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。     

早期手术治疗先天性内斜视

目的探讨先天性内斜视的临床特征和手术治疗方法和效果。方法回顾分析2002年1月至2006年12月我院收治的58例先天性内斜视病例的临床资料及治疗结果。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,伴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。结果术后治愈率为81．03％,弱视、眼球震颤、垂直斜视及双眼视功能不良是影响术后正位率的主要原因。结论先天性内斜视发病年龄早、斜视度大,应尽早手术,术后长期随访及时处理伴发症状是提高远期正位率的有效方法。     

Faden术在矫正非屈光调节性内斜视中作用分析

目的 探讨Faden术在非屈光调节性内斜视矫正中的作用.方法 取12例非屈光调节性内斜视,AC/A值＞7,远近斜视角相差在15△以上,根据斜视度行双内直肌Faden术或双内直肌后退联合Faden术.结果 术后10例患者视远和视近时基本正位,1例视近仍残余＜+15△内斜视,l例视远过矫.结论 Faden术可有效矫正非屈光...     

分离性垂直性斜视的诊断及手术

目的 探讨分离性垂直性斜视(dissociated venical divergence,DVD)的手术方法及效果.方法 28例(40眼)DVD者中双眼上斜视度不相等者做双眼不等量上直肌后退;单眼DVD做单跟上直肌后退.后退最大量8 mm.合并下斜肌亢进者做下斜肌转位术,伴有的水平斜视也同时矫正.结果 12例单眼上直肌后退,术后观察3～5周,出现对侧眼上斜视6例,上斜视度在10△左右.8例行不等量上直肌后退,效果较好,外观改善,被遮盖眼无明显上漂.6例下斜肌亢进,行下斜肌转位.经半年以上观察,手术效果好.结论 采用同视机和三棱镜检查为手术提供依据,做不等量上直肌后退.     

V征斜视的临床特点和手术治疗的远期效果

目的探讨V征斜视的临床特点和手术方法及治疗效果。方法收集63例因V征斜视行下斜肌减弱术和常规水平直肌后退和(或)缩短术患者,回顾性总结和分析手术前、后的斜视度数,上、下注视眼位的斜视度数差,斜肌功能和双眼视功能状态。平均随访时间为8.2个月。结果62例(98.4%)患者合并双眼或单眼下斜肌功能亢进(+2或+3),行下斜肌减弱术和常规水平直肌后退和(或)缩短术;1例患者合并双眼下斜肌功能亢进(+1),仅行水平直肌后退缩短术。术前上、下注视眼位的斜视度数差为25.6△,随访末期为4.5△。48例外斜视V征患者术前水平斜视度数为(外斜)37.2△,随访末期为(内斜)3.4△,其中38例(79.2%)患者的斜视度数<±10△;15例内斜视V征患者术前水平斜视度数为50.6△,随访末期为(内斜)2.4△,其中11例(73.3%)患者的斜视度数<10△。术后21例(33.3%)患者恢复立体视功能。结论V征斜视患者多合并下斜肌功能亢进,减弱下斜肌功能可有效矫治V征斜视,常规斜视矫正方法可有效矫正水平斜视;术后患者立体视功能恢复情况良好。     

眼球后退综合征的手术治疗

目的探讨并分析Duane眼球后退综合征的手术方法和疗效。方法对我院2004至2011年14例眼球后退综合征合并斜视患者的的临床特点、手术方式和效果进行回顾性总结和分析。9例患者为Duane征Ⅰ型合并内斜视,5例患者为Ⅱ型合并外斜视。内转时同时伴有眼球上/下转现象者10例,有明显代偿头位者4例。根据斜视类型,斜视度数以及内转时是否伴有眼球上/下转现象选择内外直肌后徙或加下斜肌减弱术。以术后斜视度≤±10△为正位。结果 12例患者术后眼位正位,斜视度≤±10△,占总数86%。所有患者术后眼球后退及睑裂变小体征均得到改善。6例患者眼球的上/下转现象消失,4例改善。4例有明显代偿头位患者术后头位消失。结论 Duane眼球后退综合征的手术治疗方法与常规斜视手术不同,其斜视度与手术量无明显对应关系,原则上不主张在患眼行加强术,当眼球内转时伴有明显上转或下转现象时可行内外直肌同时后徙术,必要时可考虑下斜肌手术。术前牵拉试验及术中彻底消除牵制因素是手术成功的关键。     

