眼科手术后斜视和复视的临床分析

目的　探讨眼科手术后继发性斜视的发生机制和防治方法。方法　检查 79例不同眼科手术后发生继发性斜视患者的眼位、眼球运动、复视及预后情况 ,并进行牵拉试验。对部分患者行斜视矫正术 ,术中观察眼部受累组织的情况。结果　在全部患者中 ,视网膜脱离术后患者占 38 0 %(30 / 79) ,白内障摘除手术后患者占 31 7% (2 5 / 79) ,眼眶手术后患者占 13 9% (11/ 79) ,其他为青光眼、翼状胬肉及上睑下垂术后患者。视网膜脱离手术和白内障摘除手术后部分继发性斜视症状持续时间 >6个月的患者 ,受累肌纤维化并 (或 )与结膜、巩膜及外加压物广泛粘连 ,牵拉试验呈阳性 ;眼眶手术后患者眼球主要表现为牵制性运动障碍 ;翼状胬肉切除术后患者内直肌及其周围组织损伤明显 ;抗青光眼手术后患者继发性斜视症状于术后 2～ 14d自行缓解。结论　内眼和外眼手术均可导致继发性斜视的发生 ;斜视的发生机制主要包括眼肌损伤、限制及机械压迫 3个因素。眼科手术医师应高度重视 ,积极采取针对性预防和治疗措施。

Clinical analysis of the diplopia and strabismus after ophthalmic surgeries

OBJECTIVE: To explore the mechanism and therapy of strabismus secondary to ophthalmic surgeries. METHODS: 79 cases of postoperative secondary strabismus were examined for eye position, eyeball movement, diplopia and ocular muscle traction test. Strabotomies were performed in some of the cases. Their involved extrocular muscle conditions were examined during the surgery. RESULTS: The cases of strabismus in the series were secondary to surgery of retinal detachment (38.0%), cataract extraction (31.7%), orbital surgery (13.9%), and other ophthalmic surgeries such as glaucoma, pterygium and blephatoptosis. Some cases secondary to surgery of retinal detachment and cataract extraction didn't recover in more than 6 months after surgery. The traction tests of involved muscles in some cases were positive. Fibrosis of the involved ocular muscles and adhesion of involved ocular muscles to conjunctiva, sclera and explants were found during strabotomies. Strabismus secondary to orbital surgery mainly showed impeding movement of eyeball. Strabismus secondary to pterygium mainly related to injury of the medial rectus operations. Strabismus secondary to glaucoma surgery recovered spontaneously in 2 - 14 days after operations. CONCLUSIONS: Intraocular or external ophthalmic surgeries can cause secondary strabismus. The mechanism is primarily due to direct injury of the extraocular muscles, impeding movement and mechanical compression to the eyeball. Surgeons should pay more attention for those side effects, and take effective therapy to prevent and treat iatrogenic strabismus.