209例A-V型斜视的临床表现和手术治疗

目的探讨A-V型斜视的病因、临床特点、手术矫正效果及手术方式。方法分析209例A-V综合征患者的临床表现、手术方式及治疗效果;所有患者依据是否伴有斜肌功能异常、原在位水平斜视及双眼单视功能情况行斜肌减弱术或/和水平肌手术,术后观察眼位、斜肌功能及双眼单视功能,随访3～24月,平均12月。结果A-V型斜视占同期斜视患者29.9%;其中,V型外斜占55.8%,A型外斜占9.1%,V型内斜占29.1%,A型内斜占6%;术后178例（85.1%）正位,192例（91.8%）A-V征消失,术后获得立体视功能者160例（76.5%）,包括术前16例具有立体视患者。结论A-V型斜视是一种常见的斜视类型,斜肌功能异常是发病的主要原因,原在位常合并水平斜视;根据是否伴有斜肌功能异常及双眼单视功能情况选择手术方式,多可获得较为满意的效果。     

双眼上斜肌延长术对A型斜视的影响

目的 探讨双眼上斜肌肌腱延长手术对A型斜视的影响.方法 对11例双眼上斜肌功能亢进伴A型斜视患者施行上斜肌肌腱延长术,对术前术后的眼位、A征的矫正情况、双眼视功能等进行分析.结果 11例中,术前A征10～34,平均(19.27±7.50)△,术后上方与下方水平斜视度差-12～3△,平均差别(3.67±3.28)△,术前与术后比较差异有统计学意义(P＜0.001);手术对A征的矫正量15～38△平均(20.64±4.97)△;术后A-V征均消失;6例患者恢复双眼视觉,2例存在立体视觉.结论 上斜肌延长手术治疗伴上斜肌亢进的A型斜视安全有效;特别对于轻中度上斜肌亢进、A型斜视和具有双眼视功能患者,针对性较好,不易出现并发症.     

A-V综合征106例手术情况分析

目的: 分析A-V型斜视的病因,了解A-V综合征的手术矫正效果。方法: 收集2011-01/2012-12我科住院接受手术的A-V综合征106例,斜肌异常者70例,行斜肌减弱手术解决A-V征,无斜肌及上下直肌异常且V征斜视上下转相差>20△、A型斜视上下转>15△者26例,行水平直肌垂直移位半个至一个肌腱。而对于无明显斜肌及垂直肌异常且V征斜视上下转相差≤20△、A型斜视上下转斜视度相差≤15△者10例,仅行常规水平直肌手术。结果: 术后观察A-V征消失情况,无A-V征为正位;A-V征>10△为过矫或欠矫。106例患者,V征消失75例,过矫5例,欠矫4例;A征消失15例,过矫3例,欠矫4例。水平斜视>±10△为过矫或欠矫,正位85例,欠矫11例,过矫10例。结论: A-V征主要由眼外肌方面的原因造成的,对于A-V征伴有斜肌运动异常患者,行斜肌手术,无斜肌运动异常及垂直肌异常者,行水平直肌移位术均能很好地矫正A-V现象,术后远近立体视恢复好。双眼斜肌减弱术能改变原在位眼位,对于伴有斜肌异常的A-V型斜视设计水平斜视手术量时应予以考虑。     

A型斜视的临床表现和手术治疗

目的探讨A型斜视的病因、临床特征、手术治疗方法及疗效。方法分析自1995年1月至2003年12月1825例斜视中73例A型斜视病例的病历资料及治疗效果。所有患者依据是否伴有上斜肌功能过强、原位水平斜视及双眼视觉功能情况行上斜肌部分肌腱切除术或断腱术和/或水平直肌手术,术后随访时间6～18月,平均9月。结果A型斜视占同期斜视患者4.0%。在同期所有的A-V征中,A-外斜占21.2%,A-内斜占3.8%;术后眼位恢复正位62例（84.9%）,A征消失66例（90.4%）,术后58例获得立体视功能（包括术前3例存在立体视功能患者）。结论A型斜视是一种较常见的斜视类型,发病原因以斜肌功能异常为主,常合并水平斜视,应依据是否伴有斜肌功能异常及双眼视情况,选择不同的手术方式,可获得满意的术后效果。     

