外直肌超常量后徙在某些大角度外斜视矫正术中的应用

目的:观察外直肌超常量后徙在某些类型大角度外斜视矫正术中的应用和效果。方法:回顾性分析了我院2006-01/2008-07在外斜视矫正术中行外直肌超常量后徙的临床病例48例,其中分开过强型外斜视29例,知觉性外斜视16例,麻痹性外斜视3例。所有病例外斜视度数均>40△。手术原则是尽量在2条肌肉上完成斜视度的矫正。分开过强型外斜视先行双外直肌超常量后徙(8.0~9.5mm),残余度数再行一眼内直肌缩短术。知觉性外斜视手术首选视力较差的斜视眼行外直肌超常量后徙(8.0~12mm)加内直肌缩短(6~8mm),若矫正不足再行对侧眼外直肌后徙术。动眼神经不全麻痹者行麻痹眼外直肌超常量后徙(12~13mm)加内直肌大量截除(10mm)。结果:末次随访时所有患者外观良好,29例分开过强型外斜视中,23例正位,6例欠矫;16例知觉性外斜视中13例正位,2例欠矫,1例过矫;3例麻痹性外斜视中,1例正位,2例欠矫。所有欠矫或过矫均在±8~±15△,均不需要二次手术。所有病例中3例分开过强型外斜视和2例知觉性外斜视出现轻度外转不足,外转时角膜缘距外眦角约2~3mm;3例麻痹性外斜视外转不足均在3~4mm。结论:外直肌超常量后徙术对大度数的分开过强型外斜视,知觉性外斜视及麻痹性外斜视效果满意,避免了损伤过多的眼外肌,增加了外斜视矫正术的一次成功率。

Using of supernormal lateral rectus muscle recession in the surgery of large-angle exotropia

AIM: To investigate the use and effect of supernormal lateral rectus muscle recession in the surgery of large-angle exotropia. ·METHODS: The retrospective analysis included 48 cases of large-angle exotropia who were performed supernor-mal lateral rectus muscle recession, from January 2006 to July 2008 in our hospital, which including 29 divergence excess pattern, 16 sensory exotropia, and 3 paralytic exotropia. The angles of exotropia were all higher than 40△. The principle of surgery was to correct the exotropia as possible as on two muscles. Supernormal bilateral rectus muscle recession(8.0-9.5mm)were performed firstly in divergence excess exotropia, and residual exodeviation were corrected by shortening the medial rectus. Supernormal lateral rectus muscle recession (8.0-12mm) and medical rectus muscle shortened (6-8mm) were performed primarily on the selected poor vision eye in sensory exotropia, and if it was necessary lateral rectus recession on another eye was performed. Similarly, supernormal lateral rectus muscle recession (12-13mm) and medical rectus muscle largely shortened (10mm) were performed on the paralyzed eye in paralytic exotropia. ·RESULTS: All patients got satisfactory appearance at last follow-up. Twenty-three cases acquired alignment of the eyes, and 6 were undercorrected in 29 divergence excess exotropia. Thirteen cases acquired alignment, 1 was undercorrected, and 1 was overcorrected in 16 sensory exotropia. One case acquired alignment, 2 were undercorrected in 3 paralytic exotropia. The undercorrect-ed or overcorrected angles were between ±8△ to ±15△. Slightly insufficient abversion was found in 3 cases of divergence excess exotropia, 2 sensory exotropias. and 3 paralytic exotropias. ·CONCLUSION: The supernormal lateral rectus muscle recession can avoid more intraocular muscles injuried. It has satisfactory effects for large-angle exotropia of diver-gence excess pattern, sensory exotropia and paralytic exotropia, and can improve the achievement ratio in the surgery of exotropia.