下斜肌后徙转位术后的安全性分析

目的 通过比较下斜肌(Inferioroblique IO)后徙术与IO后徙转位术,术后至少3年的疗效,评价IO后徙转位术的安全性.方法 比较IO后徙术组(22例33只眼)和IO后徙转位术组(27例33只眼)病例手术后IO运动程度和眼球上转程度,分析可能的相关因素.结果 (1)IO后徙转位术组左右眼手术后远期IO运动程度、眼球上转程度均明显低于IO后徙术组,差别有统计学意义,P＜0.001.(2)术后IO运动程度不足与手术年龄、有无弱视、屈光状态、是否同时行水平斜视手术、术前IO功能亢进程度和斜视度均无关.(3)IO后徙转位术组术后远期IO运动程度、眼球上转程度均低于近期(1周至1个月),有明显统计学差异,P＜0.001.术后中期(3～6个月)与远期IO运动程度、眼球上转程度之间差异无统计学意义,P＞0.05.结论 IO后徙转位术式存在术后眼球上转功能不足,IO功能不足的缺点,并且在术后持续存在.     

下斜肌后徙转位术对眼球运动的影响

目的观察下斜肌后徙转位术对眼球运动的影响。方法顺序选择手术后系统观察≥3年的下斜肌后徙转位和后徙手术两组病例,比较眼球运动状况,并观察前者原在位眼位。结果（1）下斜肌后徙转位组原在位均未出现下斜视,14例单眼手术病例有上转受限,以颞上方为著,6例双眼手术病例无明显上转受限。（2）下斜肌后徙转位组手术后远期（≥3年）下斜肌运动程度、眼球上转程度均明显低于下斜肌后徙组,P〈0.001。（3）下斜肌后徙转位组术后远期下斜肌运动程度、眼球上转程度均低于近期（1周～1个月）,P〈0.05,而术后中期（3～6个月）与远期下斜肌运动程度、眼球上转程度之间无明显差异,P〉0.05。结论下斜肌后徙转位术导致术后眼球运动出现非共同性变化,主要是上转受限,对侧眼上转亢进。     

下斜肌后徙术治疗先天性上斜肌麻痹的临床分析

先天性上斜肌麻痹是先天性眼外肌麻痹中最常见的类型,主要为先天性发育异常,多由出生时的创伤或婴幼儿期疾病所致。临床表现主要是上斜视及代偿头位引起的斜颈,面部不对称及背柱畸形,对儿童身心生长发育不利。资料和方法1.一般资料:收集先天性上斜肌麻痹患者17例,男10例,女7例,年龄4～17岁,平均10.5岁,均是在出生3个月后被发现眼球运动不协调及斜颈。术前所有患者行角膜映光法,三棱镜中和测定斜视角,检查双眼和单眼运动功能,对能合作的患者行同视机,Hess屏及Parks三步法检查。在所查病例中,17例均有下斜肌功能过强,向侧方注视时内转眼伴有…     

原发性下斜肌功能亢进的后徙术治疗

原发性下斜肌功能亢进在各类垂直眼外肌异常中并不少见，常因眼球内转时伴有明显上转的异常外观而就诊。笔者对患有该病的患儿6例11眼实施了下斜肌后徙术，获得了满意疗效，现报告如下。     

上斜肌后徙术矫正伴上斜肌功能亢进斜视分析

目的 探讨上斜肌后徙术矫正伴上斜肌功能亢进斜视及眼球旋转状态的效果.方法 收集伴上斜肌功能亢进的A型斜视、下斜肌麻痹和Brown综合征患者共12例,观察手术前后原在位、上下转25°及9个诊断眼位斜视度及上斜肌功能,于术前和术后行双眼眼底照相并测量黄斑-视盘夹角(FDA).结果 A型斜视患者术前上下转25°斜视度相差最小17△,最大53△,术后均小于10△,A征消失,手术前双眼FDA为(20.32±8.53)°,术后为(4.15±7.22)°;下斜肌麻痹和Brown综合症患者术前垂直斜度均大于10△,术后均小于6△,手术前双眼FDA为(11.32±7.11)°,术后为(2.65±2.52)°.结论 上斜肌后徙术可有效矫正伴上斜肌功能亢进斜视和眼球内旋状态.

