Persistent strabismus presenting after cataract surgery

To determine causative factors of persistent strabismus presenting after cataract surgery, the surgical techniques and subsequent motility findings of eight patients who had persistent postoperative strabismus were studied. In two of the eight patients, complications related to the placement of the bridle suture were believed causative based on subsequent surgical findings. A similar etiology could be speculated in an additional three patients. An isolated vascular accident coincident to the cataract operation could account for a sixth case. The final two patients were believed to have a decompensated congenital fourth nerve palsy. In no patients could the myotoxic effect of a local anesthetic or the hypoxic effect of an ocular pressure-reduction device plausibly account for the deviation.     

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.     

白内障术后斜视和复视原因的分析

作者回顾了1286例白内障手术，其中39例术后有斜视和复视。其发生的原因可分类为：白内障所掩盖的早已存在的病变；因白内障长期阻挡所发生的病变；手术对眼外肌和眶软组织的损伤；无晶状体眼或假性无晶状体眼及其与光学象差有关的原因。分析病因对治疗及手术技术的改进有重要意义。     

飞秒激光辅助白内障手术后干眼的危险因素分析

目的　探讨飞秒激光辅助白内障手术后干眼的潜在危险因素。方法　回顾性队列研究。收集2015年1月至2018年12月于我院行飞秒激光辅助白内障手术的临床病例,收集所有病例的详细病史,每位患者只统计首次手术眼。利用单因素分析和多因素logistic回归分析探索飞秒激光辅助白内障手术后干眼的潜在危险因素。结果　416例患者中,术后7 d新诊断为干眼84例,干眼发生率为20.19%;术后30 d干眼患者45例,干眼发生率为10.82%;术后90 d干眼患者8例,干眼发生率为1.92%。多因素logistic回归分析显示,女性（OR=3.973,P=0.001）、饮酒史（OR=27.444,P<0.001)、2型糖尿病（OR=12.204,P<0.001)、睑板腺功能障碍（OR=2.591,P=0.017)、既往眼部手术史（OR=67.226,P<0.001）、配戴角膜接触镜（OR=15.019,P<0.001）、累积释放能量高（OR=1.188,P=0.002)和负压吸引时间长（OR=1.101,P<0.001）均是飞秒激光辅助白内障手术后干眼的危险因素。结论　女性、饮酒史、2型糖尿病、睑板腺功能障碍、既往眼部手术史、配戴角膜接触镜、累积释放能量高以及负压吸引时间长均是飞秒激光辅助白内障手术后干眼的危险因素。临床医师应进行相应干预,降低干眼发生率。     

斜视术后并发复视555例临床分析

目的 探讨斜视矫正术后复视的发生情况.方法 回顾性系列病例研究.回顾分析1999年1月至2009年12月西安市中心医院眼科收治的5900例斜视矫正手术病例,对斜视术后并发复视的发生率、手术年龄、斜视类型进行分析,并总结手术原则和方案设计思路.结果 手术方案设计：①儿童内斜、外斜手术做到角膜映光正位,保留少量内隐斜;②成人内斜视手术做到角膜映光正位,保留少量内隐斜,不要过矫;③成人外斜视手术做到角膜映光正位,保留少量外隐斜,不要过矫;④获得性麻痹性斜视手术量宁欠勿过;⑤垂直斜视均做到少量欠矫为宜;⑥成人超过40°以上的大角度外斜视,术后保留5°外斜视,外观较满意;⑦一条肌肉不要承担过大的手术量,以避免引起眼球运动受限,造成非共同性斜视,向肌肉运动方向出现复视.术后常规用同视机进行双眼单视功能训练.5900例斜视手术病例中,术后仅有555例（9.41%）患者诉复视,其中短暂性复视患者552例（9.36%）,复视症状分别于术后3 d、1周或1个月完全消失;持续性复视患者有3例（0.05%）,术后复视症状持续半年或两年半不等.共同性外斜视术后复视的发生率较高,达12.58%（433/3443）,占总发生率的78.02%.年龄对复视的发生率影响不大.结论 斜视术后复视不可避免,一般以短暂性复视为主,只要手术设计合理,术后经 同视机训练后均能消失,持续性复视的发生率极低.     

白内障术后低视力的相关因素分析

目的：对白内障超声乳化联合人工晶状体植入术后低视力的相关因素进行分析,用于术前评估预后。
　　方法：对白内障超声乳化联合人工晶状体植入术341例418眼行术前术后相关检查,术后采用国际标准视力表行最佳矫正视力检查,进行术后低视力的相关因素分析。
　　结果：术后1 mo低视力发生率为10.3%,发生低视力的危险因素包括合并原发病及晶状体核硬度,合并原发病主要有年龄相关性黄斑变性(48.8%)、糖尿病性视网膜病变(39.0%)、青光眼性视神经病变(7.3%)、病理性近视眼底改变(2.4%)、视网膜分支静脉阻塞合并黄斑水肿(2.4%)。
　　结论：影响白内障超声乳化联合人工晶状体植入术后低视力的相关因素包括合并原发病及晶状体核硬度。提示我们临床工作中重视术前检查,术中谨慎操作保护视功能。     

白内障术后发生干眼的影响因素

目前随着我国人口老龄化的加剧,越来越多的白内障患者选择手术治疗,而术后干眼的发生率也在不断增加。因此,除了关注患者术后视力恢复情况外,还应密切关注眼表情况。为提高对白内障术后干眼的认识,本文对白内障术后产生干眼的影响因素进行综述,以期为临床预防和治疗白内障术后干眼提供参考。     

Combined cataract and strabismus surgery with adjustable sutures.

