眶壁骨折修复术后斜视和复视的手术治疗

目的 观察眶壁修复术后斜视和复视眼外肌手术矫正效果.方法 对14例眼眶爆裂性骨折修复手术6月后仍有斜视和复视的患者,采取二期眼外肌手术治疗.结果 4例为限制性斜视,二期手术探查,松解肌肉、解除限制因素,后徙受累肌或/和缩短拮抗肌后,前方及前下方视野内复视消除;10例为非限制性眼肌功能不足所致斜视,二期手术缩短受累肌/和后徙拮抗肌后,9例复视明显好转,前方及前下方视野内垂直及水平斜视度分别小于10△和15△.1例仍有眼位偏斜,需佩戴三棱镜矫正复视.结论 正确分析爆裂性眼眶骨折修复术后斜视和复视的原因,采取相应的术式,可获得较好的治疗效果.     

眶壁骨折修复术后斜视和复视手术处理

目的观察眶壁修复术后斜视和复视眼外肌手术矫正效果。方法对14例眼眶爆裂性骨折修复手术6月后仍有斜视和复视的患者，采取二期眼外肌手术治疗。结果4例为限制性斜视，二期手术后徙受累肌或／和缩短拮抗肌后，功能视野内复视消除；10例为非限制性眼肌功能不足所致斜视，二期手术缩短受累肌或／和后徙拮抗肌后，     

甲状腺相关眼病眼眶减压术后继发内斜视伴复视的手术疗效观察

目的探讨甲状腺相关眼病(TAO)眼眶减压术后继发内斜视伴复视的斜视矫正手术治疗效果。方法回顾性系列病例研究。选取2016年3月至2018年10月在天津市眼科医院因TAO行眼眶减压术后继发内斜视伴复视行斜视矫正手术治疗的11例患者资料。斜视矫正手术前、后检查患者斜视度数、眼球运动,观察复视情况。手术均在监护下麻醉联合局部麻醉下进行,术中采用被动牵拉试验结合调整缝线方法,调整至第一眼位复视消失。术后定期随访。结果11例患者中男性1例,女性10例;年龄26~42岁;均为单纯内斜视伴复视;内斜视度数10~98三棱镜度;眼眶CT提示患者内直肌不同程度增厚,外直肌增厚程度较内直肌轻。2例患者行单眼内直肌后徙术,2例行双眼内直肌后徙术,2例行单眼内直肌后徙联合外直肌缩短术,另外5例行双眼内直肌后徙联合单眼外直肌缩短术。11例患者术中内直肌后徙量为3.5~7.5 mm,7例联合外直肌缩短术患者外直肌缩短量为2.0~6.0 mm。全部患者术后复视消除,第一眼位正位,均达到治愈标准。眼球运动术前外转受限分级为(-1.91±1.04)级,术后外转受限分级为(-0.64±0.81)级。11例患者均对手术结果满意,术后随访6~24个月,效果稳定,未发现远期过矫患者。结论应用术中调整缝线技术,斜视矫正手术可以有效治疗TAO眼眶减压术后继发的内斜视伴复视。     

白内障术后的垂直性斜视

在眼科临床工作中 ,我们注意到一些白内障患者于术后出现复视现象 ,其受累肌几乎全是垂直肌 ,有资料表明其斜视的发生可能与手术性创伤和麻醉肌毒有关 〔1～ 9〕,为此我们对 2 0例白内障术后所发生的永久性垂直性复视患者进行了分析研究 ,现报告如下 :临床资料本组 2 0例白内障术后所发生的顽固性垂直性复视患者 ,斜视度均在 5△以上 ,以往无斜视、复视史 ,也无神经性疾病、甲状腺疾病和重症肌无力病史。根据斜视性质将之分为眼球运动过强型、眼球运动受限型和眼肌不全麻痹型三类。分析白内障手术时所应用的麻醉手术方法与术后斜视的关系。…     

眼外肌后徙调整缝线术治疗斜视259例疗效观察

我院自1986年5月至1996年2月采用眼外肌后徙调整缝线术治疗斜视259例,收到了较好的效果,现报告如下:对象与方法1对象:本组259例斜视中,男165例,女94例,年龄45～45岁;共同性外斜视93例,其中间歇性外斜视48例,共同性内斜视121例,先天性麻痹性斜视25例,ＤＶＤ13例,眼球后退综合征7例。2手术方法(1)1%的卡因表面麻醉及局部结膜下麻醉,做梯形结膜瓣,剪开肌间膜及节制韧带。(2)将需后徙的直肌自肌止端后1ｍｍ处用3-0白丝线做双套环缝线,线前剪断肌肉,将肌肉两端缝线分别通过肌止端中心呈八字形向角膜缘方向穿出,形成两个板层巩膜隧道,入针处相距2…     

