Evaluation of single-stage adjustable strabismus surgery under conscious sedation

Purpose

To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia.

Materials and Methods

Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients'' experience of the surgery (by questionnaire) were also compared.

Results

Mean preoperative deviation for distance in Groups I, II, III was −41.67 prism diopter (pd) ±9.0, −38.93 pd ±11.05 and −41.87 pd ±8.91 (P=0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd ±11.71, +35.47 pd ±10.86 and +42.80 pd ±10.71 respectively which was significantly different between Group III and Group I (P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable (P=0.5) in all groups. Intraoperative pain (P<0.001) and time taken for surgery (P<0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups (P = 0.5).

Conclusions

SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.     

Changes in astigmatism after horizontal muscle recession strabismus surgery: A retrospective cohort study

Purpose:The aim of this study was to evaluate the changes in astigmatism after unilateral recession of horizontal rectus muscles in pediatric patients.Methods:The authors retrospectively evaluated the medical history of 52 children with esotropia or exotropia, that underwent a unilateral recession strabismus surgery. The intervention group consisted of the 52 eyes that underwent strabismus surgery, and the control group consisted of the other 52 fellow unoperated eyes of the same participants. The intervention group was divided into medial and lateral rectus muscle subgroups, and four subgroups based on the astigmatism axis preoperatively (A: with-the-rule astigmatism, B: no astigmatism, C: intermediate meridians, D: against-the-rule astigmatism). All patients were examined one day preoperatively, and then, six weeks postoperatively. Paired tests were conducted, and the significant level was set to 0.05 or was adjusted for subgroups.Results:A mean difference 0.43 D of astigmatism (95% CI: 0.27, 0.59) was observed after the surgery between intervention and control group (P < 0.001). Astigmatism change (postoperative - preoperative) in subgroup A was 0.50 D (P < 0.001) and in subgroup B was 0.75 D (P < 0.001). Moreover, astigmatism changes of 0.50 D were found in both lateral (P < 0.001) and medial rectus muscle group (P = 0.002).Conclusion:Strabismus surgery appears to be associated with alterations in astigmatism, and in particular increase in cylindrical power in the eyes that had with-the-rule astigmatism or no astigmatism preoperatively. Those changes should be considered when planning the operation, to avoid transforming clinically non-significant astigmatism into clinically significant.     

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。     

Consecutive exotropia after surgical treatment of childhood esotropia: a 40‐year follow‐up study

Purpose: To determine the incidence of consecutive exotropia (XT) following successful surgical correction of childhood esotropia (ET) and identify factors associated with its development. Material and Methods: This is a retrospective study of 85 patients with ET, aged 2–24 , who underwent strabismus surgery by a single surgeon between 1958 and 1969 in Sweden, until they were successfully aligned to ET within 10 prism dioptre, after primary or reoperation(s). The charts of these patients were reviewed, and data regarding age at onset of strabismus, surgery performed and outcome were recorded. The patients were recalled for a complete orthoptic examination in 2001–2003. Results: The incidence of consecutive XT in this cohort was 21% (18/85). Patients who had undergone multiple surgeries had a higher risk of developing consecutive XT compared to those successfully aligned with one surgery (p = 0.00036). Restriction of adduction and convergence postoperatively was associated with a high risk of consecutive XT (p = 0.0437). The incidence of consecutive XT did not vary with the level of visual acuity in the operated eye (p = 0.6428). Age of onset, age at surgery and amount of surgery did not appear to influence the risk for developing consecutive XT (p > 0.05). Conclusion: This 40‐year postoperative follow‐up of patients with childhood ET who underwent strabismus surgery by a single surgeon in Sweden showed that multiple surgeries and presence of postoperative adduction deficit were the most important factors influencing the incidence of consecutive XT after surgery. Presence of uncorrected amblyopia did not alter the prognosis for long‐term development of consecutive XT.     

