先天性内斜视的临床表现和手术治疗

目的了解先天性内斜视的临床特征和手术治疗方法及疗效。方法回顾分析2000年10月至2003年12月我院斜视住院病人中132例先天性内斜视病例的临床资料及治疗结果。所有病例接受三棱镜、眼球运动检查,大龄合作患儿同时行同视机、线状镜等检查。手术方法以对称性双眼内直肌后退为主,斜视度较大者同时行一眼外直肌缩短,如果有垂直斜视先行垂直肌肉手术矫正。术后随访时间6～48个月,平均24个月。结果先天性内斜视多数患者就诊年龄在1岁以后,弱视发生率较小,内斜视度较大,多在40△～60△之间,眼外肌功能多表现为双眼运动时内直肌功能过强。本组资料中113例患者手术后达到临床治愈,一次手术临床治愈率86.3%。结论先天性内斜视多为双眼交替性,斜视度较大,需要手术治疗,一旦明确诊断,应尽早手术,可获得满意效果。     

先天性内斜视的手术疗效观察

目的 了解先天性内斜视的临床特征和手术方法 .方法 回顾分析2001年1月～2002年12月收治的70例先天性内斜视的临床资料.术前所有病例行三棱镜、眼球运动检查,合作者行同视机等检查.高AC/A且斜视度≤40△者行双眼内直肌后退术,其余以非对称性手术为主,据斜视角大小等情况设计不同的手术方式,有斜肌异常的一并解决.术后随访6～24个月.结果 先天性内斜视的屈光状态多为轻度远视,戴镜不能矫正眼位,斜视度≥30△,78.57%合并下斜肌亢进,21.43%合并眼球震颤,经手术治疗正位率达88.57%,12.86%不同程度恢复了双眼视功能.结论 先天性内斜视需早期手术治疗,手术方式除高AC/A且斜视度≤40△者行双眼内直肌后退术外,其他以非对称性手术为主,此方法 既满足了双眼视的发育条件,又有利于二次手术设计.     

早期手术治疗先天性内斜视40例临床观察

目的探讨先天性内斜视的手术治疗时机、手术方法及临床疗效。方法回顾分析40例先天性内斜视,年龄6个月～7岁,平均（4．47±1．52）岁。戴镜均不能矫正眼位。其中合并下斜肌亢进者16例（40．00％,单眼9例,双眼7例）;合并DVD的9例（22．5％,单眼5例,双眼4例）;合并隐性眼球震颤者6例（15．00％）。高A／C且斜视角在＋30°以内者行单眼内直肌后徙术;存＋40°～＋60°之间者行双眼内直肌后徙术;＋61°～＋80°者行单眼内直肌后徙联合外直肌缩短术;大于＋80°者行双眼内直肌后徙联合非主导眼外直肌缩短术;合并下斜肌亢进者一并手术解决;合并DVD者先行内斜视矫正术,3个月后观察眼位,冉行垂直斜视手术矫正。术后随访6～48个月,平均21个月。结果术后正位32例（≤＋10°）,正位率80．00％,欠矫8例（≥＋10°）,欠矫率20．00％,无过矫者,无任何并发症。15．00％患者不同程度的恢复了双眼视功能。结论先天性内斜视早期诊断,早期手术治疗,有利于视功能的恢复。     

先天性内斜视手术治疗后眼位的远期观察

目的:观察先天性内斜视的临床特点和治疗,随访手术治疗后眼位的变化,探讨早期治疗的意义。方法:追踪观察40例先天性内斜视手术治疗后眼位的变化,并进行分析。手术以双侧内直肌后徙术为主,少数年长且斜视角较大者采用双侧内直肌后徙加单侧外直肌截除术。结果:先天性内斜视手术治疗后远期眼正位率明显低于术后近期正位率,4岁前手术组患者双眼单视功能明显优于4岁后手术组。结论:先天性内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。     