白内障术后复视及上睑下垂的相关因素分析

目的 :探讨白内障术后复视及上睑下垂的机制。方法 :对 8例白内障术后复视及上睑下垂患者进行病史查阅 ,眼球运动检查 ,复视像检查及上睑运动功能检查 ,并对相关因素进行分析。结果 :所有病例均为球后或球旁麻醉、开睑器开睑引起 ,而与上直肌牵引缝线、结膜下注射无关。结论 :白内障术后复视及上睑下垂可能与球后或球旁麻醉时麻醉药的肌毒性作用有关     

白内障术后垂直斜视的治疗观察

目的探讨白内障摘除人工晶体植入术后垂直斜视的原因、表现和治疗方法.方法对9例白内障摘除人工晶体植入术后出现垂直斜视的患者进行角膜映光、眼球运动、三棱镜加Maddox杆、同视机、Hess屏及牵拉试验检查.并采用神经营养,地塞米松肌腹旁注射及手术治疗.结果9例患者中3例表现为上直肌受累,6例为下直肌受累;其中左眼受累7例,右眼受累2例;上直肌受累表现为肌肉不全麻痹,下直肌受累3例表现为肌肉亢进,3例表现为肌肉不全麻痹.7例经非手术治疗治愈,2例经手术治疗治愈.结论白内障术后垂直斜视的病人多数经非手术治疗可治愈,地塞米松肌腹旁注射对这种病人有一定价值.     

直肌调整缝线在间歇性外斜视术中的应用

目的 探讨间歇性外斜视的手术时机,观察直肌可调整缝线在其术中的应用效果.方法 对51例间歇性外斜视施行联合直肌可调整缝线的直肌后徙术.结果 随访3～12个月,48例达正常眼位,3例欠矫者经集合训练后得到改善.结论 联合直肌可调整缝线的直肌后徙术是矫正间歇性外斜视简便而有效的手术方式,减少再次手术.     

上直肌转位联合内直肌后徙术在治疗外展神经全麻痹中的应用

目的探讨上直肌颞侧转位联合内直肌后徙术治疗外展神经全麻痹内斜视的疗效。方法回顾性病例研究。分析11例就诊于天津市眼科医院或徐州市第一人民医院眼科的外展神经全麻痹患者术前、术后末次随访时的斜视度、代偿头位角度、受累眼外转和内转受限的程度。11例患者均行上直肌颞侧转位手术,其中8例同期联合内直肌后徙术。内直肌后徙手术采用术中调整缝线方法,根据术中眼位,确定内直肌后徙的位置。平均随访6个月以上。采用配对t检验比较术前、术后第一眼位内斜度、代偿头位角度、外转及内转受限的程度。结果10例患者一次手术矫正至正位,患者代偿头位和复视消失,患者均对手术结果满意。1例患者上直肌全肌腹转位联合内直肌后徙术后欠矫,残余代偿头位及复视,3个月后行下直肌颞侧转位术,头位及复视消除。11例患者内斜视从术前31.2°±13.7°矫正至术后3.4°±1.7°（t=7.28,P<0.01）;代偿头位从术前26.1°±7.7°矫正至术后0.9°±3.0°（t=10.75,P<0.01）;外转受限从术前-4.8±0.9矫正至术后-2.0±0.9（t=8.84,P<0.01）;内转受限从术前-0.2±0.4矫正至术后-1.0±0.4（t=4.62,P<0.05）。本组患者术后均未出现垂直或旋转复视。结论上直肌转位联合内直肌后徙术,可以同期进行。单独上直肌转位不会带来新的垂直斜视和旋转斜视。上直肌转位术联合调整缝线下的内直肌后徙术是治疗外展神经全麻痹的有效方法之一。     

白内障手术后斜视复视的病因分析和防治

目的探讨白内障手术后斜视、复视的临床表现,发病原因及防治措施.方法对白内障手术联合人工晶状体植入术后发生斜视、复视的31例患者(31眼)进行常规的视力、眼前节、眼底的检查,并进行了屈光、眼肌运动、复视像的检查.结果 31例患者中大部分受累肌为垂直肌,以下直肌受累更为多见,6例合并上睑下垂.大部分患者在3个月左右恢复正常眼位,2例出现永久性复视,年龄越大恢复越慢.结论白内障手术联合人工晶状体植入术后部分患者合并眼肌运动障碍,并引起斜视、复视,其发病原因可能与麻醉药物引起的眼肌毒性反应有关.早期治疗大部分患者可恢复双眼视觉,手术治疗有一定的效果.     