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。     

斜视矫正术中并发症的处理

目的探讨斜视矫正术中并发症的处理方法及效果。方法回顾研究了2003年8月至2006年5月完成的348例斜视手术,对术中出现的并发症、处理及效果进行观察。结果348例斜视手术中,术中巩膜穿孔3例,一例在行肌肉退后时发生,两例发生于肌肉缩短时,发生穿孔后即行巩膜外冷冻,术后随访未发现有进一步损害发生;术中缝线被剪断7例,牵引肌肉断端,重新安置套环缝线后继续完成手术;全麻术中发生严重眼心反射1例,患者出现频发室性早博,不得不终止手术,二次手术时加用阿托品及球后利多卡因浸润麻醉,平稳完成手术;术中严重出血1例,考虑为肌鞘缝合不完整所致;肌肉滑脱1例,为行内直肌缩短时发生,经仔细寻找得断端,完成手术。结论斜视矫正术中操作须认真细致,一旦发生并发症,冷静应对通常仍可取得较好手术效果。     

斜视矫正术对共同性斜视患者双眼视觉功能的影响

目的 探讨共同性斜视患者接受斜视矫正手术前后双眼视觉功能的改变及其影响因素。设计 回顾性病例系列。研究对象 北京同仁医院2013年12月至2014年8月进行斜视矫正术的共同性斜视患者191例。方法 将患者按斜视类型分为共同性内斜视组、恒定性外斜视组和间歇性外斜视组;按手术时年龄分为≤9岁组和＞9岁组。观察术前、术后1、3个月双眼视觉功能。主要指标 同视机双眼视觉三级功能及近立体视功能。结果 191例患者中,术前分别有26.7%、19.4%、11.0%及41.9%的患者具备同视机Ⅰ、Ⅱ、Ⅲ级及近立体视功能,术后1个月分别提高至90.1%、64.4%、33.0%及57.1%,术后3个月分别提高至94.8%、79.1%、37.7%及63.9%,与术前相比均有统计学差异（P均＜0.001）。术前,间歇性外斜视组38.1%、29.5%及72.4%的患者具备同视机Ⅰ、Ⅱ级及近立体视功能,高于另两组（P＜0.01）。术后3个月,间歇性外斜视组93.3%、48.6%及87.6%的患者具备同视机Ⅱ、Ⅲ级及近立体视功能,高于另两组（P均＜0.05）;恒定性外斜视组55.8%的患者具备近立体视功能,共同性内斜视组为14.0%（P＜0.001）。＞9岁组,术前28.1%、21.9%、14.6%及31.3%的患者具备同视机Ⅰ、Ⅱ、Ⅲ级及近立体视功能,术后3个月分别提高至93.8%、75.0%、37.5%及58.3%,与术前相比均有统计学差异（P＜0.01）。结论 斜视矫正术有助于共同性斜视患者双眼视觉功能的改善;间歇性外斜视患者术前术后双眼视觉功能优于其他类型斜视;大龄斜视患者术后也可能获得双眼视觉功能的改善。     

共同性水平斜视的再次手术

目的 探讨共同性水平斜视手术后施行再次斜视手术的临床特点及手术处理的特殊性.方法 共同性水平斜视手术后施行再次斜视手术的55例患者进行了回顾性临床分析,手术前后进行眼位检查、眼球运动,Titmus立体视检查双眼视觉功能.手术方法:手术前做全麻下或局麻下行牵拉试验.手术方式选择原则:依据视近和视远斜视角的不同,眼球运动受限制的受累肌肉和牵拉试验结果选择术式.术后追踪观察1～8年,平均2年.结果 (1)内斜视术后继发外斜视13例中,除即刻过矫3例在手术后48h内施行内直肌探查术外,其余施行原后徙内直肌完全复位或部分复位术,联合外直肌截除.治愈率76.9%.外斜视术后继发内斜视11例,施行原后徙外直肌完全复位或部分复位术,联合内直肌截除.治愈率81.8%.伴有V型斜视和垂直性斜视者联合水平直肌移位或斜肌减弱术.(2)内斜视欠矫15例中,8例施行内直肌边缘切开联合外直肌截除术;选择单纯在同一眼上外直肌截除术2例;伴有斜肌异常患者,则选择对侧眼内直肌后徙联合外直肌截除并下斜肌后徙5例.术后正位率86.7%.外斜视欠矫16例中:6例施行原外直肌后徙眼边缘切开联合内直肌截除术;2例Ⅴ型外斜视联合双下斜肌后徙,4例外直肌周围瘢痕松解术,4例联合调整缝线.术后正位率87.5%.结论 (1)水平斜视过矫伴有受累肌运动障碍,结合看近与看远斜视角的差别,选择内直肌或外直肌复位术.(2)调整术后缝线可将再次斜视手术的非预期结果降低到最小程度.     