A型外斜视的临床表现和手术治疗

目的: 探讨 A型外斜视的病因、临床特征、手术治疗方法及疗效。方法: 分析自 1995- 01/2003- 12 收治的 1 825 例斜视中62 例 A 型外斜视病例的病历资料及治疗效果。所有患者依据是否伴有上斜肌功能过强、原位水平斜视及双眼视觉功能情况行上斜肌部分肌腱切除术或断腱术和 / 或水平直肌手术, 术后随访时间 6￣18( 平均 9) mo。结果: A型外斜视占同期斜视患者 3.4%。在同期所有的A- V征中, A- 外斜占 21.2%; 术后眼位恢复正位 52 例( 83.9%) , A征消失 56 例( 90.4%) , 术后 54 例获得立体视功能( 包括术前 3 例存在立体视功能患者) 。结论: A型外斜视是一种较常见的斜视类型, 发病原因以斜肌功能异常为主, 常合并水平斜视, 应依据是否伴有斜肌功能异常及双眼视情况, 选择不同的手术方式, 可获得满意的术后效果。     

不同术式对V型外斜视的治疗效果

目的探讨治疗V型外斜视的最佳手术方式。方法对36例外斜V征根据不同术前检查结果选择不同的手术方式。在矫正水平斜视时,根据AC／A值大小,选择双眼外直肌后徙或内直肌缩短术,若水平斜视度较大,则加行非主导眼内直肌缩短术;对于下斜肌亢进为（＋＋＋）患者行下斜肌切断加部分切除术;对于下斜肌亢进为（＋＋）的患者行下斜肌切断术;对于下斜肌亢进为（＋）及无下斜肌亢进患者行水平直肌垂直移位术;对于只需行单眼手术的病例行水平肌的斜行重叠。结果术后6个月复查时,共有30例（83．33％）手术效果良好,双眼上中下注视时均正位;3例欠矫,水平位仍有外斜视;2例过矫;1例V征（＋）,仍存在高低眼位,但均较术前情况好转。术前10例有双眼视,7例有立体视;术后随访21例有双眼视,16例有立体视。结论V型外斜视发病原因以下斜肌亢进为主,根据病因选择不同的手术方式,术后配合双眼视功能训练,多能获得双眼视。     

V型外斜视的临床表现和手术治疗分析

目的 探讨V型外斜视的病因、临床表现及手术治疗效果.方法 分析2004年1月至2008年6月收治1340例斜视中76例V型外斜视病例的病史资料及治疗结果.根据不同临床表现和病因,行不同的手术方式,术后进行双眼视功能训练,随访6～12月.结果 76例v型外斜视患者中,共有73例(96.05%)患者存在眼外肌功能异常,包括下斜肌功能亢进患者56例(73.68%)、上斜肌功能不足39例(51.32%)、上直肌功能减弱8例(10.53%)、下直肌功能亢进2例(2.63%)、外直肌功能亢进33例(43.42%)和内直肌功能不足4例(5.26%o术后共有65例效果满意(85.53%),第一眼位正,v征消失,59例(77.63%)通过手术和训练获得了双眼视功能.结论 V型外斜视发病原因以下斜肌功能亢进为主,根据病因选择不同的手术方式,术后配合双眼视功能训练,多能获得双眼视.     

