Orbit~(TM)1.8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OrbitTM1 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OrbitTM1 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MillerJM等开发的OrbitTM1 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 :OrbitTM1 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。     

Orbit^TM生物力学模型在斜视诊断和治疗中的应用

Orbit^TM生物力学模型是近年通过计算机图像模拟软件实现的一种新颖的生物力学分析系统，利用它可以获得眼球和眼外肌运动的三维模型。它可以帮助临床医生以一种定量的方式将斜视的诊断公式化并预测手术后的结果，也为斜视眼眶解剖学和病理学的研究提供了基本手段。本就其原理、方法及其在斜视诊断治疗中应用的最新进展进行综述。     

外伤所致非共同性斜视的诊断和治疗

目的探讨外伤所致非共同性斜视的诊断和治疗方法。方法临床收集外伤所致非共同性斜视25例,在常规的斜视检查基础上,辅以CT、MRI以进行诊断。采取药物保守治疗、手术治疗及配三棱镜等方式进行矫正。结果治疗后所有病例的眼位偏斜、眼球运动障碍、复视及代偿头位均有不同程度的改善。结论外伤所致的非共同性斜视应根据病情选择适当的治疗方法,不仅可改善斜视,而且一定程度上达到功能改善目的。     

非共同性斜视手术与双眼视觉

我科 1987年 1月～ 1998年 10月手术治疗 95例非共同性斜视 ,对术后视觉情况做一回顾分析 ,现报告如下。1　临床资料95例均为在我科行斜视矫正手术的非共同性斜视 ,门诊观察达 1a以上。男 48例 ,女 47例 ,年龄 4～ 5 2岁 ,平均17.2 5岁 ,平均随诊时间 88个月。病例选择标准为 :(1)术前采用角膜映光加遮盖去遮盖法、三棱镜中和法证实斜视存在 ,并明确斜视性质及度数 ,其中麻痹性斜视 5 4例 ,V型外斜视 35例 ,眼球后退综合征 6例 ;(2 )术后斜视角≤± 5°者为正位 ,>± 5°者为欠矫 ;(3)术前 ,术后均行三棱镜中和及同视机检查双眼视觉。2　结…     

MRI在非共同性斜视中的研究应用

19世纪80年代，磁共振成像技术应用于临床工作领域。90年代，国外将这一技术应用于眼外肌学的研究，发现了眼外直肌的眶层；提出了新的眼球运动模型，即“滑车”机制的眼球运动模型；对某些非共同性斜视，如：上斜肌麻痹、AV征等提出新的病因解释；此外，磁共振成像技术在对非共同性斜视的诊断和鉴别诊断方面，具有重要的临床指导价值。现将这一领域的研究新进展作一综述。     

非共同性斜视的手术方式和效果分析

目的分析和评价非共同性斜视手术的方式和效果。方法非共同性斜视106例根据术前诊断分别采取斜肌断腱、后徙、并联合水平肌肉手术、上直肌下直肌后徙（缩短）联合水平肌肉手术、水平肌肉移位联合水平肌肉手术等手术方式。结果106例术后均达到治愈标准,异常头位消失。58例恢复了立体视。结论对于非共同性斜视要诊断准确,正确选择手术术式早期治疗。     

手术治疗共同性外斜视

目的：探讨共同性外斜视的临床特点,手术设计和手术技巧。方法分析30例58只眼的临床疗效,此30例患者采用三棱镜加交替遮盖法,角膜映光法测量33cm和5m处矫正状态及上下转25°斜视角,同视机检查三级功能,根据不同的斜视度及类型,选择不同的手术方式和手术量。术后观察眼位及视觉情况。结果30例患者中,术后正位率93.3%。术前有中心融合14.32%,术后有中心融合63.11%,术后较术前立体视锐度提高者占53.24%。无一例出血感染、眼前段缺血等并发症。结论共同性外斜视详细的术前检查、恰当的手术设计、熟练的手术操作技巧、手术效果良好,有助于双眼视功能恢复和满足美容的需要。     

外伤致非共同性斜视的治疗

外伤在非共同性斜视的致病因素中占有相当的比例，由于外伤病情多样化，其治疗也不尽相同，我们回顾性分析我院收治的外伤致非共同性斜视患者59例，诊疗情况报告如下。     

共同性水平斜视伴垂直斜视的手术治疗

0引言我科1998/2001在矫正水平斜视同时行肌止端移位治疗,无眼外肌麻痹的共同性水平斜视伴垂直斜视16例,效果满意,报告如下。1临床资料在同期收治的共同性水平斜视113例患者中,有16例患者同时伴有垂直斜视,其中男9例女7例,年龄5～22岁,内斜12例,斜视度15°40°,外斜4例,20°～3     