Abstract：

Objective To investigate superior oblique recession in treatment of strabismus with superior oblique overaction and effects on torsion status. Methods Pre- and Post-operative primary,upward, downward and 9 diagnostic eye position of deviation, superior oblique muscle function, fundus photograph were examined and analyzed in A-pattern, inferior oblique palsy and Brown syndrome with superior oblique overaction. Results The maximum pre-operative deviation difference between upward and downward gaze was 53△ whereas minimum was 17△ in A-pattern. All post-operative deviation difference was not more than 10△. The mean pre-operative fovea-disc angle (FDA) of both eyes was (20.32±8.53)°whereas (4.15±7.22)°after operation in A-Pattern. The pre-operative vertical deviation in inferior oblique palsy and Brown syndrome patients was more than 10△ whereas post-operative not more than 6△. The mean pre-operative FDA of both eyes was (11.32±7.11)°whereas (2.65±2.52)°after operation. Conclusions Superior oblique recession is effective in correcting strabismus with superior oblique overation and intorsion.     

对称下斜肌后徙术治疗原发不对称性下斜肌亢进

目的 探讨对称的下斜肌后徙术治疗正前方无明显垂直斜视的原发不对称性下斜肌亢进的手术疗效.方法 回顾性分析了2004年7月至2010年8月住院行对称下斜肌后徙术的34例原发不对称性下斜肌功能亢进患者,术前一只眼的下斜肌亢进程度为+1～+2;另一只眼的下斜肌亢进程度为+3～+4.手术前后分别观察患者的双眼下斜肌功能、A-V征、代偿头位、双眼视功能和旋位.术后随访6个月～12个月.结果 术后双眼下斜肌功能正常的30例,所有患者均没有出现下斜肌功能不足;术前24例有V征,术后V征均消失;术前外旋度数为(26.3°±0.5°),术后的外旋度数为(16.2°±3.2°),双眼术后黄斑中心凹-视盘中心夹角度数(FDA)与术前相比有内旋的趋势;术前有双眼视的4例,术后有双眼视的7例;术前6例有代偿头位,术后3例代偿头位消失,2例代偿头位好转.结论 对称的下斜肌后徙术对改善下斜肌功能和治疗由原发不对称性下斜肌亢进所引起的V征、旋位、代偿头位以及恢复双眼视功能均安全有效.

Abstract：

Objective To evaluate the effects of bilateral symmetric inferior oblique recession on the patients with bilateral asymmetric primary infenor oblique overaction and without vertical misalign ment in the primary position. Methods A retrospective study was carried on 34 patients with bilateral asymmetric inferior oblique overaction admitted to the hospital from July of 2004 to August of 2010;inferior oblique overaction before surgery were of grade -1 0r -2 in one eye and -3 0r 4 in the oth er. The degrees of inferior oblique overaction A-V pattem, degrees of fundus torsion binocular sight and abnormal heads were analyzed in all patients before and after surgery. The patients were fol lowed-up for 6 to 12 months after the surgery. Results Symptoms of the inferior oblique overaction disappeared completely in 30 patients, none of the patients showed underaction of inferior oblique muscle function; 24 cases had V strabismus before surgery, their symptoms disappeared after surgery;the degrees of fundus torsion were 26.3°± 0.5° before surgery and 16.2°± 32° after surgery; the fovea - to- disc angle (FDA) after the surgery had a tendency to incyclotorsion when compared to tbat before surgery 4 patients with binocular sight before surgery and 7 patients after surgery abnormal head position was present in 6 patients before surgery it disappeared in 3 and improved in 2 after the surgery. Conclusions Compared to primary asymmetric inferior oblique overaction, bilateral symmetric inferior oblique recession may bave modifying inferior oblique function and may have a better effect on the V strabismus, degree of fundus torsion, abnormal heads and rebuilt binocular sight function which caused by inferior oblique overaction.     

下斜肌后徙前转位术联合上斜肌折叠术治疗眼性斜颈

眼性斜颈的病因中，以先天性上斜肌麻痹最为多见，其临床特征常常表现为上斜视、继发性下斜肌功能亢进及代偿头位，即眼性斜颈。严重的眼性斜颈可继发颈部和颜面部肌肉发育不对称，并可造成脊柱侧弯，影响儿童的生理发育。由于歪头(斜颈)带来的面部不对称，由于重力的作用，使一侧面部丰满，另一侧面部瘦小。其次，对颈部骨骼的影响，造成颈椎侧弯。第三，也可能会造成脊柱的侧弯。     

