogeneity in the prevalence of exotropia (b: 0.059; p: 0.045). Sample size and publication year did not have any association with strabismus nor with other variables. There was no publication bias according to the Begg’s test.

Conclusion: The prevalence of strabismus varies widely in the world. As for factors affecting heterogeneity in the prevalence of strabismus, the results showed that age affected heterogeneity in the prevalence of exotropia, WHO region affected heterogeneity in the prevalence of strabismus and esotropia, and publication year affected heterogeneity in the prevalence of exotropia. Information about the global prevalence of strabismus can help health care planners design interventions and prioritize resource allocation.     

单眼直肌超常量手术治疗大角度知觉性外斜视

目的　观察单眼直肌超常量手术治疗大角度知觉性外斜视的手术效果。方法　回顾性分析２００４年１月至２０１４年１月在我院住院手术的大角度知觉性外斜视（≥５０△ ）患者４５例,根据手术量不同分两组,单眼超常量（内直肌缩短≥６ｍｍ、外直肌后退≥８ｍｍ）手术组（Ａ组,２３例）,常量（内直肌缩短＜６ｍｍ、外直肌后退＜８ｍｍ）手术组（Ｂ组,２２例）,观察术前及术后斜视度、手术量、眼球活动度,手术并发症。眼位≤ ±１０△为治疗成功。结果　两组术前斜视度比较差异无统计学意义（Ｐ＞０．０５）,手术成功率Ａ组８２．６１％、Ｂ组９０．９１％,两组手术成功率比较差异无统计学意义（Ｐ＞０．０５）。单眼手术率Ａ组１００．００％、Ｂ组９．０９％,差异有统计学意义（Ｐ＜０．０５）。Ａ组术后所有患者在眼前位眼球活动自如,向外侧极限眼位注视均存在外展不足现象。Ｂ组眼前位和极限眼位均无眼球活动障碍。结论　对于视力极差的大角度知觉性外斜视患者可考虑进行单眼内外直肌超常量手术,治疗安全有效,缺点是术后眼球外展不足。     

Bupivacaine injection of eye muscles to treat strabismus

BACKGROUND: Bupivacaine injected into animal muscles induces a cycle of myotoxicity, degeneration, regeneration and hypertrophy of muscle fibres, without adverse effects on other tissues. This induced hypertrophy can be harnessed to treat strabismus. METHODS: Bupivacaine, 4.5 ml of a 0.75% solution, was injected into the right lateral rectus (RLR) muscle of a patient who had diplopia and who showed 14-prism-dioptres oesotropia. RESULTS: RLR paresis persisted for 7 days. Then, the RLR regained its abducting ability, and progressive improvement of alignment to 4-prism-dioptres oesophoria occurred over the next 33 days, with the elimination of diplopia. Alignment remained the same at 54 days after injection. Magnetic resonance imaging showed a focal increase in the size of the injected RLR of 58% in the posterior area, with reduced change in anterior portions of the RLR. CONCLUSION: Injection of bupivacaine to induce hypertrophy of the injected muscle and thus alter eye alignment was effective in our patient. This approach can be a useful addition to the treatment of strabismus.     

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。     

外直肌悬吊后徙术矫治大角度外斜视

目的探讨矫治大角度外斜视在外直肌超常量徙后时,肌止端后移、肌肉缝线悬吊的效果。方法对65例大角度外斜视在做外直肌徙后时,将肌肉缝线平行外直肌上下缘于肌止端后5 mm处巩膜浅层穿出,测量肌止点与拟行肌肉缝线结扎点后肌肉断端的距离是否与术前拟行后徙量相符,确定后结扎缝线。例如后徙量为11 mm,则肌肉缝线于肌止点后5 mm处巩膜穿出,悬吊量为6 mm时结扎缝线,形如吊床状。结果65例有1例残留5°外斜,其余64例均达到正常眼位。结论采用悬吊方法进行外直肌超常量徒后,既减少了眼外肌与眼球筋膜的大范围粘连及手术操作困难带来的巩膜意外损伤,又达到了矫治大角度外斜视的目的。     

