连续性外斜视的手术治疗

目的研究连续性外斜视的发病因素及手术治疗。方法对在我市眼科医院眼肌科住院的28例连续性外斜视的病人施行手术治疗,并就其发病因素及手术疗效进行了回顾性的研究。结果内斜视的发病年龄、伴垂直性眼位偏斜、弱视、调节性集合功能减弱和双眼视功能不良等是形成连续性外斜视的重要因素。外斜视矫正的效果与术中手术量大小、术前斜视角、手术方式、术中眼位矫正情况等因素有关。术后双眼视功能较术前明显好转。结论1.内斜视术前应充分考虑到眼位不稳因素,并积极治疗。2.内斜术后应该进行长期的随访,并根据眼位变化情况及时调整眼镜度数。3.单纯内直肌复位眼位回退明显,外直肌后徙联合后徙的内直肌前移是治疗连续性外斜视的有效方法。4.术中5～10PD小度数过矫可提高术后的正位率。5.手术矫正外斜视有利于双眼视恢复。     

儿童间歇性外斜视再手术临床特征及相关危险因素分析

目的 探讨儿童IXT手术后再次手术临床特征以及其危险因素。方法 回顾性分析IXT再手术组25例及对照组100例患儿临床资料。比较再手术与对照组危险因素的差异,分析评估相关因素对再次手术的影响。结果 在再手术的患者中,有20人因复发性外斜视再次手术,5例因连续内斜视再次手术。手术年龄,斜视度,术前I视功能及近距离立体视与儿童IXT再手术有关。二元Logistic回归结果显示术前斜视度数>40PD的再手术风险高(OR=3.105,P=0.032)。与7～12岁患儿相比,3～6岁接受IXT手术再手术风险较高(OR=4.009,P=0.006)。结论 在接受IXT手术的儿童中,手术年龄小及斜视度数大再手术的风险更高。     

继发性外斜视的发病因素及手术治疗

目的 探讨继发性外斜视的发病因素及手术治疗。 方法 对近5年行二次手术的23例继发性外斜视进行回顾分析。 结果23例患者中弱视占43.5％,高度近视占26.1％,无双眼视功能者占82.6％,运动受限者占 56.5％,伴AV征、DVD、眼球震颤、垂直斜视共占73.9％。行单眼或双眼内直肌复位或缩短后复位或联合对侧外直肌退后术后,19例获得正位或水平斜度<10△,垂直斜度<5△。手术成功率82.6％。 结论 继发性外斜视的发病因素包括不正确的手术方式及手术量,弱视,高度远视,无双眼视功能,伴有其他眼肌不平衡。根据肌肉功能状态、视力、原手术量和远近斜视度设计手术方案可取得良好矫正效果。     

连续性外斜视的病因及手术效果短期观察

目的 分析连续性外斜视的发生原因并探讨个性化设计的手术方式的术后效果。设计 回顾性病例系列。研究对象 北京同仁医院17例诊断为连续性外斜视并进行外斜视矫正术的患者。方法 对上述患者临床病历资料进行回顾,分析患者发现内斜视的年龄、屈光度、矫正视力、实施内斜视矫正术年龄、手术方式,以及发生连续性外斜视年龄、斜视角度、眼球运动、屈光度、双眼视觉、实施外斜视矫正术年龄、手术方式与手术效果等。主要指标 发病年龄、屈光度、斜视角度、眼球运动、手术方式、手术效果。结果 本组17例患者中,11例1岁以前发现内斜视;实施内斜视矫正术年龄2~19岁,平均（6.79±5.39）岁（中位数年龄4岁）;连续性外斜视发病年龄为3~21岁,平均（9.00±4.97）岁（中位数年龄8岁）。屈光度为-1.0 ~ +2.0 D者9例（52.9%）,＞+2.0 D者7例（41.2%）,1例（5.9%）为高度近视（-10.0 D）。4例伴有单眼弱视;13例无双眼视功能;平均外斜视角度看近为45△（15△ ~ 95△）,看远为50△（20△ ~ 105△）;5例（29.4%）内转受限。3例行内直肌复位术,14例行内直肌复位术+外直肌后徙术。术后眼位14例（82.4%）正位,欠矫3例,1例术后半年眼位发生外斜漂移现象;术后三级视功能较术前有不同程度提高。结论 本组连续性外斜视与内斜视发病年龄小,内斜视矫正手术实施年龄小,常伴有单眼弱视、无双眼视功能等多种因素有关;对连续性外斜视进行个性化的手术设计,效果较好。（眼科, 2013, 22： 324-327）     

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。     

间歇性外斜视的研究进展

间歇性外斜视是介于外隐斜与恒定性外斜视之间的一种斜视.起病较早,发病年龄通常为1岁到4岁.与其他类型的斜视不同,间歇性外斜视的儿童在很长一段时期内仍可维持正常眼位及双眼视功能,因此如何选择合适的干预时机及治疗方式对临床医师是个挑战.本文旨在回顾近年来间歇性外斜视的最新研究进展,重点对间歇性外斜视的严重度分级、非手术治疗方式、手术时机及手术方式、过矫及欠矫处理等方面的研究进展进行简要介绍,为间歇性外斜视的治疗提出改善化建议.     

