手术治疗先天性眼球震颤合并斜视

目的 探讨先天性眼球震颤合并斜视的手术方法和效果.方法 回顾性分析先天性眼球震颤合并斜视手术24例.手术的设计根据中间带位置、代偿头位、斜视角度和主导眼的关系进行综合考虑,代偿头位矫正在主导眼上施行,斜视矫正在非主导眼上施行.结果 手术后随访3 ～12个月,平均（6.38±2.18）月.20例（83.33％）术后代偿头位消失,3例（12.50％）代偿头位明显改善,残留原方向15°以内头位扭转角,1例（4.17％）过矫.18例（75.00％）术后眼位达到正位,5例（20.83％）达到轻度欠矫或过矫,1例（4.17％）明显欠矫.所有病例原在位眼震减轻或消失,原在位双眼同时视视力均较术前提高2行或2行以上.术前术后双眼同时视视力及头位扭转角变化差异均有统计学意义（z=-5.83,-3.37,P ＜0.01）.结论 合并有斜视的先天性眼球震颤,手术既要矫正斜视又要解决代偿头位,合理的手术设计可以取得良好的治疗效果.

The surgery for congenital nystagmus with strabismus

Objective To investigate the efficacy of different surgeries for congenital nystagmus with strabismus. Methods The data of 24 cases who underment operation for congenital nystagmus with strabismus were retrospectively studied. The surgery was designed based on the location of intermediate zone, compensatory head posture, the degrees of strabismus and the dominant eye. The correction of compensatory head posture was performed in dominant eye and the correction of strabismus was performed in undominant eye. Results All patients were followed up for 3-12 （6.38 ＋-2.18） months. The compensatory head posture disappeared after surgery in 20 cases（ 83.33% ） and was much improved in 3 cases（ 12.50% ） with residual head tilt within 15~ in the original direction. Overcorrection was observed in one case （4.17%）. The eye position was normal in 18 cases （75.00%） , slight undercorrection or overcorrection in 5 cases （20.83%）, and apparent undercorrection in one case （4.17%） after surgery. Nystagrnus in the primary position of gaze was reduced or disappeared in all cases. Binocular visual acuity in the primary position of gaze was improved over 2 lines compared with preoperative one in all cases. The binocular visual acuity and degree of head tilt were significantly improved after surgery （ P 〈 0. 01 ）. Conclusion Reasonable design of surgery for congenital nystagmus with strabismus can have good clinical efficacy , which should correct strabismus and compensatory head posture.