双侧眼球后退综合征临床特征和手术治疗回顾分析

目的 探讨双侧眼球后退综合征(DRS)的临床特征和手术治疗方法.方法 回顾性系列病例研究.收集2005年7月至2009年11月我院收治的DRS患者123例,其中双侧DRS 24例(19.5％),回顾性分析双侧DRS的类型、临床表现、手术治疗方法与效果.结果 24例双侧DRS中男14例(58.3％),女10例(41.7％),年龄2～23岁.Ⅰ型16例(66.7％),Ⅱ型1例(4.2％),Ⅲ型7例(29.1％),其中Ⅲ型内斜3例,Ⅲ型外斜4例.伴有内转眼急速上转或下转现象11例,术后8例(73％)明显改善或消失.合并异常头位者15例,术后均消失或明显改善.有眼或全身合并症者7例(29％).水平斜视手术行单眼内或外直肌减弱术13例,双眼手术者11例;术后视远视近水平斜视均≤10△者21例(91％),水平斜视欠矫1例,过矫2例;并且所有患者术前眼球运动受限和眼球后退情况不同程度改善.术前原在位垂直斜视度＞10△者7例(64％),均伴内转眼急速上转或下转现象,其中行垂直肌或斜肌手术者4例.结论 双侧DRS男性较常见,水平斜视明显,合并垂直斜视多见,明显的垂直斜视与内转眼急速上转或下转现象有关.双侧DRS的手术治疗成功的关键是术前对是否存在水平直肌和垂直肌异常神经支配因素的评价;术前术中被动牵拉试验比较,判断是否解除了机械性限制因素.

Retrospective study on clinical characteristics and surgical treatment of bilateral DRS

Objective To investigate the clinical characteristics and surgical treatment of bilateral Duane retraction syndrome.Methods To collect 24 cases with bilateral DRS among 123 cases with DRS from hospital data during 2005.7 to 2009.11. Retrospective study included the clinical types,characteristics,plus diseases and surgical treatments. Results Fourteen male cases (58.3％ )and 10 female cases (41.7％),aging 2 to 23-year-old. 16 cases were type Ⅰ ( 66.7％ ),1 case was type Ⅱ (4.2％ ).7 cases were typeⅢ (29.1％ ),in which patients with esotropia or exotropia were 3 and 4 cases respectively.11 cases had up- or down-shoot pre-operation,which disappeared or improved post-operation in 8 cases (73％). 15 cases had abnormal head posture(AHP) and AHP disappeared or improved in all.Seven cases (29％) were associated with other congenital ocular or systemic anomalies. For horizontal deviation,unilateral medial or lateral rectus weakening procedures were performed in 13 cases and bilateral procedures in 11 cases.Post-operation,horizontal deviation was less than ± 10△ in 21 patients (91％),1 case was under-corrected and 2 cases were overcorrected.Simultaneously,the restriction of ocular motility and global retraction were improved in all the patients.Additional vertical or oblique muscle procedures were performed in 4 patients among 7 with vertical deviation more than 10△ and up- or down-shoot.Conclusions Bilateral DRS has more frequency in male,obviously horizontal deviation in primary position and more cases with vertical deviation which is related with up- or down- shoot phenomenon.The key point for successful surgery are forced duction test pre- and during operation to conform to relieve the mechanical factor and estimating abnormal innervation in horizontal and vertical rectus.