主眼手术与非主眼手术治疗共同性外斜视的疗效比较

目的:探讨矫正共同性外斜视的最佳手术方式。方法:对60例共同性外斜视的患者进行主眼手术,观察手术量、术后视力和立体视的恢复效果。结果:通过和非主眼手术组的对比,行主眼手术者的手术量明显减小(P<0.01),术后视力、立体视均较非主眼手术组有明显提高(P<0.05)。结论:手术治疗共同性外斜视时,主眼手术较非主眼手术有更好的效果。     

眼外肌注射布比卡因治疗斜视

动物实验证实布比卡因具有特异性肌肉毒性作用，注入肌肉后可引起肌纤维变性、增生和肥大，而对其它组织无明显副作用。眼科手术中有时行布比卡因球后注射进行麻醉，可引起术后斜视、眼外肌肥大。本研究试图利用眼肌注射布比卡因诱导肌肉肥大这一作用治疗斜视。作者将0．75％的布比卡因4．5ml注入一内斜视（14棱镜度）患者的外直肌中，术中利用针尖记录肌肉的电活动以准确定位。     

外直肌超常量后徒治疗外斜视

目的：探讨超常量外直肌后徒术治疗外斜视的方法及效果。方法：对28例（54眼）共同性外斜视及麻痹性外斜视患者行外上直肌超常量后徒手术,单眼或双眼外直肌后徒11－15mm。结果：术后眼位矫正良好,其中13眼出现不同程度的外转受限,结论：该手术方式简便,避免损伤过多的眼外肌,术后效果满意。     

共同性外斜视的手术分析

共同性外斜视的手术分析马少青，郑绍斌，林发森共同性外斜视不仅影响美容，而且常伴有弱视或双眼视功能异常。大多数共同性外斜视需通过手术治疗才能矫正眼位，改善外观上的缺陷，促进正常的双眼视功能建立，为探索外斜视斜视度与手术量的关系及术后视功能恢复情况，现将...     

成人斜视手术疗效观察

目的 了解成人共同性斜视矫正术后，眼位及视功能恢复情况。方法 将我院2003-2004年手术矫正大龄共同性斜视114例患者进行分析，其中男58例，女56例。年龄17～54岁，平均24．5岁。共同性内斜视28例，共同性外斜视86例。屈光不正85例，弱视52例。斜视角〈50^△者27例，≥50^△87例。术后早期进行视功能训练7-10次。术后观察1～16个月。结果 眼位矫正满意，正位98例，占85．94％，欠矫15例，外观满意未行二次手术，过矫者1例，配压贴三棱镜矫正。术后经过训练恢复视功能者14例，占12．28％。结论 成人斜视手术主要是美容矫正，视功能很难恢复。故弱视、斜视应早期治疗。有手术指征者应及时手术。     

不同手术方法治疗儿童基本型外斜视对术后侧转非共同性的影响

目的:研究不同手术方法治疗儿童基本型外斜视与术后侧转非共同性发生及矫正效果相关性。方法:回顾性研究。选取2018-06/2020-12于我院眼科接受治疗的180例基本型外斜视患儿临床资料。根据手术方式分为单眼一退一截术组(R&R组)104例和双眼外直肌后徙术组(BLR-rec组) 76例。比较两组患者一般资料、手术矫正效果,以及随访期间手术斜视度数、侧转非共同性发生情况。结果:两组患者术后3d, 1、6mo视近、视远斜视度比较均无差异(均P>0.05)。R&R组术后不同时间点正位率高于BLR-rec组(P<0.05)。R&R组较BLR-rec组发生侧转非共同性的风险更低(OR=0.524, Wald χ²=4.260,P=0.039)。两组患者术后6mo主要表现在水平直肌手术眼外展方向注视,但两组患儿视远和视近侧转非共同性发生率均无差异(均P>0.05)。结论:R&R对于儿童基本型外斜视的矫正效果优于BLR-rec术式,可降低侧转非共同性发生情况。     

斜视矫正手术(六)

(二)肌加强术(myostrengthening) 肌加强术和前面所讲的肌减弱术,二者都是斜视矫正手术中的重要手术。在共同性斜视,特别是大度数斜视,单作肌减弱手术往往不能矫正全部斜度,必须辅以对抗肌的加强术方可完全矫正;还有集合不足型内斜和分开不足型外斜等,也都必须采用肌加强术方可作到合理矫正。在麻痹性斜视,不少矫正手术采用加强     

