改良上斜肌矢状移位术治疗外旋转斜视

目的 探讨改良上斜肌移位术治疗后天性获得性上斜肌麻痹所致外旋转斜视的疗效.方法 对21例上斜肌麻痹致外旋转斜视的患者行改良法上斜肌矢状移位术,对手术前后患者的自觉症状、眼球运动、眼位、旋转斜视度数及双眼立体视觉变化进行分析.结果 术后患者主观症状得到较大程度的改善,旋转复视症状消失,立体视觉得到改善.结论 改良法上斜肌矢状移位术可改善上斜肌麻痹引起的外旋转斜,消除患者的旋转复视症状,改善患者的立体视觉,提高患者生活质量.     

旋转斜视临床特征及治疗的探讨

目的 探讨旋转斜视的临床特征及治疗。方法 对15例旋转斜视患者根据眼球运动、同视机、双马氏杆和眼底照相等检查，行上斜肌矢状移位术。结果 所有患者旋转复视消失、视物清晰。结论 上斜肌矢状移位术用于治疗前下方明显的外旋转斜视，是治疗旋转斜视的主要方法。     

旋转斜视的临床特征及处理

目的 探讨旋转斜视临床特征及不同处理方法。方法 12例主述旋转复视患者根据眼球运动、同视机、双马氏杆和眼底照相等不同检查结果2例行下斜肌减弱术，10例行上斜肌矢状移位术。结果 所有患者未再述旋转复视，视自然物体清晰。结论 上斜肌矢状移位术适用于前下方明显的外旋转斜视，是治疗旋转斜视的主要方法，而上半视野旋转斜视明显时应采取下斜肌减弱术。     

儿童共同性斜视矫正术后功能治愈情况的研究和手术时机探讨

目的了解儿童共同性斜视矫正术后的功能治愈率及其影响因素,为斜视手术治疗的时机选择提供依据。方法选择在斜视矫正术后获得眼正位的113例共同性斜视儿童患者作为研究对象。使用同视机及颜少明远用和近用随机点立体图对其进行双眼视功能和远、近距离立体视锐度的检测。结果①113例中术后有111例(98．23％)获得Ⅰ级以上的双眼视功能,49例(43．36％)获得≤60″近立体视锐度,54例(47．79％)获得≤60″远立体视锐度。②外斜视组84例,术后近立体视锐度≤60″者46例(54．26％),远立体视锐度≤60″者49例(58．33％);内斜视组29例,术后近立体视锐度≤60″者3例(10．34％),远立体视锐度≤60″者5例(17．24％)。两组比较(P<0．001)。③间歇性外斜视50例,术后近立体视锐度≤60″者36例(72％);远立体视锐度≤60″者38例(76％)。两组比较(P< 0．001)。④内斜视组手术年龄与术后远、近立体视锐度秒角的相关关系:近立体视锐度r=0．472,P<0．01;远立体视锐度r=0．438,P<0．05。内斜视组病程与术后远、近立体视锐度秒角的相关关系:近立体视锐度:r=0．534,P<0．01;远立体视锐度:r=0．536,P<0．01。结论①儿童后天性共同性斜视患者在视力发育敏感期内得到正确的手术治疗,功能治愈率良好。②内斜视患者术后立体视重建率低于外斜视,间歇性外斜视的功能治愈率高于恒定性外斜视。术前有一定的双眼单视功能有利于术后获得更敏锐的立体视觉。③手术时机应取决于斜视类型,并参考术前双眼单视功能检查的结果。     

