白内障术中局部注射麻醉导致的术后斜视及治疗

目的 在白内障手术中因球后或球周麻醉时药物可能导致眼外肌毒性而产生术后斜视及治疗.方法 对5例局部麻醉白内障术后患者,均于术后第一天去除眼罩时发现复视.于白内障术后3个月后在全麻下行受累肌肉的后徙及可调节缝线手术.结果 白内障术中局部注射布比卡因导致的眼肌麻痹于术后即发复视并持续存在.在观察病例中2例上直肌受累、3例下直肌受累.4例左眼,1例右眼.在受累肌肉行足量的肌肉后徙并可调节缝线,术后大部分注视方向复视消失,眼位调正.结论 白内障术后斜视应当注意到术中局麻药物肌肉毒性所致的斜视.早期由于肌肉麻痹产生复视,后期由于肌肉纤维化和(或)肥大产生与初始复视相反方向的复视.对受累肌肉的足量后徙和可调节缝线可以获得满意的术后效果.

Local-anesthetic-induced Strabismus After Cataract Surgery and Therapy

Objective A well-documented strabismus developing after retrobullbar or peribullbar anesthesia for Cataract Surgery is secondary to unintentional injection into an extraocular muscle.we reported five cases of local-anesthetic-induced strabismus after cataract surgery and therapy.Methods Five cases of strabismus after cataract surgery were reported.All of them received either retrobulbar or peribulbar anesthesia.Results Local-anesthetic-induced strabismus after cataract surgery was found almost immediately upon the removal of the patch the day after surgery,it persisted and worsened.Of 3 cases were inferior rectus muscle affected,the other 2 cases were superior rectus muscle affected.Four cases were left eyes,one case was right eye.All of them were performed with a large recession and an adjustable suture of the involved muscle.Diplopia of most gaze position disappeared after strabismus surgery with good alignment.Conclusions Strabismus immediately after cataract surgery should be noted as myotoxicity from the local anesthetic agent used at the time of surgery.Usually a large recession on an adjustable suture of the involved muscle yields gratifying correction.