直肌后徙可调缝线术在儿童共同性斜视中的应用

目的：观察直肌后徙可调整缝线术治疗儿童共同性斜视的临床效果。方法对34例儿童共同性斜视在全麻下采用直肌后徙调整缝线术治疗,术后1～2 d内进行缝线调整,随访6～24个月,观察手术效果。结果34例儿童共同性斜视患者中,11例达正常眼位,23例因欠矫或过矫需要调整,其中过矫9例及欠矫11例均调至正位,有3例欠矫者经集合训练后得到改善。在6～24个月随访中,未调整的患者中欠矫1例,经过调整的患者中欠矫2例,术后视功能较术前有明显的改善。结论采用可调整缝线治疗儿童共同性斜视是简便而有效的手术方式,可以减少再次手术风险,使儿童全麻斜视矫正手术的成功率获得较大的提高。     

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.     

联合调整缝线的直肌后徙术矫正间歇性外斜视疗效观察

目的探讨间歇性外斜视的手术时机,观察调整缝线的直肌后徙术的应用效果。方法对47例间歇性外斜视患者施行联合调整缝线的直肌后徙术。结果术后随访3～12个月,44例患者术后获得正常眼位,3例欠矫者经集合训练后得到改善。结论联合调整缝线的直肌后徙术是矫正间歇性外斜视简便而有效的手术方式,可减少再次手术。     

Results of a combined adjustable recession and posterior fixation suture of the same vertical rectus muscle for incomitant vertical strabismus

PURPOSE: The posterior fixation suture (fadenoperation) is an effective treatment for complicated incomitant vertical strabismus. Traditional operative methods do not permit the simultaneous use of an adjustable recession of the same muscle. METHODS: Seven patients with incomitant vertical strabismus and diplopia were treated with a combined adjustable recession and posterior fixation suture of the same vertical rectus muscle. Preoperative vertical misalignments in the primary position ranged from 4 to 10 prism diopters. Vertical incomitance from the primary position into the field of action of the recessed vertical rectus muscle ranged from 6 to 30 prism diopters (mean, 17 prism diopters). This was the sole operation in five patients and was combined with other vertical muscle surgery in two others. RESULTS: All seven patients experienced improvement in their diplopia. Five of 7 patients (71%) required postoperative adjustments to achieve orthophoria in the primary position. This combined procedure reduced large deviations in the field of action of the recessed vertical muscle in all cases. Six of 7 patients (86%) did not require prismatic correction after this operation. One patient required prism only in his reading glasses. CONCLUSIONS: A combined adjustable recession and posterior fixation suture of the same vertical rectus muscle was effective in reducing or eliminating vertical incomitant strabismus.     

Single-stage adjustable strabismus surgery for restrictive strabismus.

PURPOSE: To evaluate the feasibility and stability of ocular alignment of single-stage adjustable strabismus surgery (SSASS) in restrictive strabismus. METHODS: This was an observational case series comprising 12 patients with restrictive strabismus (mean age, 54.8 years) who were treated with SSASS using intravenous midazolam, fentanyl, and topical anesthesia. All were studied in a retrospective institutional manner. The refractive strabismus in 7 patients was caused by dysthyroid orbitopathy. Five patients had undergone previous ocular surgery, and 4 had undergone previous strabismus surgery. SSASS typically involved the vertical rectus muscles. Horizontal rectus muscles were adjusted when necessary. Silicon-treated polyester suture material (Ti-cron; United States Surgical, Norwalk, CT no longer available), 6-0, were used for inferior rectus recessions. Ocular alignment was set at ortho at the end of surgery and evaluated at 2 days, 6 weeks, and 3 months after surgery. The typical hang-back procedure was to lock the suture at the middle and edges of the tendon or muscle at the intended disinsertion point. The tendon was then disinserted and hung back from the original insertion with adjustments until the desired position (ortho) and single vision were attained. RESULTS: All patients remained comfortable throughout surgery and had no significant postoperative discomfort. All patients except 2 (16.6%) maintained satisfactory vertical alignment (<2 prism diopters). These 2 patients with dysthyroid orbitopathy had progressive overcorrection after inferior rectus recession. CONCLUSIONS: SSASS, using intravenous midazolam, fentanyl, and topical anesthesia, is a safe and precise alternative treatment for patients with restrictive strabismus including those with dysthyroid orbitopathy.     