共同性外斜视矫正手术联合下斜肌减弱术治疗儿童复杂斜视

目的：观察共同性外斜视矫正手术联合下斜肌减弱术治疗儿童复杂斜视的临床疗效。

方法：选取2015-01/2017-02我院收治的68例80眼复杂斜视患儿，均行共同性外斜视矫正手术，对其临床诊治进行回顾性分析，依据是否联合下斜肌减弱术治疗，分为联合组(30例35眼)与非联合组(38例45眼)，比较两组患儿手术前后视功能、5m斜视度、下斜肌亢进程度、Titmus立体试验结果，并观察两组患者术后疗效。

结果：术后6mo，两组具有同时视患者、一定融合范围患者、远立体视功能患者和近立体视正常者(40″～60″)所占比例均较术前明显升高(P<0.05)，但组间比较差异无统计学意义(P>0.05)。术后6mo，两组患儿下斜肌亢进程度、5m斜视度与术前相比得到明显改善(P<0.05)，组间比较均无统计学差异(P>0.05)； 术后1～3d，1a随访显示，两组患儿正位率、过矫率和欠矫率比较差异均无统计学意义(P>0.05)。

结论：对儿童复杂斜视采取共同性外斜视矫正手术治疗时，联合下斜肌减弱术可能不会影响外斜视矫正效果，进行手术设计时，可忽略下斜肌减弱术对患儿水平斜视度产生的影响。     

OrbitTM1.8生物力学模型在非共同性斜视诊断和治疗中的初步应用

目的：应用Orbit^TM1．8计算机模拟系统构建非共同性斜视的生物力学模型并预测手术矫正效果，探讨不同类型斜视的模拟方法以及Orbit^TM1．8在斜视诊断和治疗中的应用价值。方法：收集15例先天性上斜肌不全麻痹、1例外伤性内直肌断裂、1例外展神经不全麻痹、1例Brown综合征，手术前后均进行Hess屏及其它斜视相关检查，应用美国Miller JM等开发的Orbit TMl．8眼外肌生物力学模拟系统，分析眼外肌的原发和继发改变，通过调整相应的生物力学参数，建立与临床特征相符的斜视模型，据此验证病因推断和假设，并对手术方案进行模拟。预测术后矫正效果。结果：构建了全部18例非共同性斜视的术前生物力学模型；17例手术患者的预测矫正效果与手术后检查结果基本吻合。结论：Orbit TMl．8生物力学模型可以对斜视的病因推断和假设进行测试，并预测手术矫正的效果，具有辅助诊断和指导手术设计的应用价值。     

手术矫正142例共同性外斜视的临床研究

目的总结共同性外斜视术后眼位的变化情况、手术疗效及可能的影响因素。方法对142例共同性外斜视患者进行术后随访观察,并对其手术效果进行总结、分析。结果 142例共同性外斜视患者术后1周发现正位122人,正位率85.92%,术后1年随访正位110人,正位率77.46%。结论共同性外斜视手术效果与手术设计、患者年龄、屈光状态、斜视的类型、斜视病程、双眼视功能等诸多因素有关。应尽早手术矫正眼位,才能有利于患者建立和恢复双眼视功能。     

Management of strabismus with botulinum A toxin

Three hundred eight patients with strabismus were treated with botulinum A toxin (Oculinum) chemodenervation; 153 were followed by the authors for at least 6 months. In this study group, 97 received botulinum A toxin injections as the primary method of treatment of their ocular deviation. Fifty-six received injections after traditional extraocular muscle surgery. Botulinum A toxin was useful for management of patients with recent surgical overcorrections and for management of some patients with sixth cranial nerve palsy. Chemodenervation of an extraocular muscle was not as successful as traditional strabismus surgery for treatment of infantile esotropia and other comitant deviations. Botulinum A toxin injection was ineffective in patients who had restrictive strabismus. This drug has limited application in the management of patients with strabismus.     

Paralytic strabismus.

