白内障术后斜视的临床分析

目的探讨白内障术后斜视的临床表现、发生机制及预后.方法对白内障人工晶体术后斜视的患者除常规眼部检查外,还 进行屈光、眼肌运动、复视像检查,并用三棱镜及同视机检查眼位和偏斜度,部分患者行眼肌牵拉试验.结果15例斜视患者受 累眼肌多为术眼垂直肌,1例为对侧眼上斜肌麻痹,5例合并上睑下垂,3例牵拉试验呈阳性反应.9例患者3个月内治愈,1例经 手术矫正眼位而改善症状.结论白内障人工晶体术后部分患者合并眼肌运动障碍性复视,其发病机制可能与药物的肌毒性作用 有关,大部分患者可恢复正常.     

人工晶体植入术后复视

目的:本文报道7例人工晶体植入术后复视病例,并初步探讨其原因及预防。方法:随访60例单侧白内障摘除及人工晶体植入术连续病例。复视病例,检查复视类型、眼位、眼球活动度、屈光状态、瞳孔及眼底,并散瞳检查人工晶体位置。结果:本文报告白内障摘除及人工晶体植入术后复视发生率为11.67％。术前存在斜视,双眼融合功能障碍,局麻药物对眼外肌的毒性作用,人工晶体中心偏移,黄斑部病变及晶体后囊不均匀混浊等与术后复视有关。结论:复视是白内障摘除及人工晶体植入术后一个重要的并发症。其治疗往往较困难,根据复视的可能原因,采取预防措施对减少术后复视有帮助。眼科学报1997;13:210—212。     

白内障摘除人工晶状体植入术后继发斜视的临床分析

目的:探讨白内障摘除人工晶状体植入术后继发性斜视的发病机制和处理方法。方法:对白内障摘除人工晶状体植入术后继发性斜视的患者28例进行视力、眼前节、后节常规检查,并行眼位、眼球运动、复视相、三棱镜和同视机检查。部分患者行牵拉试验。结果:患者28例中,垂直性斜视患者占21例,水平斜视患者占2例,上直肌挛缩患者2例,下直肌挛缩患者1例,上直肌瘢痕限制性斜视患者2例。结论:白内障摘除人工晶状体植入术后继发性斜视并眼外肌运动障碍所致性复视的患者,经过早期的药物治疗可使大部分患者恢复其眼外肌正常的运动机能从而改善斜视,消除复视症状。     

白内障术后斜视和复视的相关因素分析

本文报告白内障术后出现斜视及复视的 9例患者 ,对其发生可能的相关因素、治疗及预防进行分析和初步探讨。临床资料 :本文回顾了自 1994年 9月～ 1999年 5月因白内障手术住我科的患者术后出现斜视和复视者 9例 ,男 7例 ,女 2例 ,年龄 18～ 70岁单眼行人工晶体植入者 7例 ,双眼植入者 2例。术前常规行全身检查是否有甲状腺疾病或糖尿病及中枢神经系统疾病。眼科检查白内障类型、眼位、眼球运动等。特殊检查眼部 A/ B超、角膜曲率、三棱镜等。术后查双眼视力 ,有无人工晶体偏斜、双眼屈光状态、眼底等 ,眼肌检查 :眼位、眼球运动、同视机检查…     

单眼严重白内障伴外斜视患者临床疗效观察

目的：观察单眼严重白内障合并外斜视患者术后临床效果。 方法：回顾我院2010-03/2012-12单眼严重白内障合并外斜视行白内障摘除联合人工晶状体植入手术的患者资料45例。术前44例较差眼视力均〈0.05,1例2岁患儿无法配合视力检查。随诊观察术后6mo患者的最佳矫正视力、眼底、斜视度、双眼单视功能及复视情况。 结果：先天性白内障患者2例中有1例患儿2岁,无法配合视力及复视检查,眼底正常;另1例患儿术后无同时知觉,无复视。5例不明原因中青年单眼白内障患者中,有3例患者术后视力〉0.6,眼底正常,术后眼位正,有双眼单视;2例患者术后视力为指数,眼底有异常,术后斜视度与术前无变化,无同时知觉,无复视。38例老年性白内障患者中,有31例患者术后有双眼单视;3例患者术后斜视度与术前无差异,无同时知觉,无复视;3例患者术后斜视度与术前无差异,有复视,6mo内复视均自行消除;1例患者外斜10o,术后出现复视,且6mo内无改善,可用12？矫正,建议戴镜治疗。 结论：单眼严重视力障碍合并外斜视的成年患者多数术后可自行纠正眼位,获得一定的双眼单视功能。     

