Binocularity following surgical correction of strabismus in adults.

PURPOSE: This is a retrospective study to determine the pre- and postoperative binocular status of adults who have undergone surgical correction of strabismus. METHODS: A list of all consecutive adult patients who underwent surgery for strabismus between June 1990 and December 2001 (surgery by MBM) was compiled and their medical charts were reviewed. Patients who had at least 6 weeks postoperative follow-up were included if their charts were available for review and if information on binocularity was recorded. Binocularity was measured by the Titmus stereo test (Stereo Optical Co., Inc., Chicago), and/or the Worth 4-Dot test for distance (Scioto Medical Products, Powell, OH [discontinued]), and/or the Worth 4-Dot near test (Gulden Ophthalmics, Inc., Elkin Park, PA). Improvements or decreases in stereo acuity were noted 6 weeks postoperatively and at the final office visit. Prism management was incorporated pre- and/or postoperatively in some of our patients. A total of 112 patients underwent surgery for strabismus. Of these, 72 patients, aged 16 to 80 years, were included; 24 were excluded as their charts did not contain any information on stereo acuity 6 weeks postoperatively or were lost to follow-up after surgery, and 16 were excluded because their charts were unavailable from storage. RESULTS: The mean follow-up for the study patients was 16.5 months (range 6 weeks to 79 months). Overall, 30 of the 72 patients improved in binocular function (42%), 38 remained the same (53%), and 4 decreased (5%). If you exclude those patients with 40 sec of stereo acuity preoperatively whose stereopsis, by definition, could not improve further, and look only at the 59 surgical patients who could improve, then 51% improved. A variety of surgical procedures was performed, the most common being a bilateral medial rectus recession. Eleven patients required a second surgical procedure and two required a third surgical procedure. CONCLUSION: The benefits of surgical correction of strabismus in adults include improvement in binocular function as seen in 51% of the patients in the study.     

The diagnosis and surgical treatment of congenital convergent strabismus with a vertical component

Examination of eyes in a polarized light in 108 children and 24 adults with congenital concomitant convergent squint with a vertical component has shown displacement of internal angles of the rhombus of interference pictures from the horizontal axis, this speaking about anomaly of internal rectus muscles insertion. The patients with congenital squint were treated by two methods proposed by the author--recession of internal rectus muscles, and in case of residual deviation--partial resection of external rectus muscles. Symmetrical position was achieved in 107 children and 21 adults; stable binocular vision could be developed only in children (25.2%).     

Some principles in surgical treatment of strabismus

Taking into consideration the age of the patient, the strabismus surgery targets different things. Thus, for infants, the goal of the surgical intervention for congenital esotropia, is to prevent the occurrence of amblyopia and binocular vision dysfunctions (ARC, suppression). In preschool children, we operate aiming the recovery of the binocular vision, while in children over ten years old, the surgery is done only for esthetic reasons. On the other hand, in adults, the strabismus surgery has two aspects: for esthetic reasons in monocular strabismus with amblyopia, or for diplopia treatment in strabismus of traumatic or neurological cause. To get the best results, the surgical intervention has to respect several rules, which differ with patient's age. This presentation will discuss several surgical procedures: for congenital esotropia (including its advantages and drawbacks), for preschool children strabismus and also for strabismus in adults. We will also review the surgical treatment for Duane syndrome, Ciancia syndrome and superior oblique muscle palsy.     

The surgical treatment of vertical strabismus in children

The paper deals with principles of surgical treatment of vertical squint caused by paresis of muscles of vertical action. The authors consider to be optimal one-stage surgical intervention consisting of enhancing the paretic muscle and weakening the antagonist of the same eye, i. e. the rectus and oblique muscles. The dosage of the surgery was calculated considering the angle of squint. A new method is proposed for calculating the position, on the sclera, of the point of fixation of inferior oblique muscle at its recession. Results of 73 operations are analysed. Orthotropia was achieved in 72.6% of patients. The authors recommend the operation to be widely used in clinical practice.     

儿童麻痹性斜视的手术治疗

目的探讨儿童麻痹性斜视依不同的发病原因和临床特点进行手术选择的原则。方法分析病例病史资料及治疗结果。3～12岁麻痹性斜视58例，根据术前三棱镜和／或同视机检查的结果，采用减弱拮抗肌、加强麻痹肌或减弱其配偶肌的方法进行手术。结果儿童麻痹性斜视占同期住院儿童斜视患者的21．30％，其中上斜肌麻痹23例、外直肌麻痹11例、内直肌麻痹9例、上直肌麻痹6例、下直肌和下斜肌痹各2例、DVD合并双上斜肌麻痹1例、双上直肌麻痹1例、双下转肌麻痹1例、双上转肌麻痹2例。手术治疗临床治愈40例(69．00％)、好转18例(31．00%)。结论儿童麻痹性斜视根据病因及类型，选择不同的手术方法，可获得满意的手术结果。     

斜视术后再斜视的原因及治疗

斜视是眼科常见疾病,手术是治疗斜视的重要方法,斜视矫正术后欠矫、过矫、眼位回退问题一直是研究的热点,本文就斜视术后再斜视的相关原因及治疗做一综述.     

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.     

Results of surgical treatment of intermittent divergent strabismus

Inasmuch as surgery is often suggested as the primary treatment for intermittent exotropia, we undertook an extensive literature search to ascertain the outcome of this treatment. Surprisingly, only 22 papers were located which gave presurgical and postsurgical results for intermittent exotropia using reasonably clear success criteria. Many other papers were located but were excluded because they either failed to state the criteria used, lumped exotropia and esotropia together in their reported successes, or used orthoptics along with surgery. The total number of cases reported in the 22 acceptable papers was analyzed in terms of four levels of success to permit comparison across studies. These four levels were: functional success, motor alignment, cosmetically acceptable, and unsuccessful (no change or worse). The data are tabulated and summarized.     

重视斜视手术治疗中的常见问题

斜视是儿童多发眼病之一,患病率为1％～2％。近年来在全国斜视与小儿眼科学组和各地眼科医师的努力下,斜视专业学术水平有了飞速发展。针对共同性斜视的病因,进行了大量的临床和基础研究,发现了解剖学异常和特殊的神经肌肉结构(puueys),建立了斜视的数字化模型用于评价眼外肌功能和设计手术等。在有关斜视患者手术前、后双眼视觉功能改变的研究中,发现了双眼视觉损害     

斜视手术治疗与双眼视觉功能的研究进展

斜视是眼科常见疾病,在临床上它是双眼视功能异常最常见的原因。通过手术治疗以矫正眼位,纠正了异常视网膜对应和视觉抑制,有利于双眼视功能的恢复。随着对双眼视觉研究的深入,斜视手术方式不断更新、改进,手术目的也从当初的单纯改善美容逐步向恢复双眼视觉功能发展,尤其对于具备条件的斜视患者,治疗斜视的首要目的应是努力恢复患者的双眼视觉功能。本文就斜视手术治疗方式的进展、手术时机和手术后双眼视觉功能的变化作一综述,并提出问题和解决方法。