不同手术方式治疗集合不足型间歇性外斜视疗效观察

目的探讨不同手术方式治疗集合不足型间歇性外斜视的疗效。方法将76例集合不足型间歇性外斜视患者,根据手术设计方式分为A、B两组,A组行双眼外直肌后徙术,B组行单眼内直肌缩短联合外直肌后徙术。术后随访,比较两组术后正位率、融合功能恢复率、立体视功能恢复率及残余性外斜视、连续性内斜视发生率。结果术后随访眼位总体正位率82.89%,A组为69.23%B组为90%,P〈0.05。术后融合功能恢复率、立体视功能恢复率、残余性外斜视和连续性内斜视发生率两组间差异均有显著性（P〈0.05）。结论采用单眼外直肌后徙联合内直截除术治疗集合不足型间歇性外斜视,术后正位率、融合功能和立体视功能恢复均优于双眼外直肌后徙术。     

手术治疗儿童先天性内斜视76例

目的　探讨儿童先天性内斜视的手术时机、手术方法及手术治疗效果。方法　回顾性分析采用手术治疗的先天性内斜视儿童 76例 ,行双眼内直肌后徙术 72例 ,单眼内直肌后徙加外直肌缩短术 4例。结果　术前斜视角 30 △ ～ 80 △ ,平均 5 1.5 △ 。术后正位 6 1例 ,正位率 80 .2 6 % ;欠矫 15例 ,欠矫率 19.74 % ;无 1例过矫。无任何并发症发生。结论　先天性内斜视应早期手术 ,双眼内直肌后徙术疗效好 ,内直肌粗壮、紧张者手术效果尤佳。     

先天性内斜视的临床特征及治疗

目的观察先天性内斜视的临床特征和疗效,探讨早期治疗的意义。方法统计228例先天性内斜视病例,对其临床特征和术后远期观察结果进行回顾分析。结果(1)先天性内斜视伴有弱视、下斜肌功能亢进(IOOA)和垂直分离性斜视(DVD)的比率较高,斜视角大且稳定,绝大多数以非调节性因素为主。(2)远期正位率明显低于术后正位率,～2岁组远期正位率明显低于～4岁组与～8岁组,～4岁组术后建立融合功能的比率最高。结论(1)先天性内斜视主要危害是双眼单视功能的缺陷和弱视,应早期手术,4岁前手术可能获得双眼单视功能。(2)伴随体征如DVD,IOOA可影响远期眼位,如有手术指征应与内斜视同时矫正,术后出现也应及时处理。少数患儿存在调节性因素。     

眼外肌调整缝线联合拮抗肌折叠术在先天性内斜视的临床应用

目的探讨眼外肌调整缝线联合拮抗肌折叠术矫正先天性内斜视的临床疗效。方法 2005年9月至2010年1月在北京儿童医院对102例先天性内斜视(1~4岁)患儿实施眼外肌调整缝线联合拮抗肌折叠术。所有患儿均为阿托品散瞳屈光矫正后检查术前远、近三棱镜斜视度以及术后三棱镜斜视度。所有患儿均需行两条及三条肌肉手术,即主斜眼的内直肌后徙+外直肌折叠术,对于大于35°者选择主斜眼的内直肌后徙+外直肌折叠术+另一眼的内直肌后徙术,其中后徙直肌均加用调整缝线技术。分别检查记录术前、术后2周、术后1月、术后6月、术后1年的斜视度变化并加以比较。采用均数±标准差(s)及配对t检验对计量资料进行分析。结果术前检查戴镜斜视度33cm及6M分别为+58.43△±6.5△、+54.21△±5.4△,术后2周检查斜视度分别为+6.13△±3.2△、+4.13△±2.8△。术后1个月、6个月及1年的33cm斜视度分别为+4.79△±3.6△、+2.75△±4.3△、+2.13△±4.1△。术前斜视度与术后2周斜视度比较(P<0.001),差异有显著统计学意义。而术后1个月、6个月、1年分别与术后2周比较,均无显著性差异(P>0.05)。术后3天内欠矫14例,过矫11例,调整率24.5%。术后2周正位101例,正位率99%。过矫1例,过矫率1%。结论眼外肌调整缝线联合拮抗肌折叠术矫正先天性内斜视,其手术安全可靠,操作简便时间短,术后早期正位率高,手术效果肯定。     