Faden术治疗外展神经麻痹一例

目的 探讨双侧斜肌减弱术对A-V征斜视上下方斜度矫正的定量研究.方法 收集253例伴有双侧上(下)斜肌功能亢进的A-V征斜视,其中V征221例,A征32例,均行双侧上(下)斜肌减弱联合水平直肌后退和(或)缩短术.观察手术前后上下眼位的斜视度数、斜肌亢进程度、眼位、双眼视觉及A-V征斜视度与手术和术后残余量的量效关系.结果 221例V征患者术前上、下眼位的斜视度数差平均为(25.69±9.27)△;手术平均减少了(23.24±9.42)△,随访末期残余斜度差平均为(2.45±6.37)△.对于外斜视V征,手术解决了(23.41±9.66)△.内斜视V征为(22.72±8.67)△.随访末期V征斜视矫正成功率为95.02%(210/221).32例A征患者术前上、下眼位的斜视度数差平均为(23.72±11.29)△;手术平均减少了(24.34±13.56)△,随访末期残余斜度差平均为:(-0.63±5.38)△.对于外斜视A征手术解决了(25.15±13.97)△.内斜视A征解决了(20.83±12.06)△.随访末期A征矫正成功率为96.88%(31/32).结论 伴有双侧斜肌亢进的A-V征斜视,行双侧斜肌减弱术可有效矫治A-V征斜视.虽然随着A-V征的偏斜度数增加,双侧斜肌减弱术所矫正的斜视度有所增加,但术后残余量也随之增加.     

A-V型斜视的手术治疗

目的探讨A-V型斜视的特点和手术治疗。方法分析74例A-V型斜视临床疗效。本组74例中,V型斜视51例,A型斜视23例,手术前后采用三棱镜加交替遮盖法测量33cm和5m处眼球原位斜视角,并分别检测向上注视25°和向下注视25°斜视度数,根据斜肌功能亢进的程度选择不同的手术方式。术后观察眼位和视觉功能状况,随访时间为4～24周。结果 74例中术后眼位达正位65例,占87.83%。其中4例合并DVD二期行单眼的上直肌后徙,3例再次手术施行斜肌断腱,2例未行二次手术。21例术后获得双眼单视功能。伴有下斜肌亢进且合并眼底相外旋的V型斜视33例（61眼）,行下斜肌断腱或下斜肌前转位术,下斜肌亢进消除59眼,缓解2眼。无下斜肌功能亢进和下斜肌亢进＋1且眼底相无外旋的18例行水平直肌水平移位术,术后正位16例,2例V型斜视未消除。伴有上斜肌亢进且合并眼底相内旋的A型斜视10例（20眼）,施行上斜肌断腱术;13例则施行水平直肌移位术。A型斜视2例未消除。结论 A-V型斜视手术治疗矫正原在位水平斜视的同时,根据斜肌亢进的程度,眼底相旋转情况及双眼视功能的情况来选择不同的手术方式,手术效果良好。     

V型斜视69例的手术疗效分析

目的：探讨伴有下斜肌功能亢进的V型斜视的临床特征及手术效果。 方法：对2009-02/2010-12我院收治的69例伴有下斜肌功能亢进的V型斜视患者行下斜肌减弱联合水平肌手术,观察手术前后眼位及斜肌功能的变化。 结果：术后眼位正位者65例（94.20%）,V征消失64例（92.75%）,19例（27.54%）伴代偿头位者均得到改善,15例（21.74%）患者术后行同视机训练后恢复双眼单视功能。 结论：下斜肌功能亢进是V型斜视发病的主要原因,下斜肌减弱术是治疗V型斜视的有效手术方式。     

3580例斜视手术临床分析

目的探讨斜视的种类及手术治疗方法。方法为回顾性系列病例研究。将我院8年问收治的3580例各种类型的斜视手术进行回顾性分析。结果共同性内斜视占20．95％,共同性外斜视占58．35％,麻痹性斜视占10．20％,特殊类型斜视占10．50％。斜视患者发病年龄早,而就诊年龄较晚。绝大多数斜视患者术前无双眼单视功能。手术后完全功能治愈724例,占20．21％,不完全功能治愈1422例,占39．72％,临床治愈1434例,占40．07％。结论斜视手术的目的不仅是为了外观美容,更重要的是建立双眼单视功能。因此,应尽早进行手术治疗。     

67例V型斜视的手术探讨

目的 探讨V型斜视的临床特征及不同手术方法及效果.方法 回顾性分析了67例V型斜视的手术治疗.其中外斜V征46例,内斜V征21例,依据是否伴有下斜肌功能亢进及亢进程度,行下斜肌减弱术或水平直肌垂直移位术,所有患者按原在位水平偏斜度常规矫正水平斜视.观察手术前后的眼位、斜肌功能和双眼视觉.结果 67例手术中,49例行下斜肌后徙术或后徙转位术,术后43例上、中、下均正位,V征消失;术前无下斜肌功能亢进或下斜肌功能亢进"+"者13例,行水平直肌垂直移位术后11例正位,V征消失.67例患者术后19例恢复双眼视.结论 下斜肌后徙,后徙转位术适用于下斜肌功能亢进(++)-(+++)的V征,水平直肌垂直移位术适用于无下斜肌功能亢进或下斜肌功能亢进+的V征,应根据下斜肌功能亢进程度选择手术方式.     

Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus

Vertical transposition of the horizontal rectus muscles is the preferred operation in cases of A and V pattern strabismus in which oblique muscle dysfunction is inadequate to merit oblique surgery. Fifty-nine patients undergoing standard horizontal surgery with half tendon width vertical offsets and eight patients undergoing two-thirds to full tendon width offsets were retrospectively studied. Technique for pattern measurement and surgery are discussed. Postoperative data were analysed on a short-term (less than six weeks) and long-term (greater than 12 months) basis. Standard horizontal surgery combined with half-tendon width vertical transposition is shown to be an effective operation for collapsing all subgroups of A and V pattern strabismus when indications are appropriate. The initial correction to within ± 10 D of pattern was 96% over all with 78% remaining collapsed to within ± 10 D over an average 36-month follow-up:
Recess-resect, bimedial and bilateral rectus recession operations with offsets are all approximately equally effective in pattern collapse. A graded pattern collapse response was found with greater collapse being related to greater initial pattern. The risk of conversion, from a more desirable pattern (AET, VXT) to a less desirable pattern (AXT, VET) is low (7.3%). For patterns >30 D, three quarters to full-tendon width offsets were effective in collapsing pattern. For A and V patterns with significant oblique muscle dysfunction, oblique surgery is advocated.     

Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus

Vertical transposition of the horizontal rectus muscles is the preferred operation in cases of A and V pattern strabismus in which oblique muscle dysfunction is inadequate to merit oblique surgery. Fifty-nine patients undergoing standard horizontal surgery with half tendon width vertical offsets and eight patients undergoing two-thirds to full tendon width offsets were retrospectively studied. Technique for pattern measurement and surgery are discussed. Postoperative data were analysed on a short-term (less than six weeks) and long-term (greater than 12 months) basis. Standard horizontal surgery combined with half-tendon width vertical transposition is shown to be an effective operation for collapsing all subgroups of A and V pattern strabismus when indications are appropriate. The initial correction to within +/- 10 D of pattern was 96% over all with 78% remaining collapsed to within +/- 10 D over an average 36-month follow-up. Recess-resect, bimedial and bilateral rectus recession operations with offsets are all approximately equally effective in pattern collapse. A graded pattern collapse response was found with greater collapse being related to greater initial pattern. The risk of conversion, from a more desirable pattern (AET, VXT) to a less desirable pattern (AXT, VET) is low (7.3%). For patterns greater than 30 D, three quarters to full-tendon width offsets were effective in collapsing pattern. For A and V patterns with significant oblique muscle dysfunction, oblique surgery is advocated.     

47例V型斜视的临床分析

目的探讨V型斜视的临床特征及手术矫正的效果。方法回顾性总结北京大学第一医院小儿眼科47例下斜肌功能亢进致V型斜视,行下斜肌后徒+水平肌手术,观察术后眼位,下斜肌功能。结果下斜肌后徒+水平肌手术对V型斜视疗效满意。结论下斜肌功能亢进是V型斜视发病的主要原因,V型斜视手术方式主要是下斜肌后徒+水平肌手术。     

Prevalence of horizontal deviation pattern changes with measurements in extreme gazes