获得性上斜肌麻痹的临床表现及术式选择

目的探讨获得性上斜肌麻痹的临床特点、术式选择及手术效果。方法回顾分析我院收治的21例（41眼）获得性上斜肌麻痹患者的病因、临床特点及手术治疗,对术前及术后1周、4周、3个月结果进行分析比较。结果获得性上斜肌麻痹以双侧为主,病因主要为闭合性颅脑外伤,常有昏迷病史,有旋转复视主诉,代偿头位以下颌内收多见,斜视检查表现为双下方为主的外旋。本组病例中35眼行Harada—Ito术,5眼行上斜肌折叠术,1眼行下斜肌减弱术。术中及术后随访未见并发症,术后所有患者旋转复视消失,1例仍有轻微头向肩倾斜的代偿头位。41眼术前同视机检查上方注视野外旋（9．1±2．1）°,正前方注视野外旋（11．0±2．4）°,下方注视野外旋（15．0±3．3）°,与术后1周[分别为内旋（7．5±2．3）°,内旋（4．7±2．4）°,内旋（2．2±2．4）°],术后4周[分别为内旋（5．3±1．9）°,内旋（3．5±2．3）°,内旋（1．9±2．3）°],术后3个月[分别为内旋（1．8±2．2）°,外旋（1．4±2．1）°,外旋（4．2±2．3）°]相比,旋转斜视度差异均有显著统计学意义（P均〈0．01）,随着时间推移,术后旋转斜视度有一定程度的回退趋势。结论获得性上斜肌麻痹的主要临床表现为旋转性复视,需依据临床检查结果选择Harada—Ito术、上斜肌折叠术或下斜肌减弱术进行手术治疗,手术以适度过矫为宜。手术安全可靠,效果显著。     

外伤性双上斜肌麻痹的临床观察

目的 探讨外伤性双眼上斜肌麻痹（又名外旋转斜视）的典型临床特征及治疗方法。方法 先保守治疗半年，不能治愈者，后采用上斜肌矢状移位术治疗。结果 １６例中，保守治疗治愈２例，手术治愈１４例，追踪观察１年以上无复发。结论 上斜肌矢状移位术治疗效果满意。     

后天性外旋转斜视的临床及手术治疗

目的：探讨后天性外旋转斜视的临床特点及治疗方法。方法：回顾分析21例后天性外旋转斜视病例。结果：本组病例的临床特点为：（1）有明确的外伤病史；（2）患者有极明显的的下半视野复视；（3）双马德氏三棱镜检查阳性；（4）双马德氏杆检查为外旋转斜视。本组病例中有4例经保守治疗后仍有眼位偏斜而行手术治疗。手术方法采用Harada-Ito术式或改良的Harada-Ito术式，4例手术病人术后均外旋斜消失，有立体视觉存在。结论：当外伤或其他病史所致患者有明显的下半视野复视时，要注意外旋斜视的诊断，外旋斜视保守治疗无效时应手术治疗。     

垂直肌水平移位治疗外旋斜视体会

目的 探讨垂直肌水平移位手术治疗外旋斜视的临床疗效.方法 回顾经垂直肌水平移位手术治疗的7例外旋斜视患者,2例患者行上直肌向颞侧移位一个肌腹宽度,联合下直肌向鼻侧移位一个肌腹宽度手术;5例患者合并正前方垂直斜视,行下直肌后徙同时向鼻侧移位一个肌腹宽度.所有患者随访超过6个月.结果 同时移位上下直肌平均矫正正前方外旋11°,下直肌后徙联合鼻侧移位一个肌腹宽度矫正正前方外旋7°,7例患者在各个注视位均获得双眼单视,复视和代偿头位消失,随访旋转斜度稳定.结论 垂直肌水平移位手术治疗外旋斜视有确切的效果.     

不同类型斜视手术前后远近立体视的变化

目的：探讨斜视类型对术后远、近立体视恢复的影响。

方法：选取72例不同类型斜视患者,按斜视类型分为四组：组1为非调节性内斜视,组2为间歇性外斜视,组3为恒定性外斜视,组4为外斜V征伴下斜肌亢进。手术前后分别应用同视机检查远立体视。采用颜少明编绘的《立体视觉检查图》检查近立体视锐度。记录并分析术前、术后第7d,1、3、6mo的各项检查数据。

