先天性单眼上斜肌麻痹不同手术方式疗效观察

目的:探讨不同手术方式治疗先天性单眼上斜肌麻痹的疗效以及术后双眼视觉功能的恢复重建情况。方法:回顾性病例研究。选择2016-05/2019-05郑州市第二人民医院斜视与小儿眼科收治的82例先天性上斜肌麻痹患儿作为研究对象,根据患者第一眼位垂直斜视度、患眼下斜肌功能亢进程度、单眼及双眼运动情况等术前检查结果,设计相应的手术方式。包括下斜肌断腱术(3例)、下斜肌部分切除术(63例)、下斜肌徙后术(6例)、健眼下直肌徒后术(4例)、下斜肌减弱+对侧/同侧直肌术(5例)、上斜肌折叠术(1例)。结果:和手术前比较,手术后同时知觉、融合功能、远立体视、近立体视、矫正视力、代偿头位均得到明显改善(P<0.05);有无代偿头位患儿手术后立体视无差异(P>0.05)。结论:根据先天性单眼上斜肌麻痹病情严重程度选择不同的手术方式,在改善患儿视力、代偿头位方面具有积极意义,有助于重建双眼视觉功能。

Curative efficacy of different surgical procedures in the treatment of congenital unilateral monocular oblique paralysis and its effects on binocular vision function

AIM: To study the curative efficacy of different surgical procedures in the treatment of congenital unilateral monocular oblique paralysis and its effects on binocular vision function.

METHODS: Totally 82 children of congenital unilateral monocular oblique paralysis who received therapy from May 2016 to 2019 in our hospital were selected as research objects, operative plan was determined by the degree of hyperfunction of the inferior oblique muscle, the movement of the eyeball and the vertical obliquity of the eye position, the inferior oblique muscle tendon amputation(3 cases), partial inferior oblique muscle resection(63 cases), inferior oblique muscle recession(6 cases), posterior rectus muscle repair(4 cases), inferior oblique muscle weakening+contralateral/ipsilateral rectus muscle operation(5 cases), upper oblique folding(1 cases). The effects of different surgical procedures and the changes of binocular visual function, corrected visual acuity and compensatory head position before and after surgery were compared.

RESULTS: Compared with before surgery, the fusion function, hyperstereopsis, myopia, corrected visual acuity and compensatory head position were significantly improved after operation(P<0.05); there was no significant difference in stereopsis between children with or without compensatory head position after operation(P>0.05).

CONCLUSION: Choosing different surgical methods according to the severity of congenital superior oblique paralysis has positive significance, which can improve the vision and compensating head position of children, and it''s helpful to rebuild binocular vision function.