PURPOSE: To analyse the difference between measurement of A and V pattern strabismus at 25 degrees and extreme gaze position in esotropia (ET) and exotropia (XT). METHODS: This prospective cross-section study included 27 patients with basic horizontal strabismus associated to any deviation pattern. Mean age was 11.88+/-9.17 (6-44) years. Exclusion criteria were amblyopia, intermittent XT, noncollaboration with the exam, previous strabismus surgery, craniofacial, or spinal abnormalities. The deviations were measured with prism cover test at 6 m. Measurements were carried out in primary position, upgaze (neck flexion of 25 degrees and maximum flexion) and downgaze (neck extension of 25 degrees and maximum extension). A goniometer with a bubble level controlled the neck position. RESULTS: The most significant changes were in downgaze. The pattern size increased 4 prism dioptres (PD) or more in 56.25% of the V- and in 87.5% of the A-patterns. The mean increase was 8.00+/-6.04 PD (0-17 PD) for the A-pattern ET, 4.80+/-3.70 PD (0-10 PD) for the V-pattern XT, and 6.50+/-5.58 PD (0-15 PD) for the V-pattern XT. The only case of A-pattern XT increased 8 PD. CONCLUSION: Our results suggest that measurements in extreme up and downgazes may uncover increased deviations in a significant proportion of cases. Further studies remain necessary to determine the relevance of these findings for strabismus correction.     

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.     

内斜视V征的手术治疗和临床观察

目的探讨内斜视V征的临床特点和手术疗效。方法总结我院2007年至2010年38例(76眼)住院手术的内斜视V征患者资料,其中合并下斜肌功能亢进者31例行下斜肌减弱术和常规水平直肌后退和(或)缩短术;不合并下斜肌功能亢进者7例分别行双眼内直肌后徙术和(或)联合肌止端向闭口端移位术、外直肌缩短术并肌止端向上移位术。检查分析患者手术前后斜视度数、双眼视功能及手术效果。结果术前上、下注视眼位的垂直斜视角之差为15△～40△,平均22.7△,其中15△～20△者21例(55.26%),21△～30△者14例(36.84%),≥31△者3例(7.89%);术后上、下注视眼位的垂直斜视角之差为5△～20△,平均6.8△,其中5△～14△者34例(89.47%),15△～20△者4例(10.53%);术前、术后垂直斜视角差异有统计学意义(t=16.907,P<0.05)。术前水平斜视角平均18.4△,术后为4.6△,差异有统计学意义(t=24.624,P<0.05)。术前、术后同视功能差异有统计学意义(χ2=16.110,P<0.05)。术后眼位正位、V征消失者29例(76.32%),V征缓解者5例(13.16%),V征仍然存在者4例(10.53%)。结论内斜视V征发病年龄早,多合并下斜肌功能亢进,减弱下斜肌功能可有效矫治内斜视V征。不合并下斜肌功能亢进者,行内直肌后徙联合肌止端向闭口端移位术,也可有效缓解内斜视V征。     

Latency of saccades, vergence, and combined movements in children with early onset convergent or divergent strabismus

The goal of this study was to examine latency of horizontal eye movements in the natural space (saccades, vergence, and combined saccade-vergence movements) in children with early onset convergent or divergent strabismus. Ten children were tested (8-11 years old): three with divergent strabismus, seven with convergent strabismus. A paradigm was used to elicit pure lateral saccades at far and near distance, pure vergence (convergence and divergence) and saccades combined with vergence movements. Horizontal eye movements from both eyes were recorded simultaneously by a photoelectric device (Oculometer, Dr. Bouis). The latency of saccades (at far and near distance), of vergence (convergence and divergence), and of combined movements greatly varies among subjects and has tendency to be longer than that observed in normal children of matched age, however, these differences reach significance in only a few cases. Children with divergent strabismus and residual gross binocular vision show abnormally longer vergence latencies than children with convergent strabismus without binocular vision. The initiation of combined movements does not show a dominant pattern, such as preceding vergence, as is found in normal children. Finally, strabismus surgery has no major effect on latencies. We conclude that there is no overall deficiency in latencies of eye movements in 3D space in children with early onset strabismus. Most likely, monocular visual input can be efficient as normal binocular vision for vergence movements. In a few subjects with divergent strabismus and fragile, intermittent binocular vision, latencies can be abnormally long, just because of the fragile binocular input and/or attention effort needs to use it. The absence of a pattern of initiation similar to normal children could be due to attention and fixation capabilities.