结果：斜视患者72例术后远、近立体视的恢复较术前有明显改善,其差异有统计学意义(P<0.05)。间歇性外斜视组术后远、近立体视的恢复优于非调节性内斜视组、恒定性外斜视组及外斜V征伴下斜肌亢进组,其差异有统计学意义(P<0.05)。非调节性内斜视组、恒定性外斜视组和外斜V征伴下斜肌亢进组术后不同时期远、近立体视的恢复差异无统计学意义(P>0.05)。远立体视(0例)比近立体视(19例,26%)的损害更严重,术后近立体视(51例,71%)的恢复明显优于远立体视(17例,24%),术后1mo远、近立体视恢复效果明显。

结论：不同斜视类型对术后远、近立体视恢复的影响存在差异,间歇性外斜视术后远、近立体视的恢复效果最佳。非调节性内斜视、恒定性外斜视和外斜V征伴下斜肌亢进对术后远、近立体视的恢复影响一致。斜视患者远立体视损害较重,术后近立体视恢复明显优于远立体视。     

间歇性外斜视与立体视觉

目的探讨间歇性外斜视与立体视觉关系。方法对１３２例间歇性外斜视有立体视觉者的临床资料进行分析。结果（１）间歇性外斜视以近立体视保存,远立体视大部分丧失为特征。（２）保存的近立体视锐度低于正常人群。（３）立体视锐度与斜视度大小间无用关性．（４）间歇性外斜视有立体视的病人双眼视力大致正常。结论间歇性外斜视术前检查立体视觉对手术时机选择有指导意义。     

Outcomes of surgical management in adults with unilateral superior oblique muscle palsy

PURPOSE: The purpose of this study was to determine the outcomes of surgical management in adult patients with unilateral superior oblique muscle palsy. MATERIAL AND METHODS: A retrospective review of 82 patients who underwent surgical correction at the Department of Strabismology, Cracow Eye Hospital over a 20 years period (1982-2003) was done. The patients were divided into 2 groups: congenital (group I) and acquired (group II) of superior oblique muscle palsy. Group I consisted of 43, group II of 39 patients. The mean age at surgery was 34 years in the congenital and 38 years in the acquired group. Preoperative and postoperative vertical deviation and excycloduction was measured in diagnostic positions of gaze using a major synoptoscope. RESULTS: There were a total of 97 operations: inferior oblique muscle recession was performed in 61 patients, superior oblique muscle tuck in 33, contralateral inferior rectus muscle recession in 1 patient, superior rectus muscle recession in 1 patient and inferior rectus muscle resection in 1 patient. 83% of patients underwent muscle surgery once, 16% were operated twice and 1 patient was operated three times. An average of 1.1 surgeries were performed per patient in the congenital group and 1.2 in the acquired group. In both groups, in all diagnostic positions of gaze, the mean preoperative vertical deviation in patients operated twice was found to be significantly greater than in patients operated once. There was no such relationship found for excyclotorsion. In both groups high and statistically significant correlation was found between the amount of vertical deviation and excyclotorsion before treatment and their reduction in the inferior oblique muscle recession group. For the superior oblique muscle tuck, such a relationship was found only in the acquired group. For both groups (congenital and acquired) recession of the inferior oblique muscle was found to be more effective than superior oblique muscle tuck in the reduction of vertical deviation and excyclotorsion for primary position, downward gaze and downward gaze in adduction. Only in upward gaze in adduction the superior oblique muscle tuck, proved to be more effective than inferior oblique muscle recession. Hypercorrection (vertical and torsional) was found only in the upper field of binocular gaze. Postoperative Brown's syndrome was found to be more frequent after a superior oblique muscle tuck than after recession of the inferior oblique muscle. The risk of postoperative Brown's syndrome after the superior oblique muscle tuck was particularly high in the congenital group. CONCLUSIONS: Recession of the inferior oblique muscle was found to be not only more effective but also safer than superior oblique muscle tuck.     

Temporary incyclotorsion following surgical correction of bilateral superior oblique palsy.