不同类型斜视患者术后双眼视觉重建的临床分析

目的:探讨先天性上斜肌麻痹性斜视、共同性外斜视和共同性内斜视患者手术前后双眼视功能的恢复情况及临床早期变化规律。方法:选择年龄介于3～20岁斜视矫正术后的斜视患者106例作为研究对象,按斜视类型分为三组,三组平均发病年龄分别为:7.7±1.2,8.5±1.4,8.1±1.3岁;病程分别为6.75±1.20,3.42±2.42和3.80±2.10a;斜视度分别为31.50△±5.50△,50.50△±12.56△和52.25△±13.80△。采用三棱镜加交替遮盖法检查手术前后远近斜视度,《颜少明立体视觉检查图》检查近立体视觉,同视机检查远立体视觉及融合功能,分析3种类型斜视术后眼融合功能恢复率及立体视功能恢复率情况,术后随访8wk。结果:三组术前平均发病年龄差异无统计学意义(P>0.05),先天性麻痹性斜视组与共同性斜视组病程、斜视度数差异有统计学意义(P<0.05),共同性外斜视组与共同性内斜视组病程及斜视度数差异无统计学意义(P>0.05)。术后2,4,6,8wk随访先天性上斜肌麻痹性斜视组融合功能恢复率分别为12.5%,37.5%,62.5%,68.8%,立体视功能恢复率分别为0,18.8%,50.0%,56.3%;共同性外斜视组融合功能恢复率分别为14.1%,40.8%,64.8%,69.0%,立体视功能恢复率分别为1.4%,31.0%,54.9%,59.2%;共同性内斜视组融合功能恢复率分别为26.3%,47.4%,73.7%,78.9%,立体视功能恢复率分别为5.3%,47.4%,63.2%,68.4%;术后2,4,6,8wk共同性外斜视组与共同性内斜视组术后眼正位率、立体视功能与融合功能恢复率差异均无统计学意义(P>0.05)。结论:先天性上斜肌麻痹性斜视患者斜视病程相对较长,术后近期立体视功能及融合功能恢复缓慢,且恢复率较低,于术后4wk开始明显提高,而共同性外斜视患者与共同性内斜视患者术后立体视功能及融合功能最早可于术后2wk恢复,且远期恢复率明显提高。     

Relation between early postoperative deviation and long-term outcome after unilateral lateral rectus recession and medial rectus resection for adult exotropia

AIM: To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery. METHODS: This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2y. The results were evaluated at 2y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1wk was used to evaluate relationship with long-term outcome. The long-term outcome was classified into 3 groups: successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters (PD) and exodeviation 10 PD. RESULTS: Forty-two patients were enrolled. The mean age at surgery was 26y (range, 15-49y). The median follow-up period was 30mo (range, 24-108mo). Successful outcome was found in 81% of patients at 2y and in 71% at the final visit. Overcorrection at 1wk postoperatively was associated with a successful outcome at 2y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome (RR=2.2). The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2y. CONCLUSION: Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.     

