先天性特发性眼球震颤手术治疗后视功能的恢复

背景先天性特发性眼球震颤的手术方式已日渐成熟，但其术后视功能的恢复仍然值得关注。目的探讨先天性特发性眼球震颤的手术治疗方法及其对视功能的影响。方法按照患者的头位扭转角大小和斜视度数的不同将60例先天性特发性眼球震颤患者分为4组，Ⅰ组：头位扭转角〈15°，水平斜视度≤15°，行本体感受器切除术；Ⅱ组：头位扭转角〈15°，水平斜视度〉15°，行本体感受器切除术联合斜视矫正术；Ⅲ组：头位扭转角≥15°，水平斜视度≤15°，行中间带移位术（部分同时施行本体感受器切除术）；Ⅳ组：患者头位扭转角≥15°，水平斜视度〉15°，行中间带移位联合斜视矫正术（部分同时施行本体感受器切除术），采用自身对照法对患者手术前后单眼及双眼远近最佳矫正视力、头位扭转角、斜视度、眼球运动及立体视觉的变化进行比较。结果与术前相比，术后各组患者第一眼位单眼及双眼远视力均明显提高，差异均有统计学意义（单眼：t=6．00、8．94、11．76、16．41，P=0．00；双眼：t=4．81，P=0．0l；t=6．27、4．25、4．18，P：0．00）。术后Ⅰ组和Ⅱ组患者单眼及双眼近视力与术前比较差异无统计学意义（单眼：t=1．63，P=0．18；t=1．17，P=0．26；双眼：t=2．45，P=0．07；t=2．09，P=0．06），而Ⅲ组和Ⅳ组患者术后单眼及双眼近视力均明显提高（单眼：t=2．91，P=0．01；t=5．32，P=0．00；双眼：t=3．36、4．30，P=0．00）。Ⅲ组和Ⅳ组中，术前有代偿头位的41例中，术后39例代偿头位消失，2例明显改善，头位扭转角手术前后比较差异有统计学意义（t=29．90、16．91，P=0．00）。术前26例合并斜视的患者中术后24例患者眼位正位，2例患者斜视欠矫，Ⅱ组、Ⅳ组斜视度明显降低，手术前后比较差异均有统计学意义（t=29．15、36．79，P=0．00）。所有患者术后眼球运动无受限。术前12岁以下的患儿共23例，立体视觉平均为256．52″±66．23″，术后1年其立体视觉平均为120．87″±45．31″，手术前后比较差异有统计学意义（t=12．06，P=0．00）。结论中间带移位术、本体感受器切除术及斜视矫正术可以改善先天性特发性眼球震颤患者的视功能、矫正头位及斜视。

Surgery and visual function restoration for congenital idiopathic nystagmus with or without strabismus

Background The surgery for congenital idiopathic nystagmus has make great progression recent year,but the influence of surgery on visual function is closely concerned.Objective This work was to study the surgeries for congenital idiopathic nystagmus with or without strabismus and explore the effect of horizontal rectus muscle surgery on the visual function and ocular movement in congenital idiopathic nystagmus.Methods This was a case-observational study.Sixty cases with idiopathic congenital nystagmus were enrolled assigned to four groups as follows:The patients of group Ⅰ appeared the head postures of less than 15 ° and heterotropia less than 15△underwent extraocular proprioceptiou resection,and those of group Ⅱ presented with the head postures of less than 20° and heterotropia more than 15△ underwent extraocular proprioception resection and stabismus surgery.In the group Ⅲ,the patients had the head postures of more than 15° and heterotropia less than 15△ underwent Park's surgery and part of them underwent extraocular proprioception resection) and the cases in group Ⅳ were selected with the head postures of more than15° and heterotropia more than 15△ underwent Park' s surgery and strabismus surgery ( part of them underwent extraocular proprioception resection).Baseline and follow-up evaluations included the best distance and near corrected visual acuity,head posture,ocular movement and Titmus stereotest.The examination results were compared between before and after operation.Results One year after operation,monocular and binocular distance visual acuity improved significantly in all four groups ( monocular:t =6.00,8.94,11.76,16.41,P =0.00 ; binocular:t=4.81,P=0.01 ; t =6.27,4.25,4.18,P =0.00 ),but monocular and binocular near visual acuity improved significantly only in groups Ⅲ and Ⅳ after operation compared with before operation ( monocular:t=2.91,P=0.01 ; t =5.32,P =0.00 ; binocular:t =3.36,t =4.30,P =0.00 ).The compensatory head posture from 39 subjects was disappeared after operation,showing an evident difference between before and after surgery ( group Ⅲ:t =29.90,P=0.00;group Ⅳ:t=16.91,P=0.00).Strabismus were corrected rightly for 24 patients and undercorrection for 2 patients.( group Ⅱ:t =29.15,P =0.00 ; group Ⅳ:t =36.79,P =0.00 ).The binocular visual function of 23 cases with the age below 12 years were improved throughout the follow up duration ( t =12.06,P =0.00).Conclusions Park' s surgery,extraocular proprioception resection and strabismus corrective operation can improve the visual function and head posture in congenital idiopathic nystagmus patients.