三种下斜肌转位术治疗分离性垂直斜视疗效观察

目的观察三种下斜肌转位术治疗分离性垂直斜视的手术疗效,探讨治疗DVD的最佳手术方法。方法伴有下斜肌功能亢进的DVD患者75例,根据手术方式分为3组:单纯下斜肌转位术组、下斜肌截除联合转位术组、下斜肌截除联合前徙并转位术组。观察3组术后1个月、3个月及6个月的眼位、下斜肌运动、代偿头位及并发症情况。结果 3组患者术后下斜肌亢进均消失;代偿头位均不同程度改善;单纯下斜肌转位术组和下斜肌截除联合转位术组术后效果良好者23例(92%)、下斜肌截除联合前徙并转位术组术后效果良好者24例(96%),3组间疗效无明显差异,P<0.05。单纯下斜肌转位术无明显的睑裂变化及上转受限,而联合截除术式有少部分患者出现睑裂变小和眼球上转受限。结论单纯下斜肌转位术可矫正15△~25△的垂直斜视,且术后眼球上转受限和睑裂变化也不明显,是伴有下斜肌功能亢进DVD的首选方法。

Surgical effect of three inferior oblique muscle transposition to treat the dissociated vertical deviation asso-ciated with inferior oblique overacfion,

Objective To evaluate the best surgical method for the treatment of dissociated vertical deviation（DVD） through observed three operation technics about inferior oblique muscle transposition. Methods 75 eyes of 75 patients which diagnosed DVD associated with inferior oblique overaction underwent 3 groups with random method and taken three surgeries respectively. All of the patient＇s vertical slope are within the limits of 15^△-25^△and to classified four degree according to corneal light reflection method which 6A-10A is two plus （＋＋）, 11^△-15^△is three plus（＋＋＋） and 〉16^△ is four plus（＋＋＋＋）. The details of the surgeries： （1） inferior oblique muscle transposi- tion： transposed the inferior oblique muscle to the temporal side of the end of inferior rectus muscle; （2） partial myectomy of transpositional inferior oblique muscle： cut 5mm inferior oblique muscle and transposed it to the temporal side of the end of inferior rectus muscle; （3） anterior transposition of the interceptive inferior oblique muscle： cut 5mm inferior oblique muscle and transposed it to the anterior temporal side of the end of inferior rectus muscle, the operation weight is lmm of ＋＋ , 2mm of ＋＋＋ and 3mm of ＋＋＋＋. The effectiviness of orthopia, the correction of inferior oblique overaction and compensatory head posture and complication were observed lm, 3m and 6m after the surgeries. Results The inferior oblique overaction is disappeared in all groups of 75 eyes, and compensatory head posture has amend in 9 cases. About the orthopia： according to the data of the postoperative effect which good in 23 cases（92%） of group 1 and group 2 respectively and 24 cases （96%） of group 3, and there still has residued one plus degree vertical slope in 5 cases, there no statistical difference among the three operation technics. In other respects, a little limited of eye ball up rotation and coarctation of palpebral fissure were be ob- served in group 2 and group 3. Conclusions Inferioroblique＇ muscle transposition which could amend 15^△- 25^△A vertical slope is the appropriate method to treatDVD associated with inferior oblique overaction according to our study because of more simple and less complication like the limited of the eye ball up rotation and the coarctation of palpebral fissure, and this method has the same effectiviness compared with other two methods.