下斜肌徙后术治疗先天性上斜肌麻痹30例

先天性上斜肌麻痹是儿童先天性眼外肌麻痹中最常见的一种,多由产伤或其它先天性因素造成的,主要病变是上斜肌麻痹引起的斜颈、脊柱及面部畸形,对儿童心身发育造成一定影响。１　资料与方法１．１　一般资料　本组先天性上斜肌麻痹３０例３０只眼,其中合并内斜７例,外斜４例,年龄３～２６ａ,平均１１．５ａ。所有病例行手术治疗,术前行同视机、三棱镜结合交替遮盖查斜视角,并行Ｂｉｅｌｓｃｈｏｗｓｋｙ头位试验、Ｐａｒｋ三步法检查、Ｈｅｓｓ屏检查及代偿头位检查。１．２　手术方法　常规消毒,结膜下麻醉,做“Ｌ”形结膜瓣,固…     

双侧同名肌超常量后徒术在水平斜视矫正术中的应用

目的 探讨同名肌超常规量后徒术的治疗效果,寻求斜视手术最佳方案。方法 将１１９例分成两组,双侧同名肌超常规量后徒治疗组６３例,常规手术治疗５６例作对照组。结果 术后３月眼球正位率９３％,７％欠矫,无一过桥,对照组正位率８５％,Ｐ〈０．０５。两组均未发生眼球运动障碍。结论 同名肌超常规量后徒术矫正效果好且具有快捷,易掌握,痛苦小等优点。     

下斜肌转位术与下斜肌切断术治疗斜视V征的比较

目的 比较下斜肌转位术(AT)与下斜肌切断术在治疗下斜肌功能亢进引起的斜视V征的作用.方法 回顾性分析行下斜肌转位术治疗的伴有下斜肌功能亢进,同时合并分离垂直性斜视(DVD)的28例斜视V征患者,术前下斜肌功能亢进程度为+1～+3,V征差值不超过30PD,根据双眼下斜肌功能亢进对称性以及双眼或单眼行下斜肌转位术,分为双眼AT组(15例)和单眼AT组(13例),与历史同期行下斜肌切断术治疗的伴有下斜肌功能亢进,不合并DVD的28例斜视V征患者进行非随机埘照研究,对照组根据下斜肌功能亢进对称性及双眼行对称或非对称下斜肌切断术,相应地分为对照1组(15例)和对照2组(13例),分别测最手术前后V征筹值,比较手术矫正V征差值并进行统计学分析.结果 双眼AT组平均矫正V征差值(15.67±4.03)三棱镜度(PD),对照1组平均矫正(15.20±3.51)PD,两组差异无统计学意义(t=0.338,P＞0.05);单眼AT组平均矫正v征差值(14.69±3.71)PD,对照2组平均矫正(14.00±3.94)PD,两组差异无统计学意义(t=0.462,P＞0.05).结论 下斜肌转位术与下斜肌切断术治疗下斜肌功能亢进引起的V征斜视疗效无差别.     

下斜肌前置移位治疗伴有下斜肌亢进的分离性垂直偏斜

目的:观察下斜肌前置移位治疗伴有下斜肌亢进的分离性垂直偏斜(dissociated vertical deviation,DVD)。方法:下斜肌前置移位于下直肌附着点颞侧前2mm或下直肌附着点颞侧成一直线处,同时矫正水平斜视。结果:患者8例11眼中,术前6眼DVD程度是1+,术后DVD消失;术前3眼DVD程度是2+,术后2眼垂直斜视消失,1眼DVD程度为1+;术前2眼DVD程度是3+,术后1眼DVD程度为1+,1眼为2+。所有患者下斜肌均不亢进。结论:下斜肌前置移位是治疗伴有下斜肌亢进的DVD的有效方式,无明显副作用。     

下斜肌减弱术治疗下斜肌亢进的临床分析

目的探讨下斜肌减弱手术不同方式治疗下斜肌亢进和V征的临床效果。方法下斜肌亢进122例160眼,包括原发下斜肌亢进20例37眼及继发下斜肌亢进102例123眼,采用不同手术方式,对其手术效果进行比较。结果122例中术前82例有代偿头位(67.21%)者,术后82例中代偿头位消失50例,好转28例,无效4例。下斜肌减弱术的手术方式:断腱术6眼;部分切除24眼;后徙80眼;前转位50眼。术前下斜肌亢进程度 1,21眼; 2,91眼; 3,42眼; 4,6眼;术后残留下斜肌 1,3眼;其余均得到矫正。术前V型斜视48例,术后V征消失38例,好转10例。单纯下斜肌减弱矫正原在位垂直斜度≤15△。结论下斜肌部分切除、后徙及前转位术矫正下斜肌亢进及V征同样安全有效。     