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。     

外直肌超常量后徙在某些大角度外斜视矫正术中的应用

目的:观察外直肌超常量后徙在某些类型大角度外斜视矫正术中的应用和效果。方法:回顾性分析了我院2006-01/2008-07在外斜视矫正术中行外直肌超常量后徙的临床病例48例,其中分开过强型外斜视29例,知觉性外斜视16例,麻痹性外斜视3例。所有病例外斜视度数均>40△。手术原则是尽量在2条肌肉上完成斜视度的矫正。分开过强型外斜视先行双外直肌超常量后徙(8.0~9.5mm),残余度数再行一眼内直肌缩短术。知觉性外斜视手术首选视力较差的斜视眼行外直肌超常量后徙(8.0~12mm)加内直肌缩短(6~8mm),若矫正不足再行对侧眼外直肌后徙术。动眼神经不全麻痹者行麻痹眼外直肌超常量后徙(12~13mm)加内直肌大量截除(10mm)。结果:末次随访时所有患者外观良好,29例分开过强型外斜视中,23例正位,6例欠矫;16例知觉性外斜视中13例正位,2例欠矫,1例过矫;3例麻痹性外斜视中,1例正位,2例欠矫。所有欠矫或过矫均在±8~±15△,均不需要二次手术。所有病例中3例分开过强型外斜视和2例知觉性外斜视出现轻度外转不足,外转时角膜缘距外眦角约2~3mm;3例麻痹性外斜视外转不足均在3~4mm。结论:外直肌超常量后徙术对大度数的分开过强型外斜视,知觉性外斜视及麻痹性外斜视效果满意,避免了损伤过多的眼外肌,增加了外斜视矫正术的一次成功率。     

下直肌后徙术在先天性单眼上斜肌麻痹的应用

目的探讨下直肌后徙术在先天性单眼上斜肌麻痹性斜视治疗中的效果及适应症。方法回顾性分析32例行下直肌后徙术治疗的先天性单眼上斜肌麻痹性斜视患者,观察术后垂直斜视度、双眼单视功能及代偿头位的变化。结果32例患者术前第一眼位垂直斜视度10^△～25^△（平均为14.13^△）;术后0～8^△（平均为3.8^△）,较术前有显著减少（Z=-2.11,P〈0.01）。32例患者术前4例（12.5%）具有融合功能,2例（6.25%）有立体视功能,术后继续保持,另有22例（68.75%）融合建立,6例（18.75%）立体视建立,较术前均有显著性差异（χ^2=2.419,P〈0.05）。结论下直肌后徙术是治疗先天性上斜肌麻痹性斜视的有效术式,术前详细检查,掌握适应症,合理设计手术方案,可取得良好手术效果。     

伊朗亚兹德省斜视手术的效果和并发症(英文)

目的:斜视是一种注视方向不重合而双眼指向不同方向的视觉缺陷。其患病率为2%~5%。依斜视的不同表现,其治疗方法有:手术、眼镜、滴眼液、训练、注射液。斜视手术有不同的并发症。本研究旨在评估亚兹德省斜视手术的并发症和效果。方法:本研究对连续10a来的200例斜视手术的并发症和效果进行了回顾性分析。随访时间为6mo。数据被收集并进行了相应的统计分析。结果:本组病例中女98例,男102例,平均年龄15.31±11.7岁。外斜视和内斜视分别占43.5%和47%。斜视手术的效果和手术方式显著相关,但与斜视的发病年龄及病因无关。结论:斜视手术的效果是有效而持久的。随访可观察到长期效果和晚期并发症。基于本研究的结果和我们的个人经验,基于过矫和欠矫的Rosenbaum Santiago表格需要被修订。     

云南省青少年儿童斜视手术回顾性分析

目的:分析云南省青少年儿童斜视手术情况。方法:回顾性分析2017-01/2021-12于云南大学附属医院行斜视手术的青少年儿童患者3 068例的病历资料,分析纳入患者的性别和年龄构成、斜视类型分布、合并其它眼部疾病等情况。结果:纳入患者中男性占52.12%,女性占47.88%;学龄前(1～6岁)患者占32.89%,小学生(7～12岁)占45.89%,中学生(13～18岁)占21.22%;外斜视占63.17%,其中以间歇性外斜视最常见,内斜视占19.69%,其中以共同性内斜视最常见,特殊类型斜视占17.14%,其中以A-V综合征和分离性垂直斜视(DVD)最常见;合并屈光不正者占61.02%,合并弱视者占10.89%,少数患者还合并其他眼部疾病。结论:云南省青少年儿童斜视类型以间歇性外斜视最普遍,部分患者合并其他眼部疾病。