OrbitTM1.8生物力学计算机模拟系统在先天性上斜肌不全麻痹诊断和治疗中的初步应用

目的　初步评价OrbitTM1 8生物力学计算机模拟系统在先天性上斜肌不全麻痹诊断和治疗中的应用价值。方法　对 15例先天性上斜肌不全麻痹患者行手术治疗 ,手术前、后分别行Hess屏和其他相关检查。应用OrbitTM1 8生物力学计算机模拟系统模拟改变受累眼外肌的收缩力、弹性、神经支配等参数 ,并根据相关眼外肌的继发改变 ,构建先天性上斜肌不全麻痹模型 ,分析 15例先天性上斜肌不全麻痹患者的病因、制定手术方案、预测手术效果 ,并将模拟效果与手术实际效果进行比较。结果　实际Hess屏检测 2 1个注视方向的眼位结果与OrbitTM 1 8生物力学计算机模拟系统结果的平均差值 ,斜视矫正术前水平方向为 1 6 6°± 0 4 4° ,垂直方向为 1 97°± 0 5 1° ;斜视矫正术后水平方向为 1 2 1°± 0 34° ,垂直方向为 1 5 9°± 0 4 1°。OrbitTM1 8生物力学模型的眼位和眼球运动模拟直观效果与临床体征相符。结论　OrbitTM1 8生物力学计算机模拟系统可较为准确反映正常和异常眼球运动的力学因素及其相互作用关系 ,展示眼球和眼外肌的三维图像和相关数据 ,为设计斜视矫正手术方案和预测手术效果提供直观的临床信息 ,有望成为斜视诊断和治疗的有效辅助方法。     

Paralytic and incomitant strabismus

During the past year, there have been interesting reports on the association of head tilt, facial asymmetry, and congenital superior oblique palsy. The etiology of sixth nerve palsy and its outcome in adults and children have been studied in two large series, and an orbital surgical approach has been reported to be valuable in cases of Brown's syndrome and superior oblique overaction.     

Paralytic and incomitant strabismus

In the year under review, published work has concentrated on two main topics. The first is the etiology, pathophysiology, and natural history of paralytic and incomitant strabismus. No major studies were published but some interesting findings are discussed. The second is surgical results, largely assessed by uncontrolled retrospective data analysis. Also, a number of useful tips for patient management have emerged.     

Fadenoperation for the management of complicated incomitant vertical strabismus

We reviewed retrospectively the records of 17 patients with incomitant vertical diplopia secondary to an underacting inferior rectus muscle who had been treated by surgically weakening the contralateral inferior rectus muscle with a posterior fixation suture (fadenoperation). This was the sole procedure in four patients with blowout fractures and in two patients with restriction secondary to scleral buckling procedures. It was combined with horizontal or vertical muscle surgery in 11 patients. The procedure was particularly useful in preventing diplopia on downgaze after excessive weakening of a tight inferior rectus muscle in seven patients with thyroid ophthalmopathy. In three patients it was used in anticipation of an iatrogenic incomitancy in downgaze secondary to a large recession of a tight inferior rectus muscle. All patients were markedly improved after surgery and no complications were encountered.     

Combined adjustable rectus muscle resection--recession for incomitant strabismus.

INTRODUCTION: We sought to report the results of combined adjustable suture resection and recession of a rectus extraocular muscle in a subset of patients who are asymptomatic in the primary position but diplopic in secondary functional gaze positions. METHODS: We undertook a retrospective chart review of 12 patients who underwent a surgical procedure consisting of combined resection and recession of the same rectus extraocular muscle on adjustable suture, the amount of recession being double the amount of resection. RESULTS: The amount of incomitance reduced from a preoperative mean of 11.6 prism diopters (PD) to a postoperative mean of 2.9 PD. All 4 rectus muscles underwent operation No significant change in the primary position alignment occurred. Diplopia was eliminated in 11 of the 12 patients postoperatively. CONCLUSION: The combined adjustable suture resection and recession operation is an effective and easy procedure for treatment of this subset of patients with incomitant strabismus.     

New surgical approach in the treatment of incomitant strabismus: case report

The authors report the utilization of the surgical technique proposed by Scott, in 1994, of recess and resection of the same extraocular muscle in the treatment of incomitant horizontal strabismus. A 22-year-old female presented with incomitant strabismus, with an esotropia of 9delta for distant and 30delta for near. She was submitted to a recess and resection of the right medial rectus. She presented satisfactory results in the long-term, showing that this technique could be part of the therapeutic arsenal for correction of incomitant strabismus.     

Combined resection and recession of a single rectus muscle for the treatment of incomitant strabismus.

BACKGROUND: The treatment of incomitant strabismus is challenging. Traditional approaches include the use of asymmetric bilateral surgery and the fadenoperation (posterior fixation suture). We report our experience with a different approach: combined resection and recession of a single rectus muscle. METHODS: The charts of 12 patients who underwent resection of a single rectus muscle with an equal or greater amount of recession of the same muscle were identified. In 5 patients, the procedure was performed using the adjustable suture technique, and the adjustment was performed later the same day (Group 1). In the remaining 7 patients, permanent sutures were placed at the time of surgery (Group 2). The procedure was performed for horizontal and vertical gaze incomitance, dissociated horizontal deviation, and distance-near disparity. RESULTS: Four of the 5 patients in Group 1 showed stable, long-term correction of their incomitance, both in primary gaze and in gaze in the direction of the muscle operated on. The results for patients in Group 2 showed stable, long-term correction of incomitance in 3 patients; however, these patients also had slight overcorrections in the direction of gaze opposite to the muscle operated on. An additional patient in Group 2 had a shift of her distance-near disparity, shifting from relatively exotropic to relatively esotropic disparity postoperatively. All patients in Group 2 showed at least some decrease in the amount of measured incomitance. We did not encounter complications such as muscle slippage or loss, scleral perforation, or late overcorrection in the field of gaze of the operated muscle. CONCLUSIONS: The technique of combined resection and recession of a single rectus muscle shows promise in the treatment of incomitant strabismus. It offers the advantages of posterior fixation combined with the greater technical ease of a standard hangback recession. The muscle may also be placed on an adjustable suture, allowing for postoperative adjustment in selected patients.