两种下斜肌减弱术在先天性上斜肌麻痹治疗中的运用

目的探讨二种下斜肌减弱术在先天性上斜肌麻痹治疗中的效果。方法85例先天性上斜肌麻痹患者,33例垂直眼位<15~Δ行下斜肌部分切除术,52例垂直眼位>15~Δ行下斜肌移位术。结果85例患者中垂直眼位<15~Δ行下斜肌部分切除术者,治愈及好转29人(87.9%),>15~Δ行下斜肌转位术者,治愈及好转41人(78.8%)。术前有代偿头位者均消失或改善。结论先天性上斜肌麻痹垂直眼位<15~Δ可行下斜肌部分切除术,>15~Δ者可行下斜肌移位术。     

三种下斜肌转位术治疗分离性垂直斜视疗效观察

目的观察三种下斜肌转位术治疗分离性垂直斜视的手术疗效,探讨治疗DVD的最佳手术方法。方法伴有下斜肌功能亢进的DVD患者75例,根据手术方式分为3组:单纯下斜肌转位术组、下斜肌截除联合转位术组、下斜肌截除联合前徙并转位术组。观察3组术后1个月、3个月及6个月的眼位、下斜肌运动、代偿头位及并发症情况。结果 3组患者术后下斜肌亢进均消失;代偿头位均不同程度改善;单纯下斜肌转位术组和下斜肌截除联合转位术组术后效果良好者23例(92%)、下斜肌截除联合前徙并转位术组术后效果良好者24例(96%),3组间疗效无明显差异,P<0.05。单纯下斜肌转位术无明显的睑裂变化及上转受限,而联合截除术式有少部分患者出现睑裂变小和眼球上转受限。结论单纯下斜肌转位术可矫正15△~25△的垂直斜视,且术后眼球上转受限和睑裂变化也不明显,是伴有下斜肌功能亢进DVD的首选方法。     

伴有下斜肌亢进的分离性垂直偏斜的手术疗效分析

目的分析下斜肌转位术对伴有下斜肌亢进的分离性垂直偏斜(dissociated vertical deviation,DVD)的矫正效果。方法回顾性分析我科行下斜肌转位术的24例(30眼)伴有下斜肌亢进的DVD患者的完整资料,并根据术前原在位垂直斜度将患者分为小度数、中等度数和大度数组,比较下斜肌转位术对各组近距离(33cm)和远距离(5m)原在位垂直斜度矫正效果。所有患者下斜肌固定于下直肌颞侧缘外的浅层巩膜,与下直肌附着点位于同一水平线上。合并水平斜视者同期手术矫正。结果近距离小度数DVD组、中等度数DVD组、大度数DVD组治愈率分别为100%、0、0;3组有效率分别为92.3%、7.7%、0;3组无效率分别为41.7%、25.0%、33.3%;远距离时各组治愈率分别为100%、0、0;3组有效率分别为92.9%、7.1%、0;3组无效率分别为25.0%、50.0%、25.0%;无论是近距离还是远距离,下斜肌转位术对小度数和中等度数DVD组的原在位垂直斜度矫正效果明显优于大度数DVD组,差异均有统计学意义(均为P<0.05),小度数和中等度数DVD组比较,差异无统计学意义(P>0.05)。结论下斜肌转位术对小度数DVD组(≤10△)和中等度数DVD组(11△～19△)近距离和远距离原在位垂直斜度的矫正效果明显优于大度数DVD组(≥20△)。     

Evaluation of macular thickness change after inferior oblique muscle recession surgery

Purpose:

This study aimed to evaluate the changes in macular thickness following inferior oblique muscle recession surgery.

Materials and Methods:

Thirty-eight eyes from 21 patients undergoing ocular muscle surgery were included. Patients were grouped into three groups based on the type of surgical intervention: Group I (n = 12), inferior oblique recession surgery alone; Group II (n = 12), inferior oblique plus horizontal muscle surgery; Group III (n = 14), horizontal muscle surgery alone. Each eye was scanned using the optical coherence tomography (OCT) device preoperatively and on the first postoperative day to measure macular thickness.

Results:

Following surgery, a significant increase in foveal thickness occurred in Group I (P < 0.05) and Group II (P < 0.01). In addition, a statistically significant difference was observed between the groups with regard to the increase in foveal thickness (P = 0.016), with significantly lower changes in Group III.

Conclusion:

Our findings suggested that inferior oblique muscle recession surgery is associated with an increase in macular thickness.     