We report three patients with acquired bilateral superior oblique paresis who had bilateral modified Harada-Ito procedures, which resulted in significant incyclotorsion (ranging from 6 degrees to 19 degrees ) on the first day postoperatively. For Case 1 this was the only procedure, while Cases 2 and 3 also underwent simultaneous bilateral inferior oblique weakening. This overcorrection decreased spontaneously over the following 8 months to leave all patients asymptomatic. One patient returned 8 years following the initial surgery with symptoms of diplopia and recurrence of excyclotorsion.     

Unilateral modified Harada-lto procedure for excyclotorsion secondary to unilateral superior oblique palsy

Background: The Fells modification of the Harada-lto procedure is usually performed bilaterally for the correction of excyclotorsion secondary to acquired bilateral superior oblique paresis. Excyclotorsion is not usually a major complaint in true unilateral superior oblique paresis. Occasional cases, however, may find this symptom bothersome and it may interfere with fusion. The purpose of the present study is to determine the effect of the unilateral modified Harada-lto procedure on the correction of symptomatic excyclotorsion in unilateral superior oblique paresis. Method: A retrospective case-note review of patients with unilateral superior oblique paresis undergoing unilateral modified Harada-lto procedures during the five-year period 1988-1993 was performed. Results: Six patients fulfilled the inclusion criteria. Superior oblique paresis was congenital in one case, secondary to trauma in two cases and idiopathic acquired in three cases. There were four males and two females aged from 25 to 63 years and all but one had previous surgery. The mean pre-operative excyclotorsion was approximately 10 degrees (range 8-14 degrees). Mean post-operative excyclotorsion was 3 degrees (range 2 degrees incyclotorsion -10 degrees excyclotorsion). Conclusion: The unilateral modified Harada-lto procedure is an effective surgical treatment of excyclotorsion resulting from superior oblique paresis and may improve sensory and motor fusion.     

CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease: multi-institutional case series

AIM: To compare the changes in excyclotorsion after inferior oblique (IO) recession in patients with primary and secondary inferior oblique overaction (IOOA). METHODS: We retrospectively analyzed the data obtained from patients with IOOA who underwent graded IO recession. The patients were followed up for at least 3mo after surgery. Fundus photographs were taken pre- and postoperatively, and the sum of the angles of torsion in both eyes was used to analyze changes in excyclotorsion. Patients were divided into two groups: those diagnosed with primary IOOA were enrolled in the 1''IOOA group, and those diagnosed with secondary IOOA caused by superior oblique palsy (SOP) were enrolled in the 2''IOOA group. Excyclotorsion before and after surgery were compared between the two groups. RESULTS A total of 78 patients were enrolled in this study: 34 eyes in the 1''IOOA group and 44 eyes in the 2''IOOA group. In the 78 patients, torsional angle significantly decreased from 15.31±7.40 degrees (°) to 12.11±6.53° after IO recession (P<0.001). Mean preoperative torsional angle was larger in the 2''IOOA group than in the 1''IOOA group (P=0.03). In both groups, excyclotorsion significantly decreased after IO recession. (P=0.001 and P<0.001, respectively), however there was no significant difference in the amounts of changes in excyclotorsion between the two groups. CONCLUSION: Excyclotorsion was significantly larger in secondary IOOA than in primary IOOA, and a significant decrease in the torsional angle occurred after IO recession in both types of IOOA.     

Surgical correction of excyclotorsion due to bilateral superior oblique muscle paralysis

Torsional diplopia developed in a 41-year-old man after he sustained severe head trauma and bilateral paralysis of the superior oblique muscles. Funduscopy revealed bilateral excyclotorsion. The patient underwent a modified Harada-Ito operation in both eyes. Fundus photographs showed bilateral excyclotorsion preoperatively and correction to the normal position after surgery. The author has stated that he does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Traumatic Superior Oblique Palsies