白内障手术后斜视复视的病因分析和防治

目的探讨白内障手术后斜视、复视的临床表现,发病原因及防治措施.方法对白内障手术联合人工晶状体植入术后发生斜视、复视的31例患者(31眼)进行常规的视力、眼前节、眼底的检查,并进行了屈光、眼肌运动、复视像的检查.结果 31例患者中大部分受累肌为垂直肌,以下直肌受累更为多见,6例合并上睑下垂.大部分患者在3个月左右恢复正常眼位,2例出现永久性复视,年龄越大恢复越慢.结论白内障手术联合人工晶状体植入术后部分患者合并眼肌运动障碍,并引起斜视、复视,其发病原因可能与麻醉药物引起的眼肌毒性反应有关.早期治疗大部分患者可恢复双眼视觉,手术治疗有一定的效果.     

伴有知觉性外斜视白内障患者79例的疗效观察

目的：评价超声乳化白内障吸除联合人工晶状体植入术对伴有知觉性外斜视的白内障患者的疗效。方法：通过前瞻性研究观察伴有知觉性外斜视的白内障患者79例,行超声乳化白内障吸除联合人工晶状体植入术。于术前、术后1,3mo观察其视力、眼位、双眼视功能及复视情况。并对眼位改善情况、复视情况与引起知觉性斜视的原因做相关分析。结果：术后随访3mo,术后1mo最佳矫正视力≥0.3的有48例,其中≥0.5的有31例,≤0.02有8例。53例患者术后1～3mo外斜眼位均已自发纠正,且获得不同程度双眼视功能恢复。术后3mo,30例患者复视消失。单纯由白内障所致的知觉性斜视患者术后视力、眼位及复视均改善优于其他眼病所致的白内障患者。结论：对于伴有知觉性斜视的白内障患者作相应的治疗,斜视程度可以得到一定的改善。     

眼科手术后斜视和复视的临床分析

目的　探讨眼科手术后继发性斜视的发生机制和防治方法。方法　检查 79例不同眼科手术后发生继发性斜视患者的眼位、眼球运动、复视及预后情况 ,并进行牵拉试验。对部分患者行斜视矫正术 ,术中观察眼部受累组织的情况。结果　在全部患者中 ,视网膜脱离术后患者占 38 0 %(30 / 79) ,白内障摘除手术后患者占 31 7% (2 5 / 79) ,眼眶手术后患者占 13 9% (11/ 79) ,其他为青光眼、翼状胬肉及上睑下垂术后患者。视网膜脱离手术和白内障摘除手术后部分继发性斜视症状持续时间 >6个月的患者 ,受累肌纤维化并 (或 )与结膜、巩膜及外加压物广泛粘连 ,牵拉试验呈阳性 ;眼眶手术后患者眼球主要表现为牵制性运动障碍 ;翼状胬肉切除术后患者内直肌及其周围组织损伤明显 ;抗青光眼手术后患者继发性斜视症状于术后 2～ 14d自行缓解。结论　内眼和外眼手术均可导致继发性斜视的发生 ;斜视的发生机制主要包括眼肌损伤、限制及机械压迫 3个因素。眼科手术医师应高度重视 ,积极采取针对性预防和治疗措施。     

玻璃体切除术后白内障摘除及人工晶体植入术

目的：探讨玻璃体切除术后的白内障手术技巧及术式的选择。方法：玻璃体腔灌注维持眼内压、行白内障囊外摘除或超声乳化或（和）人工晶体植入术。结果：本文对18例玻璃体除术后白内障患者中,8例行囊外摘除及人工晶体植入术,5例行超声乳化及人工晶体植入术,5例单纯囊外摘除术。13例术后视力≥0.1占72％,8例视力≥0．3占44％,术后视力无改善及下降者5例占27．7％。手术并发症有晶体核脱位至玻璃体腔内1例、玻璃体出血1例。结论：玻璃体切除术后的白内障手术必须应用玻璃体腔体灌注维持及调整眼内压;对于白内障核硬化明显的患者,白内障囊外摘除比超声乳化更适用。     