下斜肌不等量切除前转位术治疗伴有非对称性下斜肌功能亢进的分离性垂直斜视

目的：探讨下斜肌不等量切除前转位术在伴有非对称性下斜肌功能亢进的分离性垂直斜视治疗中的应用。

方法：回顾性分析2015-06/2017-06在我院行下斜肌不等量切除前转位术治疗伴有非对称性下斜肌功能亢进的分离性垂直斜视病例22例28眼,男10例,女12例,年龄3～28(平均12.32±6.81)岁,从术后双眼视功能恢复情况、DVD疗效、下斜肌功能亢进疗效、眼位及代偿头位、并发症等方面观察,术后随访6～18(平均10.05±3.87)mo。

结果：术后双眼视功能恢复情况：无双眼视功能者11例(50%); 恢复Ⅰ级视功能者6例(27%); 恢复Ⅱ级视功能者3例(14%); 恢复Ⅲ级视功能者2例(9%)。DVD疗效：满意17例(77%),好转5例(23%),无效0例。下斜肌功能亢进疗效：治愈13例(59%),好转9例(41%),无效0例。术后眼位及代偿头位：(1)水平眼位：外斜矫正术后水平眼位欠矫1例,内斜矫正术后水平眼位欠矫1例,过矫0例,正位20例;(2)垂直眼位：垂直斜视度≤5^△者13例,5^△<垂直斜视度<10^△者9例,平均5.55^△±2.35^△,垂直眼位无过矫;(3)代偿头位：术后6例代偿头位消失,1例代偿头位明显改善。并发症：1例患者发生轻微抗上转综合征,1例患者发生轻微睑裂缩窄,睑裂缩窄量<1mm。

结论：下斜肌不等量切除前转位术治疗伴有非对称性下斜肌功能亢进的分离性垂直斜视患者疗效满意,规范的术前检查、个性化手术设计以及手术技巧至关重要。     

Effectiveness of modified inferior oblique muscle belly transposition for V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction

AIM: To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction. METHODS: Thirteen cases (23 affected eyes) of V-pattern exotropia with inferior oblique muscle overaction (+ or ++) who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed. The amount of V-pattern, grade of inferior oblique overaction, degree of vertical strabismus, abnormal head posture, and the fovea-disc angle were evaluated before and after surgery. RESULTS: The V-pattern was corrected in all cases, and the amount of V-pattern reduced by 17.85±5.13 prism diopter (PD) on average (t=16.07, P<0.001). The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0% (20/23). The degree of the fovea-disc angle has a mean reduction of 5.45°±2.87° (t=3.95, P=0.003) after surgery. The mean vertical deviation in 5 cases with a small-angle hypertropia (5.23±3.06 PD) in the primary position reduced by 3.15±1.86 PD (t=6.10, P<0.001). No serious complications were observed. CONCLUSION: The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern, which is safe and easy to perform.     

改良下斜肌切断术治疗伴下斜肌功能亢进的V型斜视

目的：探讨改良下斜肌切断术治疗伴下斜肌功能亢进的 V 型斜视的疗效。方法对68例（106眼）伴下斜肌功能亢进的 V 型斜视行改良下斜肌切除联合水平直肌后退及（或）缩短术,术后观察评价下斜肌功能、眼位及双眼单视功能。结果术后100眼（94.3%）下斜肌功能亢进消失、6眼（5.6%）下斜肌亢进、无下斜肌功能不足者。术前水平斜视角平均64.5△,术后9.2△,术前垂直斜视角平均15.8△,术后随访为2.2△,平均降低13.6△。术前7例（12.5%）有双眼单视功能,术后47例（73.5%）有不同程度的双眼单视功能。结论改良下斜肌切断术是伴下斜肌功能亢进的 V 型斜视的有效术式。     

DVD与下斜肌功能过强手术的临床探讨

目的 探讨下斜肌功能过强者采取下斜肌减弱手术的疗效。方法 采取下斜肌减弱手术(截断或切除5～8mm)83例117眼。结果 117眼下斜肌减弱手术，下斜肌功能过强89眼，76眼完全矫正，13眼不同程度改善，其中下斜肌截断15眼，2眼未完全矫正；下斜肌切除5～8mm68眼，11眼未完全矫正。垂直分离性斜视(DVD)28眼，4眼未完全矫正。术前代偿头位32例，28例完全改善，余4例不同程度改善。结论 认真检查或观察斜视度，采取下斜肌减弱手术，均可矫正不同程度的斜视度。