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。     

Duane眼球后退综合征21例手术治疗临床观察

目的探讨眼球后退综合征（DRS）的临床特点和手术方法。方法21例眼球后退综合征根据术前不同的斜视度、斜视类型、牵拉实验结果、同视机检查结果以及眼球内转时是否伴有上射和（或）下射现象,在解除限制因素的前提下分别采取内直肌后退或悬吊术,外直肌后退或悬吊术,内外直肌同时后退或悬吊术以及外直肌Y型劈开联合后退术。结果术后内转眼上射和（或）下射现象及代偿头位有不同程度的改善或消失。14例内斜视术后12例斜视度≤10^△,2例斜视度〉10△.其中2例在行内直肌后退术后出现外斜视。7例外斜视中,5例行外直肌后退或悬吊术,2例行外直肌Y型劈开联合后退术,其中6例术后斜视度≤10△,1例斜视度〉10△。结论在解除限制因素的前提下,水平直肌大量后退可以消除或改善代偿头位,亦可恢复原在位的眼位。对于斜视度≤20△且有代偿头位的DRS患者,可以戴棱镜矫正。直肌Y型分开联合后退术或水平直肌同时后退术在解决内转眼上射和（或）下射现象时有显著疗效。     

双眼内直肌后退术治疗高AC/A非屈光性调节性内斜视

目的对高AC/A的非屈光性调节性内斜视患者,进行双眼内直肌后徙术,观察手术疗效.方法选取15例高AC/A的非屈光性调节性内斜视患者进行双眼内直肌后徙术,后徙量依据斜视度数而定,术后观察眼位,AC/A值及双眼单视功能.结果15例患者术后视远斜视度数平均减少36.80棱镜度,视近斜视度数平均减少48.80棱镜度;9例患者术后双眼立体视锐度有不同程度的提高;13例患者术后不再需要双光镜.2例患者视近斜视度数没有得到改善,术后仍需戴双光镜.结论对高AC/A的非屈光性调节性内斜视患者进行双眼内直肌后徙术,是一种有效的治疗方法.     

远视合并固定性内斜视手术效果分析

目的:分析远视合并固定内斜视的特征及手术效果.方法:远视合并固定性内斜视26例,水平内斜视20△者,行单眼内直肌后徙5mm;40△～60△者,双眼内直肌后徙5～6mm,垂直斜度20△者,行双上直肌后徙5mm:垂直斜度大于20△者,下斜肌亢进者行下斜肌转位术.术后,同视机训练3级视功能.结果:术后观察12wk,本组26例中,21例内斜视小于10△,4例10△～15△,1例过矫外斜小于15△,术后正位率77%.10例有周边融合,2级视功能占73%.其中6例有立体视,立体视锐角小于500"(Titloms立体视检查).9例弱视者视力提高6例,占67%.结论:远视合并固定性内斜视早期诊断,早期手术,有利于提高视力,三级视功能建立.     

后天性共同性内斜视手术治愈后的双眼视觉

目的：探讨后天性共同性内斜视手术治愈后双眼视觉的恢复规律。方法：对40例后天性共同性内斜视经手术治愈后患者的临床资料进行分析。结果：40例后天性共同性内斜视患者术前36例(90％)无双眼视觉。术后40例(100％)具有同时知觉能力，40例(100％)可获得融合功能，但融合范围低于正常人群，26例(65％)获得远立体视，18例(45％)获得不同程度的近立体视。结论：后天性共同性内斜视患者黄斑中心凹立体视损害最严重，对于后天性共同性内斜视的临床处理应更加积极，树立婴幼儿期的持续性内斜应急诊处理的观念，使更多患儿获得良好的立体视觉。     

早发内斜视的临床分析

目的以发病时间（生后6个月以内）为进入研究的唯一条件,分析出生后早期发生的内斜视的疾病构成,并对未治疗先天性内斜视患者的疾病概况做一统计,期望对临床诊断和治疗有所帮助。方法选取主诉为出生后6个月以内发病、经检查诊断为内斜视的患者179例,分析其疾病构成。并对其中诊断为先天性内斜视的患者,按年龄分组,分别统计视力、屈光状态、斜视角、伴发垂直斜视、伴随调节因素、双眼视功能等情况,对各种异常的出现频率做一比较及分析。结果 179例患者中,171例为先天性内斜视,其余为眼球震颤阻滞综合征,眼球后退综合征、第6颅神经麻痹。先天性内斜视患者按年龄分为5组,屈光状态大多为轻到中度远视;斜视角为＋15 PD～＋110 PD（三棱镜度）;伴发垂直斜视者占13.3%～37.9%;伴随调节因素者占6.2%～43.3%;发生弱视者占26.7%～47.7%。除5例同视机检查有Ⅱ级以上视功能外,其余患者同视机检查及颜少明立体图检查均无双眼视功能。结论早发性内斜视的主要类型为先天性内斜视,其疾病表现复杂,弱视的成因中以斜视性弱视最多见,斜视角较小的患者有可能获得部分双眼视功能,基于先天性内斜视对双眼视的巨大危害,应早期手术。     

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.     