A 型肉毒毒素治疗先天性内斜视的疗效观察

目的 观察经结膜内直肌注射A型肉毒毒素（BTXA）治疗先天性内斜视的效果。设计 回顾性病例系列。研究对象 先天性内斜视患儿12例（24眼）,确诊年龄6~34个月（平均19.69±8.61个月）。方法 对所有患儿行眼科常规检查：包括视力、眼前节、眼底、睫状肌麻痹后的屈光度,角膜映光法和三棱镜+交替遮盖法测量33 cm 和6 m 斜视度,有屈光不正者测量裸眼及戴镜斜视度。对不能配合常规三棱镜检查的患儿,使用角膜映光法或Krimsky三棱镜法测量。在肌电放大仪引导下行双眼内直肌注射BTXA 2.5单位,注射后2周,3、6个月,1、2年和末次随访重复注射前各项检查。注射后看远斜视度≤10△作为正位标准。如果复诊到3个月斜视度持续大于20△进行第二次注射。主要指标 视力、屈光度、斜视度检查,双眼视觉功能检查。结果 12例患者就诊时等效球镜度+0.375～+3.625 D,平均（1.88±0.84） D;治疗前斜视度数+20△~+80△（平均47.91△±25.71△）,随访时间4～84个月（平均25.83±13.13个月）。8例行1次双眼内直肌注射,4例行2次双眼内直肌注射。单纯肉毒毒素注射成功率为83.33%（10/12例）。1例于注射后14个月行手术治疗,术后正位。1例注射后残留较小度数（+15△）,配戴压贴三棱镜治疗。末次随访时12例经综合治疗眼位在正常范围,4例获得正常双眼立体视功能。结论 BTXA治疗先天性内斜视短期有效,重复注射有利于维持效果。     

先天性内斜视的临床特征与治疗

目的观察先王码性内斜视的临床特征和疗效,探讨早期治疗的意义.方法统计228例行天性内斜视病例,对其临床特征和术后远期观察结果进行回顾分析.结果 (1)先天性内斜视伴有弱视、下斜肌功能亢进(IAOO)和垂直分离性斜视(DVD)的比率诬蔑同,斜视角大且稳定,绝大多数以非调节性因素为主.(2)远期正位率明显低于术后正位率,～2岁组远正位率明显低于～4岁组与～8岁组,～4岁组术后建立融合功能的比率最高.结论 (1)先天性内斜视主要危害是双眼单视功能的缺陷和弱视,应早期手术,4岁前手术可能获得双眼单视功能.(2)伴随体征如DVD,IOOA可影响远期眼位,如有手术指征应与内斜视同时矫正,术后出出也应及时处理.少数患儿存在调节性因素.     

儿童外斜视术后继发性内斜视的手术效果短期观察

目的 探讨儿童外斜视术后继发性内斜视的特点及原因,评价手术治疗效果。设计 回顾性病例系列。研究对象 17例外斜视术后继发性内斜视并再次手术的患儿。方法 总结17例患者既往外斜视手术方法和特点,外斜视术后出现内斜视时间、术后处理、继发性内斜视手术方式以及手术中探查发现。选择间歇性外斜视50例作为对照组,以探讨继发性内斜视的原因。主要指标 第一次手术外斜视的类型、手术方法、术后处理,继发性内斜视出现的时间。第二次手术探查发现、是否合并其他类型的斜视、手术方式以及手术后眼位。结果 17例患者合并垂直斜视9例（52.9%）,其合并中V征2例,合并DVD 4例;而对照组合并垂直斜视者9例（18.0%）,两者比较差异有统计学意义（X2=6.33,P=0.01）。继发性内斜视出现时间为术后1~12个月,平均2个月。继发性内斜视患者16例为恒定性内斜视,1例为不典型周期性内斜视;17例中外展受限10例,手术探查发现肌肉滑脱2例,粘连综合征3例,3例术后进行缝线调整。17例患者治愈14例（82.3 %）,2例过矫,1例欠矫。结论 继发性内斜视平均在外斜视术后2个月出现,外展受限、粘连综合征、肌肉滑脱以及合并垂直斜视为继发性内斜视可能的病因,合并垂直斜视的复合斜视在手术后更容易出现继发性内斜视。（眼科, 2013, 22： 327-331）     

The relationship between nystagmus and surgical outcome in congenital esotropia.