间歇性外斜视的手术治疗

间歇性外斜视是介于外隐斜与恒定性外斜视之间的一种斜视,是儿童最常见的外斜视。起病较早,发病年龄通常为6月龄～ 4岁。与其他类型的斜视不同,间歇性外斜视的儿童在很长一段时期内仍可维持正常眼位和双眼视功能,因此如何选择合适的干预时机及治疗方式对临床医师是个挑战,同时手术方式的选择及术后效果也存在不同的观点。本文旨在对间歇性外斜视的发病机制和临床特征、手术时机和手术方式的选择进行简要介绍,为间歇性外斜视的治疗提供参考。     

间歇性外斜视的手术治疗106例

目的　探讨间歇性外斜视手术成功的因素及术后双眼视功能恢复情况。方法　对 10 6例记录资料完整的间歇性外斜视手术情况及术后 6周到 1年情况进行分析。结果　手术后正位率 1周为 84.91%、6周为 76.42 %、1年为 75 47%。术后双眼视功能恢复与年龄有关 ,年龄越小恢复率越高 ,5～ 8岁组为 10 0 % ,9～ 14岁为 67.3 % ,>14岁组为 17.5 %。结论　间歇性外斜视手术时机越早越好 ,年龄越小双眼视觉恢复越好。术前有无融合功能对术后双眼视功能的恢复至关重要。     

间歇性外斜视手术时机的研究进展

手术是治疗间歇性外斜视(IXT)的主要选择,目前对于IXT手术最佳时机的选择存在一定的争议。本文通过回顾分析近年来对于IXT最佳手术时机的临床研究及相关成果,对眼位控制力、斜视度、年龄、立体视及心理健康及生活质量等与手术时机密切联系的因素进行综述,希望为临床工作中IXT的手术时机选择提供帮助。     

影响共同性外斜视手术正位率的因素的探讨

目的探讨影响共同性外斜视术后正位率的因素。方法53例共同性外斜视按麻醉方式、年龄、斜视类型及斜视度数分组,分析比较术后正位率情况。结果共同性外斜视术后正位率与麻醉方式、年龄或斜视类型无关,斜视度数是影响其术后正位率的因素。结论共同性外斜视度数越低,术后正位率越高,而且每1mm肌肉矫正量越小。     

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.     

继发性外斜视手术方式及术后眼位变化

目的研究内斜视术后继发外斜视的手术方式及术后眼位的变化。方法手术治疗43例内斜视术后继发外斜视的病人,探讨其手术方式并观察术后1周、6周、6个月和1年的眼位变化情况。结果单眼内直肌前徙7例,单眼内直肌缩短4例,单眼内直肌前徙＋单眼外直肌后徙20例,双眼外直肌后徙5例,单眼外直肌后徙3例;4例外斜视度数≥50△行3条肌肉的手术。术后1年35例眼位正位（81.3%）,其中单眼内直肌前徙或缩短11例术后8例（72.7%）正位,外直肌后徙8例（5例为双眼,3例为单眼）术后6例（75%）正位,单眼内直肌前徙＋单眼外直肌后徙20例术后18例（90%）正位;1周～6周斜视度数变化-5.2△±0.4△,6周～6个月变化-1.2△±0.4△,1周～1年变化-6.4△±2.1△。1周～6周有25例患者（58.1%）有外斜视漂移,变化-8.0△±1.4△,其中术中过矫组的10例继发外斜视患者,术后6周内均出现了外斜视漂移,平均为-8.3±2.0△。结论外直肌后徙联合后徙的内直肌前徙是治疗继发性外斜视的有效方式。术中5△～10△小度数过矫可提高远期的术后正位率。     

Clinical risk factors for the development of consecutive exotropia: a comparative clinical study

AIM: To compare a group of patients with consecutive exotropia with patients who had ≤10 prism diopters (PD) esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. METHODS: The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. RESULTS: The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 (P=0.634). There was no significant difference of preoperative near and distant deviations among two groups (P=0.835, 0.928 respectively). The mean amount of medial rectus recession and lateral rectus resection was similar in both groups (P=0.412, 0.648 respectively). Convergence insufficiency and neurological diseases were more frequent in group 1 (P=0.007, 0.045). Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios (OR): 5.75 (1.04-31.93)]. CONCLUSION: Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors. KEYWORDS: consecutive exotropia; esotropia; medial rectus recession; neurological disorder; lateral rectus resection     

知觉状态与儿童间歇性外斜视术后眼位

间歇性外斜视手术治疗的目的是矫正眼位,恢复双眼视觉。当术后过矫发生连续性内斜视,尤其是视觉发育未成熟的患儿,会导致双眼视觉的严重损害。间歇性外斜视术后早期眼位过矫可通过干预知觉状态以减轻各种集合成分,减少连续性内斜视的发生。（眼科,2013, 22： 292-294）     

共同性外斜视21例的手术治疗

目的：探讨共同性外斜视的手术效果。方法：对21例共同性外斜视的手术矫正效果进行分析。结果：手术时〈＋8^△适度过矫10例,术后正位6例,2例〉-8^△欠矫,2例〉＋8^△过矫（系轻度远视性屈光不正,因有难以耐受的复视而行二次手术）;手术时完全正位11例,术后正位6例,5例〉-8^△欠矫。结论：手术适度过矫,术后欠矫率低,有利于维持术后正位,但有远视性屈光不正者术后需注意调整屈光状态或手术适量。     

外斜视V征的手术治疗

目的探讨外斜视V征的手术治疗方法。方法总结69例外斜视V征手术，观察手术前、后眼位的变化和双眼单视功能的情况。结果69例中有40例（76眼）行下斜肌减弱术。29例（58眼）行外直肌后退术并肌止端向上移位术，其中12例（12眼）行内直肌缩短术并肌止端向下移位术。术后眼位恢复正位61例（88．41％），术后获得双眼单视功能42例（60．87％）。结论外斜视V征的手术方法是根据病因不同，选择下斜肌减弱术或者水平肌止端移位术联合外斜视矫正术。