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.     

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.     

The clinical course of consecutive esotropia after surgical correction

PURPOSE: To investigate the clinical course in patients who underwent surgical correction of consecutive esotropia. METHODS: The medical records of 13 patients who underwent surgical correction of consecutive esotropia were reviewed retrospectively. The authors investigated the deviation and surgical method at the time of exotropia surgery. During the follow up period, the authors also studied incidence of amblyopia development, the effect of occlusion therapy, surgical methods for consecutive esotropia, and postoperative change of deviation. RESULTS: The average exodeviation was 27.1 prism diopter (PD). Bilateral lateral rectus muscle recession was performed in all patients. In all patients, alternate occlusion was tried from 2 weeks after development of consecutive esotropia. However, there was no effect on 7 patients. None of the patients developed amblyopia. Surgery for consecutive esotropia was performed on the average 15.3 months after exotropia surgery. The average esodeviation was 21.1PD. Medial rectus muscle recession was performed in 10 patients and lateral rectus muscle advancement in 3 patients. The average deviation of the subject group immediately after surgery was 1.2PD esodeviation, 0.9PD esodeviation one month after surgery, 2.4PD exodeviation 6 months after surgery, and 4.7PD exodeviation at the last follow up, and it showed a tendency to progress to exodeviation as the follow up period increased. Ten patients (76.9%) showed deviation within 8PD at the last follow up. CONCLUSIONS: The success rate of surgical correction for consecutive esotropia was a favorable outcome. But, careful decisions of the surgical method and amount is needed because the conversion of exodeviation during long-term follow-up is possible.     

Comparison of clinical characteristics of familial and sporadic acquired accommodative esotropia.

PURPOSE: To compare the clinical characteristics of patients with familial and nonfamilial acquired accommodative esotropia. METHODS: We recruited 48 patients from 33 families with acquired accommodative esotropia (an inward deviation of the eyes of 10 PD or more, a hypermetropia greater than or equal to +1.50 D, and an onset of esotropia at, or later than, 1 year of age). Our control group consisted of 20 patients with no known family history. Spherical error of refraction, stereoacuity, and need for strabismus surgery were determined and the 2 groups were compared. RESULTS: No statistically significant difference was found between the spherical equivalent error of refraction in familial cases (mean = +4.50 OD, +4.63 OS; range = +1.50 to +10.30 OD, +2.00 to +9.38 OS) versus those with nonfamilial disease (mean = +4.93 OD, +5.02 OS; range = +2.50 to +11.00 OD, +2.50 to +10.90 OS) (P =.47 OD; P =.47 OS). There also was no difference between the percentage of patients with familial disease who had some degree of stereoacuity (58%) and those without a family history (59%) (P > .99). Patients with familial acquired accommodative esotropia did not require more surgical interventions (26%) than those with nonfamilial acquired accommodative esotropia (30%) (P = .79). CONCLUSIONS: The general clinical characteristics of familial and nonfamilial acquired accommodative esotropia are very similar.     

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）     

Common forms of childhood esotropia

OBJECTIVE: To determine the most common forms of childhood esotropia. DESIGN: Prospective, consecutive, observational case series. PARTICIPANTS: All esotropic children younger than 11 years of age from a predominantly rural Appalachian region evaluated from August 1, 1995 through July 31, 1998. METHODS: Demographic and clinical data were collected for all patients. MAIN OUTCOME MEASURES: The percentage ratio of the various forms of childhood esotropia. RESULTS: Two hundred twenty-one consecutive children without prior surgical treatment were evaluated for esotropia. One hundred seventeen (52.9%) of the 221 children had some form of accommodative esotropia, 38 (17.2%) were associated with congenital or acquired abnormalities of the central nervous system, 23 (10.4%) displayed acquired nonaccommodative esotropia, 15 (6.8%) resulted from ocular sensory defects, 12 (5.4%) had confirmed congenital esotropia, seven (3.2%) had paralytic esotropia, and an unverified age at onset prevented an accurate categorization in the remaining nine (4.1%). CONCLUSIONS: Children with accommodative esotropia accounted for more than half of the study patients and were diagnosed nearly 10 times more frequently than children with congenital esotropia. Esotropic patients with central nervous system defects or with an acquired nonaccommodative deviation were also more common than children with congenital esotropia. Children with congenital esotropia or with a paralytic or sensory cause of their deviation were relatively uncommon.     

Consecutive exotropia following strabismus surgery

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.