斜视手术中遇到的困难及处理对策

斜视手术中有时会遇到一些意想不到的困难,如手术中观察仍矫正不足或过度矫正,钩不到下斜肌或上斜肌,手术眼睑裂变大或变小等。手术者必须镇定思考,冷静分析,才能找出可行的解决方法。本文分析其可能的原因,提出几种可选择的解决方法。(眼科,2007,16:291-293)     

不同手术方式治疗小度数基本型间歇性外斜视疗效观察

目的:比较单眼外直肌后退术与单眼小量外直肌后退联合小量内直肌缩短术治疗小度数基本型间歇性外斜视的疗效。方法:对73例小度数(斜视度-15~-30PD)基本型间歇性外斜视住院患者进行回顾性分析,所选病例分为A,B两组,A组行单眼外直肌后退术,B组行单眼小量外直肌后退联合小量内直肌缩短术。术后随访6mo,对两组的眼位,双眼单视功能(同时视、融合功能、远近立体视功能)分别进行观察和分析,比较两组术后正位率、双眼单视功能恢复率、欠矫及过矫发生率;比较年龄与双眼单视功能恢复率间的关系。结果:术后随访6mo,眼位正位率,B组明显高于A组,两组间差异具有统计学意义(P<0.05);术后随访6mo,双眼同时视:两组同时视功能均基本恢复,两组之间差异无统计学意义(P>0.05);术后随访6mo,双眼融合功能,远、近立体视功能恢复率B组均明显高于A组,两组间差异均具有统计学意义(P<0.05);术后随访6mo,年龄与双眼单视功能恢复率间差异:4~12岁组双眼融合功能,远、近立体视功能恢复率高于13~30岁组,两年龄组间差异具有统计学意义(P<0.05)。结论:采用单眼小量外直肌后退联合小量内直肌缩短术治疗小度数基本型间歇性外斜视,术后眼位正位率、双眼单视功能恢复率均优于单眼外直肌后退术;早期手术更有利于双眼单视功能恢复。     

斜视手术后屈光状态的变化

斜视是指任何一眼视轴偏离的临床现象,可因双眼单视异常或控制眼球运动的神经肌肉异常或各类机械性限制引起。手术治疗是斜视矫正的重要方法,最初人们的关注点只在眼位,但随着对手术患者逐渐深入地观察及随访,有研究发现斜视手术可能改变眼球原本的屈光状态。本文从斜视手术后受术者屈光状态、眼球参数的改变、其可能的发生机制以及影响因素等作一综述,希望能对斜视手术有更为全面的认识,同时为确定术后验光配镜的理想时间提供依据。     

Long-term outcomes of strabismus surgery in Mobius sequence

ABSTRACT

Purpose: Mobius sequence is a rare disorder that results from underdevelopment of the sixth and seventh cranial nerves, with subsequent facial weakness and impairment of ocular abduction. Approximately half of the affected patients have esotropia with limitation of extraocular movements. This study retrospectively reviews the long-term outcome of strabismus surgery for such patients.