BACKGROUND AND OBJECTIVE: To report the results of combined cataract and strabismus surgery using an adjustable suture technique in patients of different ages. PATIENTS AND METHODS: Twenty patients underwent combination surgery between March 1999 and January 2004. All adjustments of the muscle sutures were done 24 hours postoperatively to prevent diplopia, and topical anesthesia was used for all but 1 patient. Bilateral lateral rectus recession was performed for 5 patients; medial rectus resection and lateral rectus recession was performed for 11 patients, and medial rectus recession and lateral rectus resection was performed for 4 patients. Extracapsular cataract extraction and phacoemulsification plus intraocular lens implantation was done according to the type of cataract. RESULTS: Preoperative visual acuities ranged between 20/8000 and 20/400. Eighteen of the patients had a cataract and 2 of the patients had aphakia due to previous cataract surgery. Considerable improvement in vision was obtained in 10 patients, and a postoperative visual acuity of 20/25 was achieved in 1 patient. Deviations improved from between 30 and 45 prism diopters preoperatively to between 2 and 8 prism diopters postoperatively. CONCLUSION: Combined cataract and strabismus surgery with adjustable sutures can be an alternative to the conventional method. It is less time-consuming for both the patient and the surgeon, and provides faster cosmetic and functional rehabilitation in a single operation.     

斜视手术术后屈光状态的变化

目的探讨不同斜视手术术后矫正视力、屈光状态随时间的变化。方法前瞻性临床研究。选择2013年12月16日至2014年8月13日于北京同仁医院行斜视矫正术的患者133例（194眼）。根据手术方式不同分为4组：1 组为一条直肌后退术（63例102 眼）;2 组为一条直肌后退联合一条直肌截除术（19例27眼）;3 组为一条直肌后退联合一条直肌改良线状折叠术（40例50 眼）;4 组为一条直肌后退联合一条斜肌后退术（11例15 眼）。采用两因素重复测量方差分析对各组术前,术后1、3、6个月术眼的矫正视力和屈光状态进行比较。术前与术后1、3、6个月散光类型的比较采用χ²检验。结果术前1、2、3、4组最佳矫正视力（BCVA）、等效球镜度（SE）、散光度差异均无统计学意义。4组患者矫正视力、SE比较显示组间、各时间点差异均无统计学意义。4组患者散光度比较显示组间差异无统计学意义,组内各时间点差异有统计学意义（F=30.50,P＜0.001）,进一步两两比较显示4组散光度术后1、3个月均较术前增加（P＜0.05）,术后6个月散光度与术前、术后1个月、术后3个月相比有所下降,但差异均无统计学意义。术前与术后1、3、6个月散光眼比例分别为57%、73%、76%、62%,与术前相比,术后1个月和3个月散光眼比例明显增加,差异有统计学意义（χ²=20.29、19.80,P＜0.001）,其中以顺规散光增加为主,术后6个月散光眼比例与术前差异无统计学意义。结论斜视手术对术眼的矫正视力无影响,对散光度存在一定影响,但在6个月内多可恢复到术前水平。不同术式对术后矫正视力和屈光状态变化无影响。     

Long-term results after strabismus surgery

The results of surgery after 4 years' or more postoperative follow-up have been evaluated in a total of 1031 cases (575 esotropia, 456 exotropia). There is a difference in the angle of strabismus 1 month after surgery and 4 years after surgery. Based on these findings, the results of strabismus surgery must be evaluated after a sufficient amount of time has passed. The angle of strabismus to be aimed at, to provide best binocular vision and patient satisfaction, should be in the range of –2 +7 degree for esotropia and +2 –10 degree for exotropia, regardless of the patient's age at surgery.Dedicated to Dr. G.K. von Noorden on the occasion of his 60th birthday     

Hemodynamic changes after strabismus surgery

AIM: The aim of this study was to investigate the hemodynamic changes that may occur in the retrobulbar circulation after strabismus surgery, using color Doppler ultrasonography (CDI). METHODS. Fifteen healthy volunteers (control group, n=15) and sixteen patients diagnosed with strabismus were enrolled in the study. Either recession or resection was planned on one horizontal rectus muscle in the eyes of Group 1 (n=11) and on two horizontal rectus muscles in the eyes of Group 2 (n=10). CDI was performed to measure peak systolic velocity (V max ), end-diastolic velocity (V min ) and mean blood flow velocity (V mean ) in the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in the control group and in Groups 1 and 2, both preoperatively and 2-7 days postoperatively. RESULTS. The postoperative resistivity indexes in Groups 1 and 2 were found to be different from those in the control group. Preoperative V max and postoperative V min and V mean values of the vessels in Group 2 were different from those in both Group 1 and the control group (p&lt;0.001). In both treatment groups, the differences between postoperative and preoperative measurements of the parameters in the OA, CRA and PCA demonstrated statistical significance (p&lt;0.001). CONCLUSION. After strabismus surgery on the horizontal recti, there are some alterations in the retrobulbar blood flow with a significant difference between pre- and postoperative blood flow velocities after single and double rectus surgery. The clinical significance of these results needs to be determined because CDI may be a useful tool in the investigation of hemodynamic alterations after anterior segment interventions that may cause anterior segment ischemia.     

Formaldehyde-induced keratopathy after strabismus surgery

We report on a patient who developed corneal haze and permanent ptosis after strabismus surgery. Formaldehyde-disinfected sodium hyaluronate which was used to protect the corneal epithelium during surgery was thought to have induced keratopathy and other findings. To our knowledge, this is the first report of corneal haze formation together with ptosis secondary to formaldehyde toxicity as a complication of strabismus surgery.     

Consecutive strabismus after infantile nystagmus syndrome surgery and potential risk factors

Graefe's Archive for Clinical and Experimental Ophthalmology - The aim of this study is to evaluate the incidence of consecutive strabismus after infantile nystagmus surgery and its potential...