PURPOSE: Congenital esotropia is often associated with congenital nystagmus. This study examines the relationship between the presence of nystagmus and surgical outcome in the treatment of patients with congenital esotropia. METHODS: In this institutional retrospective study, we reviewed the charts of 200 consecutive patients who underwent surgical correction for congenital esotropia between 1991 and 1995. Preoperative clinical characteristics and subsequent need for additional strabismus surgery for a residual or consecutive deviation were noted. Minimum follow-up was 6 months after the original operation. RESULTS: Of the 84 patients who met the inclusion criteria, 15 patients (18%) had latent or manifest latent nystagmus, and 69 patients (82%) had no nystagmus. Eight of the 15 patients with nystagmus had or required reoperation according to our criteria (53%). Nineteen of the 69 patients (28%) without nystagmus had or required reoperation (P =.155). CONCLUSIONS: Nystagmus, when associated with congenital esotropia, may increase the risk of requiring additional strabismus surgery for residual or consecutive deviations. Appropriate and complete preoperative counseling of patients with congenital esotropia who also have nystagmus should include this increased risk.     

Acquired nonaccommodative esotropia in childhood.

PURPOSE: Acquired nonaccommodative esotropia (ANAET) in childhood is reported to occur infrequently and is often associated with an underlying neurologic or neoplastic disorder. The primary objective of this study was to ascertain the prevalence and clinical characteristics of this form of childhood esotropia. METHODS: A cohort of all children younger than 11 years with esotropia from a predominantly rural Appalachian region was prospectively identified from August 1, 1995, through July 31, 1998. The age at onset, family history of strabismus, perinatal and medical history, ophthalmologic findings, and surgical results were reviewed for all patients with ANAET. RESULTS: Twenty-three (10.4%) of 221 consecutive children with esotropia were diagnosed with ANAET compared with 12 (5.4%) diagnosed with congenital esotropia. The median age at esotropia onset for the 23 children with ANAET was 31.4 months (range, 8-63 months) with a mean initial angle of esotropia of 24 PD. Although at least 2 children presented with diplopia, none of the 23 patients were known to have harbored intracranial tumors or other lesions of the central nervous system during the follow-up period. Fourteen of the 19 patients who underwent surgery attended follow-up visits for at least 6 months after their last surgical procedure: 13 were within 8 PD or less of orthotropia, whereas the final patient had persistent esotropia. Twelve of the 13 patients within 8 PD of orthotropia demonstrated some level of stereopsis, including 2 children with bifoveal fixation. Two (10.5 %) of the 19 operated patients later required a low hyperopic spectacle correction to control their deviation. CONCLUSIONS: ANAET was more prevalent than congenital esotropia in this cohort of children with esotropia. This clinically distinct form of strabismus typically begins between 1 and 5 years of age and appears to be infrequently associated with underlying disease. The angle of deviation is relatively small and early surgical correction is more likely to achieve bifoveal fixation for these patients than for those with congenital esotropia.     