The differences in the clinical and diagnostic characteristics of 33 consecutive traumatic unilateral (21 patients, 62% ) and bilateral (12 patients, 38%) superior oblique palsies were studied. The unilateral palsies had a large hypertropia in primary postion, more vertical than torsional diplopia, a compensatory head tilt to obtain fusion, and a positive Bielschowsky head tilt test. In contrast, the bilateral palsies had small hypertropias in primary gaze that alternated on right and left gaze, a large V-pattern esotropia with excyclotorsion that was frequently bilateral, and a compensatory head position with fusion in upgaze. The results of the study indicate that a V-pattern in excess of 25 prism diopters, an excyclotorsion of greater than 10 degrees, or head trauma severe enough to cause loss of consciousness should also signal bilateral involvement. Torsional diplopia was present in only 20% of unilateral palsies vs 75% of bilateral palsies. The Bielschowsky head tilt test was diagnostic in 100% of the patients with unilateral palsy and 83% of the patients with bilateral palsy. It was undiagnostic in the supine position in all patients. Spontaneous resolution occurred in 65% of the unilateral palsies but in only 25% of the bilateral palsies. Surgical correction was successful in relieving persistent symptoms.     

355例上斜肌麻痹的临床分析

目的　探讨上斜肌麻痹 (superiorobliquepalsy ,SOP)的发病情况、分类、临床表现、常用检查方法的应用价值及手术选择的基本原则。方法　系统分析 1 4年间收治的 3 5 5例SOP病例。结果在各类麻痹性斜视 60 1例中 3 5 5例 (5 9 1 % )为SOP。先天性和后天性分别为 2 93例 (82 5 % )和 62例 (1 7 5 % )。双侧病变 90例 (2 5 4% )。 3 1 9例 (89 9% )归属于Knapp的分类标准。先天性SOP和后天性SOP有代偿头位者分别为 :1 60 / 2 93例 (5 4 6% )和 47/ 62例 (75 8% ) ,P <0 0 1 ;合并水平斜视者分别为 :1 90 / 2 93例 (64 8% )和 2 0 / 62例 (3 2 3 % ) ,P <0 0 0 1 ;先天性SOP 1 1 0 / 2 0 8例(5 2 9% )继发弱视。有同时视者 ,先天性 1 1 4/ 2 0 2例 (5 6 4% ) ,后天性 2 3 / 2 3例 (1 0 0 0 % ) ,P <0 0 0 1 ;有融合功能者 ,先天性 66/ 1 5 7例 (4 2 0 % ) ,后天性 2 0 / 2 0例 (1 0 0 0 % ) ,P <0 0 0 1 ;有远立体视者分别为 :41 / 1 48例 (2 7 7% )和 1 3 / 1 8例 (72 2 % ) ,P <0 0 0 1 ;有近立体视者分别为 :1 9/ 1 46例 (1 3 0 % )和 3 / 1 6例 (1 8 8% ) ,P >0 0 5。 92 8%先天性SOP眼有下斜肌亢进。 82 5 %后天性SOP者有明显自觉复视。自觉外旋斜视检出率为 46 2 % (先天性者检出     

Traumatic Rupture of the Superior Oblique Muscle Tendon

Traumatic rupture of the superior oblique muscle is rare. We report a case of a 54-year-old man injured by the metal hook of a hanger, resulting in a rupture of the superior oblique muscle tendon. He complained of torsional diplopia when in the primary position. The distal margin of the superior oblique muscle was reattached to sclera 5 and 9 mm apart from the medial insertion of the superior rectus muscle. One week after the operation, torsional diplopia disappeared. However, a 4-prism diopter ipsilateral hypertropia was observed. Three months later, hypertropia gradually increased to 20 prism dioptors and the second operation was done to correct vertical diplopia.     

28例后天性上斜肌麻痹的临床分析

目的：探讨后天性上斜肌麻痹的临床特点和治疗方法。方法：回顾分析28例后天性上斜肌麻痹病例。结果：临床特点：(1)发病原因较多，以外伤占首位。(2)复视主要表现在前下方或侧下方。(3)同视机及双4^△三棱镜检查均表现外旋斜视。(4)眼底摄影视盘和黄斑的位置发生改变。28例患者中26例经药物治疗基本痊愈，2例行手术治疗，术后第一眼位外旋斜视消失。结论：后天性上斜肌麻痹症状隐匿，易漏诊，应详细行眼肌专科检查，制定最佳治疗方案。