外直肌超常量后徒矫治大角度外斜视42例

目的观察外直肌超常量后徒的临床效果。方法对42例大角度外斜视行超常量徒后外直肌(8～14mm)。结果术后 1周眼位基本正位(正位或≤5°)者32例(76％),术后随访8～16月中,眼球运动正常者34例(81％)。结论外直肌超常量 后徒术矫治大角度外斜视疗效满意。     

Ⅴ型斜视的手术治疗

目的探討Ⅴ型斜視不同術式的治療效果.方法采用直肌符着點垂直移位及下斜肌部分切除兩種方法治療Ⅴ型斜視.結果V型斜視采用下斜肌部分切除術和直肌符着點移位術均取得較好治療效果,但下斜肌部分切除效果更為明顯.結論采用直肌符着點垂直移位及下斜肌部分切除術矯正Ⅴ型斜視不但可矯正眼位,而且可重建視功能.     

Strabismus and employment: the opinion of headhunters

Purpose: The aim of this study was to determine the influence of strabismus on an individual’s ability to find employment based on the opinion of Swiss headhunters. Methods: Forty Swiss headhunters retrieved from a Swiss online telephone directory were interviewed using a validated questionnaire in order to determine if strabismus would have an impact on a person's ability to find employment. Photographs of a strabismic man and woman as well as of other computer‐generated facial anomalies could be downloaded from the Internet during the interview. Results: 72.5% of headhunters judged that strabismic individuals would have more difficulties in finding a job than orthotropic persons. These difficulties were judged to be stronger in women than in men (P = 0.006), and in exotropic compared to esotropic persons (P = 0.01). Asked about seven facial anomalies, exotropia was found to have the third and esotropia the fourth (women) or fifth (men) most strongly negative impact on finding employment, after having strong acne and a visible missing tooth. Headhunters judged that persons with strabismus are significantly perceived as less attractive and less intelligent by potential employers. Conclusion: Visible strabismus negatively influences individuals’ ability to find a job and therefore has an impact on their economic status. Successful strabismus surgery realigns the visual axes, producing a normal facial appearance and therefore eliminating the negative impact of strabismus on employability.     

V型斜视手术探讨

目的 :探讨V型斜视不同术式 ,以求达到矫正斜视 ,消除V征 ,建立双眼视功能目的。方法 :按V征上下斜角差的大小分为 <2 0 Δ、 2 0～ 30 Δ、 >30 Δ 三组 ,分别采用水平直肌垂直移位 ,下斜肌减弱及下斜肌减弱加水平直肌垂直移位三种术式 ,分别矫正上下斜角差异不同的V型斜视。结果 :以上术式不仅矫正了水平斜视 ,消除V征 ,而且可能建立和恢复原在位及阅读眼位双眼单视功能。结论 :水平直肌垂直移位 ,下斜肌减弱及下斜肌减弱加水平直肌垂直移位三种方法能达到矫正眼位的目的 ,术后测定远近立体视锐度 ,对双眼单视功能及疗效的评价有重要意义。     

Effects of slanted bilateral lateral recession vs conventional bilateral lateral recession on convergence insufficiency intermittent exotropia: a prospective study

AIM: To observe the surgical effects of slanted bilateral lateral recession (S-BLR) versus conventional bilateral lateral recession (C-BLR) in convergence insufficiency intermittent exotropia (CI-IXT). METHODS: Using a randomized, double-blind, prospective design, 22 patients with CI-IXT who were admitted to Renmin Hospital of Wuhan University from July 2019 to December 2020 were included. Patients were randomly divided into either S-BLR or C-BLR group for their subsequent strabismus surgery. All patients were followed up for 12mo. Near deviation, distant deviation, and near-distance difference (NDD) were measured in all patients. RESULTS: Twelve months after surgery, NDD improvement was 10 (8, 13) prismatic degrees (PD) in S-BLR group and 3 (1, 6) PD in C-BLR group (P=0.011). The near deviation of S-BLR group was 0 (-2, 2) PD, while that of C-BLR group was -4 (-6, -3) PD (P=0.005). Before and after surgery, the difference in the distant deviation between the two groups was not statistically significant. There was no statistically significant difference in near stereopsis between the two groups (P=0.380) at 12mo. The success rate at 12mo after operation was 90.91% and 72.73% in the two groups (P=0.280). CONCLUSION: CI-IXT patients treated with S-BLR have better surgical outcomes than those treated with C-BLR, which indicates S-BLR is a safe and effective operation pattern.     

