垂直斜视75例手术临床分析

目的探讨垂直斜视手术治疗方法,评价疗效。方法回顾分析75例垂直斜视手术患者。根据原在位垂直斜度、下斜肌亢进程度及其合并症不同分别采取下斜肌截断术、下斜肌截除术、下斜肌截除+转位术、下斜肌截除+转位+同侧眼上直肌后徙/或对侧眼下直肌后徙术、伴有水平斜视者按水平斜视矫正原则联合水平斜视矫正术、对无下斜肌亢进者行上直肌和/下直肌后徙术共6种手术方式,并进行平均3年以上的随访。结果 75例患者,通过6种手术方式进行一期手术,治愈57例(76%);好转12例(16%);无效6例(8%),其中欠矫4例(5.3%),过矫2例(2.7%),总有效率为92%。结论垂直斜视临床表现复杂,没有固定的手术模式,需根据术前详细的检查结果制定合理的手术方案,本文6种手术方法对治疗垂直斜视是可行的,绝大部分垂直斜视可通过一期手术获得临床治愈。     

成人斜视患者生存质量的调查研究

目的探讨成人斜视患者生存质量的现状。方法收集2010年1月至2014年1月诊断为显性斜视的成人患者104例,相同年龄的健康人106例作为对照,采用中文版成人斜视患者生存质量量表进行问卷调查。结果斜视组患者生存质量总分及两个维度得分均低于对照组(P0.01);高中及以上斜视患者心理维度得分和生存质量总分高于初中及以下患者(P0.05)。结论斜视无论是在社会心理方面还是功能方面均显著降低了成人患者的生存质量,且患者的文化程度是影响因素之一。     

成人斜视生存质量量表在斜视患者术前生存质量评估中临界值的研究

目的探讨成人斜视生存质量量表在成人斜视患者术前生存质量状况评估中的最佳临界值。方法对306例成人斜视患者,于入院第1天采用成人斜视生存质量量表及国家眼科研究视功能量表进行调查,以国家眼科研究视功能量表作为诊断"金标准",绘制受试者工作特征曲线,确定成人斜视生存质量量表的最佳临界值。结果成人斜视生存质量量表得分与国家眼科研究视功能量表得分呈正相关(r=0.481,P0.01);当成人斜视生存质量量表临界值为74.5时,受试者工作特征曲线在左上方离标准参照线最远,此时灵敏度、特异度、假阴性率及假阳性率分别为0.784、0.875、0.216、0.125。受试者工作特征曲线下面积为0.893,面积的标准误为0.038。由于量表采用Likert 5级评分,临界值取为整数74分。结论成人斜视生存质量量表在斜视患者术前生存质量状况评估中的最佳临界值为74分,是成人斜视患者术前生存质量状况评估的有效工具。     

A Post-Surgical Stereovision Surprise in an Adult With an Exotropia Since Infancy Previously Managed,at Two Years With Surgery

Aim:To describe an unexpected sensory outcome in an adult male who is seeking ocular re-alignment for a psychosocially symptomatic large non-specific exotropia with suppression. The primary diagnosis was infant onset exodeviation of unclear diagnosis, was managed with bilateral strabismus surgery at two years of age, little memory of follow-up.Result:Measurable binocular single vision (BSV) was demonstrable following surgery at 17 years of age, albeit slowly between two weeks and six months postoperatively and subsequently enhanced. His newly acquired sub-optimal BSV led to symptomatic occupation-associated asthenopia. Following two subsequent operations over a 15-year period, he has stable, symptom-free ocular realignment within three prism diopters of orthophoria and performing tasks that require extended periods of near-vision activity.Conclusion:Delayed high levels of stereovision were unexpectedly achieved in an adult with infant onset exotropia with pre-operative sensory suppression that was surgically aligned to near orthophoria. The re-establishment of BSV in such a clinical scenario has to attain a level that is robust enough to meet an individual’s social and occupational needs.     