Methods: The long-term follow-up results in five children with Mobius sequence, who were observed after strabismus surgery for congenital esotropia, were analyzed.

Results: All patients had a limitation of abduction in both eyes. Preoperative esotropia ranged from 20 to 30 prism diopters (PD) (mean 27 PD). Patient age at surgery ranged from 4.5 to 14 months. Bilateral medial rectus muscle recession was performed in all cases, ranging from 4.0 to 6.5 mm. Inferior transposition of the medial rectus muscles was performed in two patients for treatment of V-pattern, and two patients also had surgery for vertical strabismus. Follow-up ranged from 4 to 19.5 years (mean 11.7 years). The final horizontal alignment was <8 PD in all patients, and all demonstrated some binocularity.

Conclusion: Bilateral medial rectus muscle recession is an effective treatment for esotropia associated with Mobius sequence, with good long-term stability.     

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。     

屈光手术在成人斜视弱视领域中的应用

屈光手术包括角膜屈光手术和眼内屈光手术,不仅仅用来矫正单纯的屈光不正,其在治疗斜弱视领域也担任着重要角色。本文系统介绍了屈光手术在治疗儿童以及成人屈光参差性弱视以及调节性内斜视方面的一些研究进展,尤其是在治疗成人屈光参差性弱视和调节性内斜视方面,显示出独特的疗效,本文对此进行综述。     

共同性斜视手术后AC/A比率的变化

目的分析共同性斜视术后AC/A比率的变化特点及其相关的主要因素。方法AC/A比率测量同术前一样采用同视机法。随访术后≥6周病例,内斜视19例:外斜视32例。将各类型的斜视均值同其术前相应的AC/A比率均值及正常人的均值对比,并行不同术式AC/A比率均值分析。结果术后ACJA比率均值:内斜视3.16±1.15;外斜视2.32±1.03。内斜视主要类型的AC/A比率较术前下降(P<0.01),同正常人比无统计学意义(P>0.05)。外斜视分开过强型较术前下降(P<0.01),集合不足型较术前上升(P=0.012),其它类型无统计学意义(P>0.05)。外斜视仅基本型低于正常人(P<0.05)。共同性斜视的异常值均较术前显著减少(P<0.05或0.01)。各术式对内斜视AC/A比率的影响无明显差异(P>0.05),对外斜视的影响部分有差异(P<0.05或0.01)。结论手术可使共同性斜视异常的AC/A比率趋于正常。其影响与斜视的种类及类型有关,内斜视所受影响与术式无关,外斜视尚不能肯定其与术式的关系。     

球后麻醉在斜视手术中的应用

目的探讨在斜视手术中应用球后麻醉的可行性及其临床意义。方法将84例斜视随机分为传统麻醉组及传统麻醉联合球后麻醉组,记录钩取眼外肌前后心率变化,比较两组眼心反射发生的阳性率并对其术后正位率进行统计学分析。结果联合球后麻醉组眼心反射发生的阳性率明显低于传统麻醉组,两组术后正位率在统计上无差异。结论在传统麻醉的基础上联合球后麻醉可以减少眼心反射的发生,在提高斜视手术安全性的同时并不影响手术效果。     