以复视为首发症状的非斜视性复视的病因分析

目的:探讨以复视为首发症状的非斜视性复视的病因分布情况。方法:以复视为首发症状的非斜视性复视患者69例,常规检查患者裸眼视力、矫正视力、屈光状态、眼前节及眼底情况,检查患者单眼和双眼的运动情况,检查双眼视功能、同视机检查融合功能、马氏杆检查。根据病史,眼科专科检查,全身相关检查及相关科室会诊意见,分析病因分布情况。结果:集合不足是最多见的原因,集合不足32例,翼状胬肉术后(角膜散光)8例,早期白内障8例,晶状体或人工晶状体半脱位4例,后发性白内障3例,青光眼术后(虹膜根部离断)2例,黄斑前膜2例,视网膜脱离术后2例,玻璃体液化1例,玻璃体后脱离1例,外伤致双瞳1例,病理性高度近视术后1例,原因不明4例。结论:以复视为首发症状的非斜视性复视中,集合不足是最多见的原因。单眼复视和双眼复视比例相当,中青年和老年复视发病比例相当。     

Strabismus surgery in pseudophakic patients

PURPOSE: To analyze the results of strabismus surgery after previous cataract extraction with primary or secondary IOL implantation and to determine predicting factors of squint. MATERIAL AND METHODS: Eight patients with squint deviation after cataract surgery with primary or secondary IOL implantation were enrolled into this study. Each patient had complete ophthalmologic and orthoptic examination. Patients were divided into two groups. Group I consisted of 5 patients with secondary IOL implantation after traumatic cataract surgery, and group II consisted of 3 patients without ocular trauma, with primary IOL implantation. Five patients from both of groups had diplopia after IOL implantation. RESULTS: Strabismus surgery was performed in all cases. Surgery was combined with preoperative botuline toxin injections and Fresnel prism correction. Two patients were treated with adjustable suture technique. Treatment was successful in all cases. Five patients had no diplopia in primary position, two of them had occasional diplopia in secondary positions, while 3 patients with pour visual acuity achieved only esthetic effect. CONCLUSIONS: 1. Strabismus surgery in patients with pseudophakia is a complicated procedure which can optimize visual alignment, improve binocular vision and reduce diplopia. 2. Patients with diplopia or squint after IOL implantation ought to be informed about the possibility of strabismus surgery, both for diplopia and esthetic effect.     

单眼与双眼老年性白内障摘除人工晶状体植入术后的双眼视觉比较分析

目的　比较分析单眼与双眼老年性白内障摘除人工晶状体植入术后双眼视功能恢复状况。方法　对单眼和双眼人工晶状体手术患者各 6 0例分别检测矫正视力、屈光状态、双眼影像 ,以及用同视机等方法检查双眼视功能。结果　两组患者的双眼同时视功能、融合功能无显著差异。双眼手术组患者的远近立体视功能显著优于单眼组。影响单眼手术患者双眼视功能恢复的主要原因是另侧非手术眼的白内障所导致的视力低下和两眼屈光参差。结论　双眼视功能恢复水平是评价人工晶状体术后视觉质量和生活能力改善的重要指标。单眼手术和双眼手术者双眼视觉的差异主要体现在立体视功能上     

Nonoperative treatment of diplopia after IOL implantation

PURPOSE: Analysis of effects of non-operative treatment of diplopia complicating cataract surgery with IOL implantation or secondary IOL implantation. MATERIAL AND METHODS: 22 patients with diplopia occurring after cataract surgery with IOL implantation or secondary IOL implantation were enrolled into the study. Only the patients who were not eligible for surgery or declined surgical treatment, were included. Each patient had complete ophthalmic and orthoptic examination with Hess-screen-test and prism alternate cover tests. Predicting factors of persistent diplopia were determined. RESULTS: The therapy consisted of prism correction in 77.3% of patients and prism with botulin toxin injections in 9.1% of patients. In two persons diplopia persisted due to cyclotrophia and decentration of IOL, and these patients were eventually treated surgically. The treatment was succesful in 72.7% of patients in whom single vision was achieved. In 18.2% of patients occasional diplopia was found and in 9.1% the therapy was not effective. Disorders precipitated by prolonged cataract--related occlusion and uncorrected aphakia, disorders resulting from surgical trauma to extraocular muscles (retrobulbar or peribulbar anesthesia) and preexisting complications of ocular alignment, all predict related persistent diplopia after IOL implantation. CONCLUSIONS: (1) Cataract surgery with IOL and secondary IOL implantation should be performed before the loss of binocular function. (2) Retrobulbar and peribulbar anesthesia may cause surgical muscular trauma, therefore topical anesthesia is recomended. (3) Prism correction (with or without botulin toxin injection) is an effective therapy.     

