急性共同性内斜视的临床特点和非手术治疗的疗效评估

目的:探讨急性共同性内斜视的临床特点,并评估非手术治疗的临床疗效。方法:回顾性系列病例研究。收集2015年8月至2017年11月在中国人民解放军武汉总医院眼科确诊的急性共同性内斜视患者18例。收集完整的临床资料,包括患者基本资料、神经内科会诊情况,眼前节及眼底、远近斜视度、双眼视觉状态、头颅影像学检查。随访2~8个月,平均3.9个月。采用配对t检验进行统计分析。结果:患者年龄21~52(29.7±10.3)岁。戴镜看远斜视度为+9^△^+60^△(+36±13)^△;看近斜视度为+7^△^+45^△(+28±12)^△。看远斜视度大于看近,差异有统计学意义(t=6.32,P<0.001)。所有患者全身查体、中枢神经系统及内分泌系统检查均未见异常。在屈光矫正的基础上,使用底朝外三棱镜按照11的比例分别加到左右眼上。3例在随访期间不接受三棱镜矫正,改行斜视手术;其余患者均坚持戴镜,末次随访未诉戴镜看远复视明显,戴镜看远斜视度+6^△^+23^△,看近斜视度+4^△^+18^△。11例表示满意,4例认为一般,3例不满意。结论:急性共同性内斜视主要发生在近视人群,看远斜视度大于看近斜视度。三棱镜验配对于改善大部分急性共同性内斜视患者看远复视及斜视具有较好疗效,达到了治疗目的且避开了因患者处于发病早期斜视度数尚不稳定带来的手术治疗的风险,但长期疗效还需进一步观察。

Clinical Features of Acute Acquired Comitant Esotropia and a Therapeutic Evaluation of Non-Surgical Treatment

Objective: To describe the clinical characteristics of acute acquired comitant esotropia (AACE) and evaluate the effect of non-surgical treatment. Methods: Eighteen cases referred to General Hospital of the People's Liberation Army from August 2015 to November 2017 were reviewed. All participants underwent a complete medical history, ophthalmologic and orthoptic examinations, and brain and orbital imaging. The patients were followed up from 2 to 8 months, average 3.9 months. A paired t test was used for statistical analysis. Results: Age at onset was 29.7±10.3 years (21-52 years). All patients complained about uncrossed diplopia only at distance. The angle of esotropia at distance was from +9 to +60^△ and was from +7 to +45^△ at near (t=6.32, P<0.001). Each patient was examined by a neurologist, and MRI or CT imaging was performed. All the results were normal. After wearing a base-out Fresnel prism, 15 patients reported single vision with prismatic correction, 3 patients decided to undergo surgery after prismatic correction was unsuccessful. The angle of esotropia at distance was from +6 to +23^△ and was from +4 to +18^△ at near after prismatic correction. Eleven patients were satisfied, 4 patients were normal and 3 patients were dissatisfied. Conclusions: The clinical characteristics of AACE in our study were a sudden onset of nonaccommodative comitant esotropia with diplopia at distance. And happened in myopic patients, angle of esotropia at distance was larger than at near. Prismatic correction had good results on the improvement of diplopia and estropia. Long-term efficacy needs further observation.