调整性直肌后徙斜视矫正术

目的　探讨调整性直肌后徙斜视矫正术的治疗效果。方法　共同性斜视患者 34例 ,常规眼部消毒、铺巾、局麻后暴露及分离直肌 ,根据直肌后徙量 ,将缝线垂直于肌肉缝合在巩膜浅层 ,调整直肌后徙量至眼位达理想位置 ,再将缝线缝合于肌止缘 ,缝合结膜。结果　全部患者经手术中调整直肌后徙量 ,均一次性矫正斜视眼位 ,随访 6个月无复发。结论　调整性直肌后徙斜视矫正术治疗斜视其操作简便 ,矫正位置比较理想     

Moving muscles with microchips, mathematics and models: an update on the 'reverse' model

This paper reviews the current status of our computer model for the management of strabismus and its future direction. Vector analysis was first used in the 1950s for the assessment of strabismus. Robinson's model' was the first computer simulation of ocular motility. Using physiological principles and anatomical approximations, Robinson's model sought to predict the strabismic pattern to be expected from a given injury. The Kault/Stark 'reverse' model works in the opposite direction, to first simulate the given strabismic pattern and then advise the surgery required to restore orthophoria. The surgeon is able to 'trial' various operations and compare the expected postoperative results. An automated system is currently being developed to ease the difficulty in measuring the position of the eyes in all nine positions of gaze. This paper includes three illustrative case reports.     

Management of fixed divergent squint in third nerve palsy using traction sutures

Background: Long-standing fixed divergent squint is a difficult management problem, presenting marked cosmetic and functional symptoms in the patient, and a significant challenge for the squint surgeon to overcome.
Methods: We describe use of through-the-lid traction sutures in 24 consecutive patients with fixed divergent squint secondary to long-standing third nerve palsy. Very large recessions of the lateral rectus were combined with large resections of the medial rectus and traction sutures placed through the insertions of the superior and inferior rectus were brought out through the extreme medial for-nices and skin of the upper and lower lids. Sutures were tied overtarsorrhaphy bolsters and left in situ for six weeks.
Results: After removal of the traction sutures, the eye maintained a good cosmetic position in all but two cases. Postoperative motility was extremely limited or absent. Complications were limited to transient skin ulceration in two cases.
Conclusions: Supramaximal horizontal recess-resect procedure combined with adducting traction sutures left in situ for six weeks is a safe and effective procedure to restore the eye to the centre of the palpebral fissure.     

The development of fixing and focusing behaviour in normal human infants as observed with the Otago photoscreener

The Otago photoscreener is an optical instrument which gives a very sensitive indication of the accuracy with which a subject's eyes are fixing and focusing. Early experience suggested that this instrument could be used effectively to screen for the presence of amblyogenic factors in pre-verbal infants. This communication describes the development of ocular fixation and focusing in 137 normal infants who were followed at regular intervals during the first year of life. Accurate fixation and focusing was found in 13% of three-month-old infants, in 68% of six-month-old infants and in 76% of one year olds. The levels of 'focusing' visual acuity obtained from the photoscreen data are considerably better than the levels of cortical acuity measured by the standard behavioural and electrophysiological methods. This suggests that human infants fix and focus accurately for a considerable period before they are able to perceive all the details obtained in their retinal images.     

Injection treatment of endocrine orbital myopathy

Eight Patients with endocrine orbital myopathy received botulinum toxin injection of extraocular muscles for strabismus or injections of the levator for lid retraction. Strabismus of 25 prism diopters or less, especially during early stages of eye muscle involvement, responded well to injection with realignment and, probably, with avoidance of fixed muscle shortening. Long-standing strabismus, large angles, and lid retraction responded less well.     

Ophthalmic prisms. Measurement errors and how to minimize them

Variable results of strabismus surgery may be due in part to errors in prism measurement. The amount of deviation neutralized by an ophthalmic prism is variable depending on how the prism is held. For example, a 40 delta glass prism with the posterior face held in the frontal plane gives only 32 delta of effect. Glass prisms are calibrated for use in the Prentice position. Plastic prisms are calibrated for use in the frontal plane position. Surprisingly large errors in prism measurement are produced when adding a small prism to a large prism. For example, adding a 5 delta glass prism to a 40 delta glass prism gives not 45 delta of effect, but 59 delta. This error can be minimized but not eliminated by holding one prism in front of each eye. The error can also be calculated so that the appropriate correction can be made.