白内障人工晶状体植入术后多维立体视评估

目的 比较双眼白内障患者单眼及双眼不同类型人工晶状体（IOL）植入术后多维立体视的变化。方法 回顾性分析双眼白内障摘出联合IOL植入术患者的数据。比较不同类型IOL植入术后各阶立体视的差异,并比较单眼术后和双眼术后各阶立体视的变化。对影响各阶立体视的因素进行Logistic回归分析。结果 双眼白内障患者在行双眼手术后比单眼手术后各阶立体视均有改善,差异具有统计学意义。单眼术后立体视与患者年龄和双眼间最佳矫正视力（BCVA）差相关,年龄越小、双眼间BCVA差值越小,则立体视越好。IOL的不同类型对立体视无显著影响。结论 不同类型IOL植入术后均可获得良好的立体视,且差异无统计学意义。由于不同患者对立体视的需求不同,在单眼术后可依据双眼BCVA差值选择另眼手术的时机。     

Strabismus and diplopia as complications after cataract surgery with IOL implantation

Summary In our Department of Orthoptics we have seen an increasing number of patients suffering from diplopia after cataract surgery with IOL implantation. Between 1993 and 1997 the total number of patients with this problem was 24 (2.7 % of all patients, mean age 71 years, age range 38–88). We addressed the question of whether there is a common pattern of motility dysfunction. Methods: After evaluation of the clinical history and the basic ophthalmological findings the following parameters were examined: binocular function (Bagolini test), squint angles (Maddox cross), ocular motility. Results: The 24 patients could be divided up into three groups. Group 1 consisted of 9 patients (mean age 82 years, range 64–88) who complained about diplopia because of strabismus incomitans with vertical deviation and restricted motility on the first day after surgery. In 8 of the 9 patients strabismus surgery was done. Group II consisted of 10 patients (mean age 66 years, range 38–77) who noticed diplopia and strabismus within 7 days after surgery. We found various kinds of heterotropia. Seven of these patients were operated on and two had a prism correction. Group III consisted of 5 patients (mean age 67 years, range 61–78). Their already known strabismus paralyticus or concomitans deteriorated, leading to diplopia in some cases. All patients in this group were operated on. Discussion: For group I we believe that retro-, para- or peribulbar anesthesia caused the motility dysfunction. In groups II and III it is unlikely that local anesthesia had a causative role. The prolonged disruption of binocular vision and the abrupt change in the sensory situation after the cataract operation with lens implantation may be the leading causes for strabismus or deterioration of a preexisting strabism, respectively. Conclusions: These patients need a subtil meticulous diagnostic work-up and follow-up because of the possibility of early surgical therapy, which has a good prognosis. Evaluation of binocular vision and eye movements prior to cataract surgery appears to be helpful for later strabismic surgery.      

Outcomes of cataract extraction in functionally monocular patients. Case-control study

PURPOSE: To compare the ocular comorbidities, visual outcomes, and surgical complications between a series of functionally monocular patients who had phacoemulsification and intraocular lens (IOL) implantation and a control group of age- and sex-matched binocular patients. SETTING: Jules Stein Eye Institute and the Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California, USA. METHODS: The records of a consecutive series of 100 functionally monocular patients who had phacoemulsification and IOL implantation were reviewed. The records of a control group of binocularly sighted patients who were matched to the monocular patients by age, sex, and date of surgery were also reviewed. RESULTS: Thirteen patients in the monocular group were monocular because of surgical complications. The remaining patients (87%) were monocular from medical conditions. Monocular patients had significantly more ocular comorbidity than binocular control patients (P <.0001). Age-related macular degeneration, diabetic retinopathy, and open-angle glaucoma were the most common reasons for monocular status and the most common ocular comorbidities in study eyes. The median preoperative best corrected visual acuity (BCVA) was 20/50 in the monocular group and 20/40 in the binocular group. The median postoperative BCVA was 20/25 and 20/20, respectively. A final BCVA of 20/40 or worse was the result of preexisting macular pathology or glaucoma in every instance. Surgical complications (P =.096) and the number of postoperative procedures (P =.724) were similar between the 2 groups. CONCLUSIONS: Ocular comorbidity was significantly more prevalent in the eyes of monocular patients. Monocular and binocular patients experienced a 3-line improvement in BCVA after cataract surgery; however, the final median acuity was 20/25 in the monocular group and 20/20 in the binocular group. The 2 groups had a similar complication rate.     