The use of sophisticated imaging techniques has led to a greater understanding of the mechanisms of some forms of strabismus. In particular, studies of strabismus in high myopia have demonstrated abnormal muscle courses and provided a basis for corrective surgery. Although injection of botulinum toxin has a place in modern strabismus management, there have been few controlled studies validating its use. An important paper in the review period directly compares botulinum with surgery to confirm its effectiveness for at least one indication.     

Role of Inferior Rectus Botulinum Toxin Injection in Iatrogenic Vertical Strabismus

Introduction: We describe the uses and effectiveness of botulinum toxin to the inferior rectus muscle in iatrogenic vertical strabismus.

Methods: A retrospective review of our database to identify patients who had undergone inferior rectus botulinum toxin injection between 1982 and 2006 for iatrogenic vertical strabismus.

Results: There were 13 patients, 5 female, with an age range of 14 to 78 years. Eight left eyes were injected. The mean period of follow-up was 3.3 years. Etiologies included post–local anesthetic, post–plaque radiotherapy for malignant melanoma, adherence syndrome after inferior oblique surgery, and post–botulinum toxin to the levator muscle to produce a temporary therapeutic ptosis. Reversal on first injection occurred in 7 patients and occurred in a further 2 patients on second injection. Pre-injection binocularity was not demonstrable in 3 patients; 2 of these patients did have binocular vision demonstrable after botulinum toxin injection. Seven patients had one injection, 3 patients had two, 1 had three, 1 had five, and 1 had six.

Discussion: The data demonstrate the range of indications that can be successfully treated and managed with inferior rectus botulinum toxin injection in iatrogenic vertical strabismus.     

Injection treatment of endocrine orbital myopathy

Eight Patients with endocrine orbital myopathy received botulinum toxin injection of extraocular muscles for strabismus or injections of the levator for lid retraction. Strabismus of 25 prism diopters or less, especially during early stages of eye muscle involvement, responded well to injection with realignment and, probably, with avoidance of fixed muscle shortening. Long-standing strabismus, large angles, and lid retraction responded less well.     

A型肉毒毒素注射与手术治疗儿童共同性斜视的临床比较

目的比较A型肉毒毒素(BTA)注射与手术治疗儿童共同性斜视的疗效。 方法纳入2018年4月至2019年8月就诊于北京同仁医院眼科中心的共同性斜视患儿142例作为研究对象。其中,男性74例,女性68例;年龄3~15岁,平均年龄(7.2±2.6)岁。按照家属的选择意愿分为注射组和手术组。注射组患儿采用BTA眼外肌注射治疗,手术组患儿采用斜视矫正术治疗。检查并记录治疗前与治疗后6个月患儿的斜视度、双眼视觉功能以及并发症情况,治疗后6个月患儿的眼位正位率等指标。注射组和手术组患儿斜视度与双眼视觉功能的定量数据,用均数±标准差描述,采用独立样本t检验进行组间比较,采用配对样本t检验进行组内比较。患儿双眼视觉功能的定性数据,眼位正位率与并发症等指标的描述采用频数和百分率表示,采用卡方检验进行组间比较。 结果治疗后6个月,注射组患儿的眼位正位率为58.2%,手术组患儿的眼位正位率为69.3%。两组患儿眼位正位率的比较,差异无统计学意义(χ²＝1.90,P>0.05)。注射组患儿斜视度绝对值在注射前和注射后6个月分别为(35.23±6.69)△和(12.35±10.16)△;手术组患儿斜视度绝对值在手术前和手术后6个月分别为(35.40±8.74)△和(9.16±9.43)△。治疗前与治疗后6个月,两组患儿斜视度绝对值的比较,差异无统计学意义(t＝-0.13,1.92;P>0.05)。注射组和手术组患儿在治疗后6个月随访时,具有正常同视机Ⅰ级功能(同时视)的分别有25例(占39.1%)和38例(占50.7%);具有正常同视机Ⅱ级功能(融合视)的分别有43例(占67.2%)和70例(占93.3%);具有正常同视机Ⅲ级功能(立体视)的分别有26例(占40.6%)和37例(占49.3%);具有正常近立体视功能的分别有27例(占42.2%)和38例(占50.7%),与治疗前相比均有所增加。治疗后6个月,手术组具有同视机Ⅱ级功能(融合视)患儿的比例高于注射组,差异有统计学意义(χ²＝15.52,P<0.05),其余差异均无统计学意义(χ²＝1.88,1.06,0.99;P>0.05)。注射组所有患儿主诉出现复视,16例患儿表现出轻度上睑下垂和结膜下出血,均于随访1~3个月时消失。 结论对于斜视度为中低度数(15△~50△)的患儿,BTA注射与手术治疗儿童共同性斜视在治疗后6个月临床疗效相近,是一种安全有效的治疗方法。     