Ultrasound Biomicroscopy in Strabismus Surgery: Efficacy in Postoperative Assessment of Horizontal Muscle Insertions

ABSTRACT

Purpose: To study the efficacy of ultrasound biomicroscopy (UBM) in assessment of extraocular muscle insertion sites after strabismus surgery.

Methods: This double masked prospective interventional study included 16 eyes of 15 patients with deviation <60 prism diopters (PD) who underwent primary horizontal strabismus surgery. Preoperative muscle insertion was measured by UBM and compared with measurements done intraoperatively by surgical caliper. Both measurements by surgical caliper were taken intraoperatively before and after performing the planned repositioning of the muscle insertion. Postoperatively muscle insertion was remeasured by UBM and compared with the presumed muscle insertion after surgery. Clinically limits of agreement of?±?1?mm were taken as acceptable.

Results: Mean age of patients was 21?±?3 years (range 16–28 years). Preoperative average distance of the medial rectus (MR) from limbus was 5.3?±?0.3?mm (4.9–5.9?mm) by the UBM and 5.6?±?0.3 (5–6?mm) by surgical caliper (p?=?0.05). For lateral rectus (LR), UBM measurements from the limbus were 6.8?±?0.7?mm (5.9–8.3?mm) and 7.1?±?0.4?mm (6.5–8?mm) by calipers (p?=?0.067). Post–op UBM at 3 months could visualize new muscle insertion for all operated MR muscles (i.e., 100% of cases) and for LR muscles in only 50% of cases. However, accuracy could be achieved only in 78.6% of cases for MR muscle and for LR in 62.5% of cases (among LR muscles that were visible post-op). Maximum distance posterior to the limbus that the UBM was able to detect MR was 11.2?mm and for LR was 13.5?mm.

Conclusion: UBM does not detect the new position of LR with any consistency postoperatively. Even after detection of muscle, the new insertion is only within ±1?mm of the actual muscle insertion in 62.5% of the cases. Hence it is not a reliable tool for planning resurgery.     

双眼视觉训练对间歇性外斜视儿童术后双眼视功能重建的疗效观察

目的:观察双眼视觉训练对间歇性外斜视儿童术后双眼视功能重建的疗效。方法:将2010-01/2011-10收治的112例间歇性外斜视患儿,术后分为3组,第1组采用同视机进行双眼视觉训练,第2组采用视知觉学习训练软件进行双眼视觉训练,第3组为对照组,未进行双眼视觉训练。对三组患儿术后视远、视近立体视锐度及术后1a眼位正位率进行观察比较。结果:两组视觉训练患儿视远、视近立体视锐度显著高于对照组,差异有显著性。在术后1a随访时,对照组眼位正位率显著低于其他两组。结论:间歇性外斜视患儿术后进行双眼视觉训练,可显著促进患儿双眼视功能的重建,降低眼位回退率,提高手术成功率。     

直肌移位联合改良肌联结术治疗麻痹性内斜视

目的：观察直肌移位联合改良的肌联结术治疗麻痹性内斜视的手术效果。方法对31例（33眼）麻痹性内斜视病人采用直肌移位联合改良加强的肌联结并同时行相应内直肌后徙术治疗。观察术后原在位眼位、代偿头位、眼球运动及复视的改善效果。随访6月~36月,平均14.5月。结果术后26例（27眼）原在位〈＋10△,2例（3眼）欠矫10△以上,3例（3眼）轻度过矫。原在位满意者（＋10△~-10△）占90.9%。术后27例代偿头位矫正。2例残存微小头位。外转过中线5°~20°,平均9°。随访期间过矫的3例恢复。原在位满意者占81.8%。未发现眼前节缺血并发症。结论直肌移位联合改良的肌联结术是一种有效治疗麻痹性内斜视的良好方法。     

眼球后退综合征的手术设计

目的 探讨眼球后退综合征(DRS)手术设计的特点。方法 11例眼球后退综合征患者，采用常规的方法检查眼位，单眼、双眼水平注视野，异常头位的偏斜角度。手术方式患眼外直肌不等量后徙。结果 原在位外斜，双眼注视野位于患眼颞侧，面部转向健眼一侧。手术后外斜视得到矫正，异常头位消失。结论 为了矫正原在位存在外斜视，即使外直肌力量不足，手术后外转进一步受限，也需减弱外直肌，以期获得良好效果。