下斜肌截除及前转位术治疗大度数垂直斜视临床分析

目的 评价下斜肌截除及前转位术治疗大度数垂直斜视的疗效.方法 以2001年1月至2009年6月收治的53例大度数垂直斜视(≥15△)患者为研究对象,均采取下斜肌截除(3～8mm)及前转位术,即转位于下直肌颞侧缘前1 mm处.对于垂直斜度在15△～25△之间者,下斜肌截除3～5mm;垂直斜度在25△以上者,下斜肌截除6mm及前转位后,术中照影观察,将残留的垂直斜度按1∶1.5的原则分配在该眼的上直肌与另一眼的下直肌(上、下直肌后徙1mm可解决1.5°的垂直偏斜);对于垂直斜度在60△以上的先天性下直肌缺如合并小角膜患者,下斜肌截除6～8mm及前转位术.伴有水平斜视时,按水平斜视矫正原则进行一并矫正.结果 经3～36mo随访,平均18mo.53例大度数垂直斜视患者Ⅰ期治愈40例(75.5%),好转9例(17.0%),未愈4例(7.5%).总有效率92.5%.结论 在大度数垂直斜视患者中,伴有下斜肌功能亢进者,首选下斜肌截除及前转位术,不足以矫正垂直偏斜时,联合该眼的上直肌与另一眼的下直肌后徙术,合并水平斜视时,均可Ⅰ期矫正.

Clinical analysis of the large degree's vertical strabismus with the myectomy and anterior displacement of inferior oblique surgical treatment

Objective To evaluate the patient's efficacy whose large degree's vertical strabismus treated by the myectomy and anterior displacement of inferior oblique surgery. Methods Included 53 patients with large degrees vertical deviation (≥ 15△) who treated by our department from January 2001 to June 2009 as the research object. All were treated by the myectomy (3-8mm) and anterior displacement of inferior oblique surgery, that was translocate the muscle 1mm before the temporal margin of inferior rectus. For the patients whose vertical gradient between the 15 △-25 △, the inferior oblique to be cut 3-5mm; For those patients whose vertical gradient above 25△, intraoperative observed after the inferior oblique to be cut 6mm and anterior displacement of inferior oblique surgery, then distribute the vertical gradient of the residual to the superior rectus /another inferior rectus of the eye according to principle of 1:1.5 (The upper and lower rectus moved back 1mmcan resettle the vertical deviation 1.5°). For the congenital absence of inferior rectus muscle in patients concurrent microcomea whose vertical gradient above 60△, the inferior oblique to be cut 6-8mm and anterior displacement of inferior oblique surgery. When accompanied horizontal strabismus, it was to restructure the strabismus according to principle of the horizontal strabismus at the same time. Results After 3-36mo reciprocal, with an average 18mo, 53 cases of vertical strabismus in patients with large degrees of stage Ⅰ cured 40 cases (75.5%), improved in 9 cases (17.0%), healed in 4 cases (7.5%). The total effective rate was 92.5%. Conclusions The large degree vertical strabismus patients who accompanied by inferior oblique hyperfunction,the first choice is the myectomy and anterior displacement of inferior oblique surgery. If it is insufficient to correct the vertical deviation, At the same time move back the superior rectus of the eye or move back inferior rectus of another eye. When combined with horizontal strabismus, all can receive stage Ⅰ correction.