继发性外斜视手术方式及术后眼位变化  

Surgical treatment cliniques and postoperative ocular alignment drift of consecutive exotropia.

作　　者：孙卫锋[1] 韩惠芳[1] 刘素江[1] 

机构地区：[1]邢台市眼科医院斜视与小儿眼科,054001

出　　处：《中国斜视与小儿眼科杂志》2010年第4期156-158,152,共4页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的研究内斜视术后继发外斜视的手术方式及术后眼位的变化。方法手术治疗43例内斜视术后继发外斜视的病人,探讨其手术方式并观察术后1周、6周、6个月和1年的眼位变化情况。结果单眼内直肌前徙7例,单眼内直肌缩短4例,单眼内直肌前徙+单眼外直肌后徙20例,双眼外直肌后徙5例,单眼外直肌后徙3例;4例外斜视度数≥50△行3条肌肉的手术。术后1年35例眼位正位(81.3%),其中单眼内直肌前徙或缩短11例术后8例(72.7%)正位,外直肌后徙8例(5例为双眼,3例为单眼)术后6例(75%)正位,单眼内直肌前徙+单眼外直肌后徙20例术后18例(90%)正位;1周～6周斜视度数变化-5.2△±0.4△,6周～6个月变化-1.2△±0.4△,1周～1年变化-6.4△±2.1△。1周～6周有25例患者(58.1%)有外斜视漂移,变化-8.0△±1.4△,其中术中过矫组的10例继发外斜视患者,术后6周内均出现了外斜视漂移,平均为-8.3±2.0△。结论外直肌后徙联合后徙的内直肌前徙是治疗继发性外斜视的有效方式。术中5△～10△小度数过矫可提高远期的术后正位率。Objective To review surgical treatment chniques and postoperative ocular alignment of consecutive exotropia.Methods We performed a retrospective chart review of 43 patients who underwent surgery for consecutive extropia.To study the surgical treatment cliniques and the postoperative ocular alignment drift in 1week,6 weeks,6 months and 1year.Results 7 patients underwent unilateral medial advancement,4 patients underwent unilateral medial resection,20 patients underwent lateral recuts recession and medial advancement,5 patients underwent bilateral recession and 3 patients were unilateral lateral recuts recession,4 patients with large deviations（〉50△） underwent three muscle surgeries.After1 year,satisfaction alignmentste was achieved in 35patients（81.39%）,among 8/11（72.72%） in unilateral medial advancement or medial resection,6/8（75%）in lateral recuts recession（5patients underwent bilateral recession and 3 underwent unilateral recession）,18/20（90%） in lateral recuts recession and medial advancement.From 1week to 6 weks mean deviation change-5.2△±0.4△,from 6 weeks to 6 months mean deviation change-1.2△±0.4△,from 1week to 1year mean deviation change-6.4△±2.1△.Our results also demonstrated 25 patients（58.1%） had a significant drift-8△±1.4△ from1week to 6 weeks,average-8△±1.4△,the 10 patients who were overcorrected groups all had more prominent exodrift in 6 weeks,average-8.3△±2△.Conclusions We recommend lateral rectus recession with medial rectus muscle andvancement of the previously recessed medial rectus as a suitable procedure.We conclude that a suitable ocular alignment for consecutive exotropia is a small-angle esotropia of 5△ to 10△ in the surgery.

关 键 词：继发性外斜视 术后眼位 漂移 

分 类 号：R779.6[医药卫生—眼科]