下直肌后退术治疗甲状腺相关眼病性眼外肌病变

目的 探讨下直肌后退术治疗甲状腺相关眼病性眼外肌病变的适应证、手术特点和效果等.方法 回顾分析诊治的39例甲状腺相关眼病性眼外肌病变需作下直肌后退术的患者.其中男24例:女15例:年龄28.0～66.0岁(平均49.9岁).手术方式包括下直肌后退术31例;下直肌断腱术1例:下直肌后退+上白:肌缩短3例;下直肌后退+内直肌后退2例:右眼下直肌后退+左眼内直肌后退外直肌缩短1例;左眼下直肌后退+右眼上直肌后退下直肌缩短1例.术后平均随访1.4年.结果 术后25例正位,复视消失;欠矫5～15°10例,复视明显改善:过矫4例.20°以内的下斜视行下直肌后退术每1mm后退平均可矫止2.5°.大度数垂直斜(20°～＞45.),78.9%(15/19)行患眼下直肌后退术可矫正;21.0%(4/19)需行下直肌断腱术或加患眼上直肌缩短术.所有大度数垂直斜均需作眼球缝线固定术.结论 下直肌后退术治疗甲状腺相关眼病性眼外肌病变的限制性下斜视效果满意,文中对手术时机、手术特点、手术方式与手术注意点进行了详细的讨论.     

Strabismus Complications from Local Anesthetics

Strabismus developing after retrobulbar or peribulbar anesthesia for both anterior and posterior segment eye surgery may be due to myotoxicity to an extraocular muscle from the local anesthetic agent. Initial paresis often causes diplopia immediately after surgery, but later progressive segmental fibrosis occurs, and/or hypertrophy of the muscle, producing diplopia in the opposite direction from the direction of the initial diplopia. The inferior rectus muscle is most commonly affected. Usually a large recession on an adjustable suture of the involved muscle(s) yields good alignment. Using topical anesthesia or sub-Tenon's anesthesia can avoid this complication.     

甲状腺相关性眼病的治疗

目的探讨甲状腺相关性眼病局部应用皮质类固醇的治疗效果;探讨甲状腺相关性眼病斜视的手术治疗效果及并发症发生。方法将87例甲状腺相关性眼病患者分为保守治疗组54例和手术治疗组33例。将保守治疗组分为2组。Ⅰ组29例眼局部给于地塞米松,Ⅱ组25例局部用药,观察并记录眼突、睑裂高度和斜视角、眼球运动的变化,并对两组结果进行统计学处理。手术治疗组33例患者行直肌后退术,手术成功标准为原在位和阅读位无复视。结果(1)87例斜视患者以多条直肌受累为主,下直肌受累频率最高(82%),外直肌受累频率最低(14%)。单条肌肉受累者占27%。(2)保守治疗组眼局部用地塞米松者较不用药者复视、眼球突出度、眼睑退缩和角膜着色明显好转,有统计学意义。(3)33例416眼58条直肌行后退术,其中18例(55%)治愈,11例(33%)明显改善;4例(12%)治疗效果差。所有患者行可调缝线手术,21例(64%)患者手术中或手术后需调整缝线的位置。2例术后产生轻度A 型外斜视,2例出现下睑退缩。结论甲状腺相关性眼病以多条直肌受累为主,早期用皮质类固醇激素治疗可以明显减轻症状,对稳定期患者的斜视采用可调缝线的直肌后退术矫正,治愈率高手术效果满意。     

The surgical management of strabismus with large angle in patients with Graves’ ophthalmopathy

Background Strabismus with large deviation in Graves’ ophthalmopathy is relatively common in developing countries, such as China. However, little information is available in the literature on this condition. We report here our surgical results of strabismus with large deviation in Graves’ ophthalmopathy. Patients and methods The surgical management of strabismus in 27 patients with Graves’ ophthalmopathy with large angle (≥25°) were retrospectively analyzed. The strabismus surgery included recession or free tenotomy of involved rectus muscle, recession of rectus plus resection of ipsilateral antagonist, and recession of rectus plus recession of contralateral antagonist. The patients were followed up for an average of 1.2 years. Results Among 27 patients, 17 were male and 10 were female, with their age ranging from 28 to 68 years old (mean: 51.9 years). There were 12 cases with excellent results, 10 with good results, 3 with fair results, and 2 with poor results. Only one surgery was required in all cases except three who needed re-operation. Based on the rectus muscles involved, just one rectus muscle recession combined with traction suture could correct the strabismus with large angle in 20 patients; two muscles were required in 9 patients and three in 1 patient. Four patients had surgical overcorrection of strabismus. Eight patients had complicated eyelid retraction postoperatively. Conclusions The surgical management of strabismus with large deviation in patients with Graves’ ophthalmopathy was remarkably good. Just one rectus muscle recession combined with traction suture could correct the large angle strabismus in 74% (20/27) of cases. The choice of surgical procedure and some special attention in performing surgery are discussed.