单眼一退一缩术式矫正集合不足型间歇性外斜视短期效果分析

目的：观察一退一缩术式对集合不足型间歇性外斜视的效果和术后回退程度。

方法：对45例集合不足型间歇性外斜视患者由同一术者进行单眼一退一缩术式后,检查术后1d,2wk的斜视度,并进行统计分析。

结果：集合不足型间歇性外斜视患者45例进行单眼一退一缩术式后,术后1d,视远平均过矫8.27±7.17PD,视近平均过矫2.40±8.86PD,术后2wk视远平均欠矫1.18±6.98PD,视近平均欠矫4.36±7.83PD。术后2wk内,视远平均回退9.45±6.40PD,视近平均回退6.77±7.92PD。视远及视近回退呈正相关。术后2wk视远视近斜视度差异(3.18±5.60PD)较术前(7.65±6.55PD)明显减小,两者呈正相关。

结论：集合不足型间歇性外斜视患者适合一退一缩术式,适当加大内直肌手术量可减少术后远近斜视度的差异,且不改变患者内外直肌的张力状态。术后视远视近回退呈同步状态,视远约回退10PD,术后近期过矫10PD可有利于远期正位。     

Surgical treatment of myopic strabismus fixus: a graded approach

Background  Surgical treatment of myopic strabismus fixus is challenging. Options for its correction range from conventional combined recession-resection surgery to innovative surgical procedures aiming to correct the deviated muscle paths. In this report we review our experience and compare the results of various surgical options for treatment of strabismus fixus. Methods  We report the surgical outcomes of nine adults with acquired strabismus fixus due to myopia with a follow-up of 1 year. Patients were enrolled between May 2003 and April 2007 in this retrospective study. The surgical procedure was determined depending on the angle of deviation and extent of motility impairment. A new transposition technique was performed in one patient who had an extreme variant of strabismus fixus. Results  Combined recession-resection surgery was performed in four patients with resulting small-angle esotropia. In patients with both esotropia and hypotropia due to muscle alignment, we performed an additional upward displacement of both horizontal recti muscles combined with a myopexy of the lateral rectus muscle. The results were satisfying; in particular in one patient who had a transposition procedure a significant improvement was achieved. Conclusions  For treatment of myopic strabismus fixus, a graded approach seems advisable. Combined recession-resection surgery yields good results for smaller deviations with mildly impaired motility, additional fixation techniques need to be applied once the horizontal muscle paths are deviated, and in extreme cases, a transposition procedure is required.