单眼外直肌超常量后徙联合拮抗肌截短术治疗大角度知觉性外斜视的临床疗效分析

目的　观察单眼外直肌超常量后徙联合拮抗肌截短术治疗大角度知觉性外斜视的临床疗效。方法　回顾性分析２００９年１月至２０１４年７月在我院行斜视矫正术符合条件且资料齐全的知觉性外斜视患者１２例（１２眼），男７例，女５例，手术年龄１７～４５岁，平均２９．３岁；术前平均偏斜度－８７．５Δ（－７５Δ ～－１１０Δ）。行主斜眼或视力差眼外直肌后退９～１０ｍｍ，剩余偏斜度行同眼内直肌截短５～８ｍｍ，三棱镜检查患者的斜视度，检测患者术前和术后眼位和单眼眼球运动情况，随访时间２～６０个月，平均随访时间１８．３个月。结果　１２例患者在术后末次随访时９例眼位正位，正位率为７５．０％；３例外斜视术前偏斜度为－９０Δ、－９０Δ、－１１０Δ，末次随访时残余外斜度为－２５Δ、－３５Δ、－３５Δ，术后眼位外观改善明显，无过矫现象。１２例患者术前内转均正常，外转均亢进，为＋１～＋３。术后末次随访内转均到位，９例外转不足－１，１例外转不足－２，２例患者的眼球运动在术后６周恢复正常。１２例患者单眼眼球运动末次随访与术后６周时情况一致，说明术后６周眼球运动已稳定。结论　单眼外直肌超常量后徙联合拮抗肌截短术可有效地矫正７５Δ及以上知觉性外斜视；但可引起部分患者外转轻度受限。

Monocular supernormal amount strabismic operation for large-angle sensory exotropia

Objective To appraise the clinical efficacy of large-angle sensory exotropia by supernormal urulateral rectus recession. Methods Twenty patients ( 12 eyes) with large-angle sensory exotopia ( degree of deviation from - 75A to - IIOA. mean -87. 5A) were operated with strabisnuc operation in our hospital from January 2009 to July 2014. The male was 7 cases . female was 5 cases . and the surgical age was from 17 years t0 45 years. The surgical procedures included lateral rectus muscle recession (9 - 10 mm) and medial rectus muscle resection (5 - 8 mm) on one eye. The follow-up time ranged from 2 months t0 60 months, averaged 18. 3 months. The residual deviation and eye movement was documented in different time after operation. Results Nine patients were achieved good appearance ( 75. 0% ) . The preoperative deviation in 3 cases was - 90A , _ 90A , - 110/, and the residual deviation at the final follow-up was _ 25A , _ 35A , _ 35A , respectively. 12 patients marufested abduction hyperactivity with range from + I to + 3 before operation. while at the final follow-up, only 2 patients moved outward normally , 9 patients marufested abduction deficiency - I , and I patient marufested - 2. The eye movement in 12 eyes at the final follow-up was consistent to the condition at the postoperative 6 weeks , suggested that the eye movement at the postoperative 6 weeks was stabled. Conclusion Unilateral rectus recession with supernormal amount and medial rectus resection can effectively correct large-angle sensory exotropia. The lateral rectus muscle recession can cause risk of abduction deficiency.