儿童水平斜视矫正术后眼球屈光状态的变化

目的:探讨儿童水平斜视矫正术后眼球屈光状态的变化,决定术后首次散瞳验光时机。方法:前瞻性临床研究。对2009-01/2010-12在南昌大学第二附属医院儿童眼科接受水平斜视矫正术的3～8岁儿童进行随访,搜集资料完整、无失访的患儿178例318眼。分为四组,分别为外直肌后徙术(Ⅰ组),内直肌后徙术(Ⅱ组),内直肌后徙+外直肌缩短组(Ⅲ组),外直肌后徙+内直肌缩短组(Ⅳ组)。排除全身重大疾病及眼部器质性病变。进行术前1mo,术后1wk,1,2,4,8mo的眼部检查、弱视相关检查、散瞳检影检查。结果:术后1wk,Ⅲ和Ⅳ组患儿散瞳检影球镜屈光度与术前比较有明显差异(P<0.05),术后1mo各组与术前比较已无明显差异(P>0.05),术后8mo各组的球镜屈光度较术前出现一定程度下降(P<0.05)。术后1wk各组柱镜屈光度与术前比较存在明显差异(P<0.05)。术后1mo,Ⅲ和Ⅳ组柱镜屈光度与术前比较仍有明显差异(P<0.05)。术后2mo后各组与术前比较均无明显差异(P>0.05)。术后各时段与术前比较,散光的循规性及散光轴基本保持不变。结论:儿童水平斜视手术后短期内的屈光度确实存在变化,但在一定时间内多可恢复至术前水平。总的来说,不同术式对术后屈光度变化的影响并无明显差异。一般情况下,患儿散瞳验光配镜可于术后2mo以后进行,最迟不应超过4mo。     

盐酸奥布卡因表面麻醉剂在斜视矫正术中的应用

目的:探讨盐酸奥布卡因滴眼液表面麻醉下行斜视矫正术的临床麻醉效果。方法:对118例斜视患者术前滴盐酸奥布卡因滴眼液5次,常规行斜视矫正术。结果:Ⅰ级麻醉效果83例(70.3%),Ⅱ级麻醉效果34例(28.8%),因眼胃反射终止手术1例。结论:盐酸奥布卡因表面麻醉下行斜视矫正术安全、有效、并发症少,简单易行。     

不同局部麻醉方式下斜视手术疗效的分析

目的:探讨青少年与成年人在两种不同麻醉方法后的斜视手术治疗效果及对患者心理健康的影响。方法:回顾性分析我科2004-01/2008-04在单纯局部麻醉后行斜视手术146例及2008-07/2011-07在局部麻醉联合神经安定后行斜视手术90例患者的疗效比较。结果:单纯局部麻醉后斜视手术146例,术后眼位矫正134例,欠矫10例,二次手术2例,无1例过矫;局部麻醉联合神经安定后斜视手术90例,术后眼位矫正85例,欠矫5例,无1例二次手术。结论:在局部麻醉联合神经安定后进行斜视矫正术可减少患者术中因精神紧张及疼痛所致的眼位表现异常,从而减少二次手术的几率,明显提高手术治愈率。     

斜视手术对间歇性外斜视患儿生存质量的短期影响

目的：：应用间歇性外斜视患者生存质量量表( intermittent exotropia questionnaire,IXTQ)研究间歇性外斜视患儿的生存质量状态,评估斜视手术对其生存质量的改善情况。方法：本研究为前瞻性研究。选择5~17岁的42例间歇性外斜视患儿作为病例组,另外选择非间歇性外斜视患儿42例为对照组,采用中文版间歇性外斜视患者生存质量量表进行问卷调查,分别比较病例组和对照组儿童、间歇性外斜视患儿术前1 d与术后3 mo以及对照组与病例组患儿术后3 mo的Child IXTQ评分,分析生存质量差异以及手术对其生存质量的改善情况。结果：对照组儿童Child IXTQ各维度评分及总评分都明显高于病例组患儿,差异有统计学意义(P<0.01);除了条目“小伙伴们因为我的眼睛取笑我”和“我因为眼睛觉得交朋友很难”无显著性统计学差异外(P>0.05),各条目比较差异有统计学意义(P<0.05);病例组术后3mo各维度评分及总评分都明显高于术前1d,差异有统计学意义( P<0.01);术后患儿Child IXTQ各维度评分及总评分仍低于对照组,差异有统计学意义(P<0.05)。结论：间歇性外斜视从视觉功能和社会心理两个方面影响患儿的生存质量,其中视觉功能影响相对较大,最显著的问题是畏光及调整眼位,而他人嘲笑、交朋友方面影响较小。斜视手术有助于改善间歇性外斜视患儿的生存质量。