急性共同性内斜视的临床特征分析和手术 治疗体会

目的：分析101例急性共同性内斜视患者的临床特征、手术方式及治疗效果。方法：回顾性系列病例 研究。连续纳入2018年11月至2020年11月于武汉爱尔眼科医院就诊的急性共同性内斜视患者101例, 其中男71例,女30例,年龄5~76（20.7±11.3）岁。收集患者的临床资料包括患者基本资料、眼部情 况以及头颅影像学检查等。采用配对t检验对看近和看远斜视度及手术前后斜视度进行比较。采用 χ2检验分析不同年龄段、不同性别的患者屈光状态的差异。结果：101例患者中近视81例,远视19例, <12岁组以远视为主,12~30岁组以中高度近视为主,>30岁组以低中度近视为主。发病年龄12~30 岁有71例,占比70.3%（71/101）。其中学生有63例,近距离用眼时长大于8 h的占比46.5%（47/101）。 裸眼看近斜视度（+42.0±18.3） △,裸眼看远斜视度（+43.7±17.2） △,裸眼看远斜视度大于看近斜视 度（t=2.82, P=0.011）;戴镜看近斜视度（+41.6±18.6） △,戴镜看远斜视度（+43.2±17.7） △,戴镜看远 斜视度大于看近斜视度（t=2.61, P=0.007）。裸眼与戴镜看远斜视度数大于看近斜视度数患者占总人 数24.8%,裸眼与戴镜看近斜视度数大于看远斜视度数患者占总人数7.9%。83例内直肌止端距角膜 缘的距离平均为4.74 mm,小于正常值的5.50 mm。最常用的手术方式为内直肌后徙联合外直肌缩 短术,所有患者手术均一次成功,术后患者看近看远的斜视度的均数为0 △。结论：急性共同性内斜 视患者多为青少年和20多岁的年轻人,可能与近距离用眼时长过长有关。不同屈光状态患者均有出 现急性共同性内斜视的可能。内直肌止端前移解剖异常。急性共同性内斜视患者中裸眼和戴镜看远 斜视度数大于看近斜视度数占比高于看近斜视度数大于看远斜视度数。采用内直肌后徙联合外直肌 缩短术治疗的患者术后均有良好的手术效果。     

低龄儿童不同类型斜视手术远期疗效

目的 分析早期手术治疗儿童斜视的远期疗效,探讨低龄儿童不同类型斜视的手术时机和设计.方法 手术治疗397例3岁以下斜视患儿,手术后随访6～144个月,观察术后眼位、双眼单视功能及二次手术情况.结果 (1)外斜视组、垂直分离性斜视(DVD)组远期正位率分别为78.1%、68.4%,低于术后正位率,P＜0.05;内斜视组、上斜肌麻痹(SOP)、A-V综合征及特殊类型斜视远期正位率与术后正位率无差异,P＞0.05.(2)各组远期立体视＜800"的比率均高于术前,P＜0.05.(3)发病年龄早、伴有垂直斜视及术后一周欠矫或过矫是影响内、外斜视术后远期效果的主要因素,P＜0.05;手术年龄在24个月内与25～36个月远期眼位无差别,P＞0.05.结论 (1)内斜视,SOP及A-V综合征,3岁前手术远期眼位较满意并有利于立体视功能.(2)内、外斜视近期应适度欠矫和过矫,以+10△之内为宜.垂直斜视诊断明确者尽量一次手术,特殊类型斜视宜选分次手术.

Abstract：

Objective To analyze the long-term outcome of early surgical treatment,to review the operation design and timing of different types of strabismus in young children.Methods A total of 397 strabismus cases received operation under 3 years old,postoperative follow-up 6 to144 months,position of eye,binocular vision and second operation were reviewed.Results (1)The long term orthophoria rate ofexotropia and DVD was 78.1%,68.4%,lower than postoperative,P ＜0.05; The orthophoria rate of esotropia,SOP,A-V syndrome and special strabismus had no significant difference at long-term follow-up,P ＞0.05.(2)The ratio of ＜800 " of binocular vision of different group were higher than the preoperative at long-term follow-up,P ＜0.05.(3)The occurrence age early,accompanied by vertical strabismus and postoperative position of eye more or less proper was primary factor for position of eye at long-term follow-up,P ＜0.05.Conclusions (1)For esotropia,SOP and A-V syndrome,operation under 3 years old contribute to orthophoria and binocular vision at long-term follow-up.(2)The operation design of esotropia and exotropia should be moderate more or less proper +10 △.The vertical strabismus should design for once as possible,specific strabismus choose divide into two period operations.     

Relationship of dissociated vertical deviation and the timing of initial surgery for congenital esotropia

PURPOSE: To clarify the incidence of dissociated vertical deviation (DVD) among patients with congenital esotropia and to identify any relationship between the time when patients undergo their initial strabismus surgery and the time when they may subsequently have DVD develop. DESIGN: Noncomparative case series. PARTICIPANTS: One hundred five consecutive patients undergoing surgery for congenital esotropia over a 10-year period. METHODS: All patients underwent bimedial rectus recession before 24 months of age. MAIN OUTCOME MEASURES: Patients were followed postoperatively to note the age at onset of clinically evident DVD. RESULTS: By 6 years of age, 92% of available patients had DVD. The mean age at onset was 2.81 +/- 1.37 years. There was no significant difference between patients surgically aligned before 6 months of age compared with those aligned between 6 and 12 or 12 and 24 months of age. CONCLUSIONS: DVD occurs in almost all patients with surgically treated congenital esotropia, and its development is unrelated to the timing of surgical intervention during the first 24 months of life.     