外伤性白内障人工晶体植入后双眼单视的探讨

目的探讨单眼白内障摘除后植入后房型人工晶体能否恢复双眼单视及立体视。方法将３６例外伤性白内障摘除后分一期和二期植入后房型人工晶体。术后分别观察其裸眼及矫正视力、双眼屈光状态，并用同视机、线状镜、障碍阅读及Ｔｉｔｍｕｓ立体视觉检查图检查双眼视及立体视的状态。结果３６例术后视力均显著提高，３个月后矫正视力４．９５以上者２４例（６６．７％），４．８以上者３０例（８３．３％）。其中２６例检查双眼视及立体视，２１例恢复良好。结论单眼白内障尤其是儿童，应提倡早期植入人工晶体，以促进双眼单视及立体视觉的恢复和发育。     

双眼粉尘状白内障单眼人工晶状体植入术

目的　评估双眼先天中央粉尘状白内障单眼人工晶状体植入术后的生活质量。方法　 3 0例先天中央粉尘状白内障患者随机分为两组 ,试验组 (单眼手术组 )与对照组 (双眼手术组 )。采用晶状体超声乳化吸出后房人工晶状体植入术。用问卷的方式 ,对试验组术前及术后进行调查计分。对照组仅对其术后进行调查计分。对视觉和生活质量方面的问题进行全面的调查。采用加权Kappa值计算法对计分员的一致性进行评估。结果　试验组术前总分值为 3 2 7分 ,术后为 5 41分 ,生活质量明显提高 (P <0 0 2 )。对照组总分值为 462分 ,低于试验组 (P <0 0 1)。结论　对于双眼先天性粉尘状白内障患者采用单眼人工晶状体植入术 ,是一种较好的选择 ,可以全面提高患者的生活质量。     

直肌肌束部分转位移植矫正麻痹性斜视的临床观察

目的 探讨直肌肌束部分转位移植矫正麻痹性斜视手术方法和治疗效果.方法 总结27例麻痹性斜视行直肌肌束部分转位移植,并观察在术前、术后麻痹肌的运动情况、双眼视功能、眼球运动情况、眼位及复视消失情况等结果.结果 27例患者术后眼球运动功能有不同程度好转,除2例外全部过中线,转动1～2mm者12例、3mm者10例、4～5mm者2例、7mm者1例.术后被转位的肌肉运动正常.术后21例患者不同程度恢复了双眼视功能,其中具备Ⅰ度双眼单视功能13例,具备Ⅱ度双眼单视功能6例,2例有Ⅲ度双眼单视功能.6例同视机检测仍是单眼抑制.术后眼位正位22例,欠矫5～10度5例,23例复视消除,3例轻度改变注视方向也可消除复视.1例仍有复视不能耐受行二次手术.结论 直肌肌束部分转位移植可矫正麻痹性斜视眼位,消除复视,改善眼球运动,恢复部分双眼视功能,而且睫状肌血管分离保留可减少眼前段供血不足的危险,是目前安全、可行、有效地手术方法.     

Persistent binocular diplopia after cataract surgery

We reviewed the records of 38 consecutive patients who had persistent binocular diplopia after cataract surgery. The patients were divided into ten categories based on the suspected conditions underlying the diplopia. Of 16 patients who underwent strabismus surgery, five achieved the therapeutic goal of single binocular vision in the primary and reading position, and four attained this with prismatic or botulinum toxin therapy in addition to surgery. Seven patients continued to have diplopia despite strabismus surgery and adjunctive therapy. Even small residual deviations were often intolerable, because of highly diminished fusional amplitudes.