Botulinum toxin A in the treatment of concomitant strabismus in children

PURPOSE: To evaluate the results of treatment of esotropia, exotropia and hypertropia with botulinum toxin A. MATERIAL AND METHODS: 72 children with esotropia, exotropia and hypertropia treated with intramuscular injection of botulinum toxin A. RESULTS: Squint angle decreased 76% in children with alternant esotropia, 70% in children with monocular esotropia, 64% in alternant exotropia and 54% in monocular exotropia after treatment with botulinum toxin A. In hypertropia squint angle reduced in 50%. CONCLUSIONS: The use of injections of botulinum toxin A in treatment of concomitant strabismus improves position of eyes, which creates better conditions for development of localization with normal retinal correspondence.     

Botulinum Toxin Injection into Extraocular Muscles as an Alternative to Strabismus Surgery

Sixty-seven injections of botulinum A toxin were given to patients for correction of strabismus. No systemic complications of any kind have occurred. The maximum time of paralysis occurs four to five days following the injection, and then gradually diminishes, depending on the dose. The maximum correction of strabismus has been 40 prism diopters. The maximum follow-up following injection is six months. Injection of botulinum A toxin into extraocular muscle to weaken the muscle appears to be a practical adjunct or alternative to surgical correction.     

Role of Botulinum Toxin A in Diplopia following Orbital Decompression

Diplopia following orbital decompression is a common complication in Graves' ophthalmopathy. Strabismus surgery is often required to treat the persistent diplopia. The author presents a successful treatment with botulinum toxin A injection in a case of diplopia following orbital decompression. Treatment with botulinum toxin A in the management of new-onset diplopia following orbital decompression has been suggested in a case that is not amenable to prism treatment and may eliminate strabismus surgery in some cases.     

Role of botulinum toxin A in diplopia following orbital decompression

Diplopia following orbital decompression is a common complication in Graves' ophthalmopathy. Strabismus surgery is often required to treat the persistent diplopia. The author presents a successful treatment with botulinum toxin A injection in a case of diplopia following orbital decompression. Treatment with botulinum toxin A in the management of new-onset diplopia following orbital decompression has been suggested in a case that is not amenable to prism treatment and may eliminate strabismus surgery in some cases.     

A型肉毒毒素在甲状腺相关眼病限制性斜视治疗中的应用

目的探讨A型肉毒毒素(BTXA)治疗甲状腺相关眼病(TAO)限制性斜视的疗效及作用特点。方法回顾性分析BTXA眼外肌注射治疗TAO限制性斜视的临床资料,在肌电图的引导下,对33例TAO限制性斜视患者的眼外肌肌腹注射BTXA,注射前后记录眼位、眼球运动、复视等情况。结果本组患者垂直斜视25例,水平斜视3例,水平斜视合并垂直斜视5例。水平斜视度平均35·00△±20·53△(20△~80△,M=27·5△),垂直斜视度29·33△±17·27△(10△~100△,M=27·5△)。随诊时间5·00~67·73个月,平均(17·04±12·77)个月。注射眼外肌61条,其中下直肌31条,内直肌16条,上直肌10条,外直肌4条。每条眼外肌平均注射次数(6·48±2·12)次,(4~11次,M=6次)。注射间隔时间0·50~26·00个月,平均(2·96±0·70)个月。注射后斜视度减小,治愈15例,有效12例,治疗无效6例。单次注射用药剂量平均(8·16±1·43)U。结论BTXA治疗TAO引起的限制性斜视效果良好。注射时机以TAO早期为佳。每次注射BTXA剂量大于麻痹性斜视和共同性斜视的用量,矫正的斜视度较低,注射的间隔时间和疗效持续时间较短,随治疗次数的增加,注射剂量需不断增大。部分患者可能免除复视而不需手术。