Clinical features of comitant strabismus related to family history of strabismus or abnormalities in pregnancy and delivery

PURPOSE: To elucidate the genetic or environmental background for clinical features in the three major types of comitant strabismus. METHODS: Interview based on a questionnaire asking background factors such as family history of strabismus and abnormalities in pregnancy and delivery was conducted with 101 consecutive patients with infantile esotropia (5-180 months of age), 83 with accommodative or partially accommodative esotropia (6-201 months of age), and 143 with intermittent exotropia (3-216 months of age) seen during 7 months from May to November 1998. The clinical features of strabismus obtained from medical records were analyzed statistically by logistic regression to determine their relation with these background factors. RESULTS: In infantile esotropia, patients with family history of strabismus had a significantly higher chance of showing latent nystagmus (odds ratio, 3.553; 95% confidence interval [CI], 1.077-11.717; P =.0373, logistic regression analysis). In a subgroup of 40 patients with infantile esotropia whose birth followed no abnormalities in pregnancy or delivery, patients with family history of strabismus had a significantly higher chance of showing inferior oblique muscle overaction (odds ratio, 7.714; 95% CI, 1.246-47.761; P =.0280), dissociated vertical deviation (odds ratio, 6.667; 95% CI, 1.176-37.787; P =.0321), and latent nystagmus (odds ratio, 7.333; 95% CI, 1.168-46.060; P =.0336). In accommodative or partially accommodative esotropia and intermittent exotropia, no relation was found between the clinical features and the background factors. CONCLUSIONS: Inferior oblique muscle overaction, dissociated vertical deviation, and latent nystagmus in infantile esotropia might have a genetic background.     

Epidemiology of Surgical Strabismus in Saudi Arabia

Purpose:?To describe the types and age differences of surgical strabismus.

Methods:?Records of 4,886 strabismus patients who underwent surgery at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia from 1982 to 1996 were analyzed. Demographic and clinical data were collected from all patients as a retrospective case series. The percentages and ratios of various types of strabismus were correlated with age and gender.

Results:?The average age of our patients was 13.2 years (range 4 months to 82 years). Esotropia was the most common type of strabismus (69.3%), while exotropia was less common (26.9%). Of patients undergoing esotropia correction, infantile esotropia and partially accommodative esotropia were equally common; non-accommodative was less common. Constant exotropia was almost three times more common than intermittent exotropia. The rate of sensory strabismus was high, 20.8% of all patients in the series, with a slight preponderance of sensory esotropia.

Conclusions:?The ratio of esotropia to exotropia in our study is comparable to previous studies done in predominantly European and Middle Eastern populations. Surgical esotropia decreased with age while surgical exotropia increased. Overall, our rates of sensory strabismus were much higher than previously reported, even if we compare only the younger patients.     

计算机辅助儿童斜视客观检查方法在先天性外斜视早期手术中的应用

【摘要】目的探讨利用计算机辅助方法对先天性外斜视进行早期诊断与治疗的可行性。方法利用计算机辅助斜视客观检查方法，对18例先天性外斜视患者进行了早期的定性与定量诊断，并对所有患者进行了手术治疗，分析其疗效。结果单纯先天性外斜视者14例，合并分离性垂直偏斜（dissociated vertical deviation，DVD）者4例，其中同时合并DVD与上斜肌麻痹者1例。经过早期手术，18例患者中17例获得了眼轴的正位。结论先天性外斜视合并DVD多见。其手术方式，水平斜视者采用双眼外直肌后退，合并DVD者采用上直肌后退。计算机辅助的客观斜视定量检查方法有助于先天性外斜视的早期诊断与早期手术。