早期手术治疗先天性内斜视40例临床观察  

The observation of clinical curative effect of early surgical treatment of congenital esotropia in 40 cases.

作　　者：秦剑英[1] 周畅达 梁四妥[1] 张立友[1] 陈忠飞[1] 

机构地区：[1]河北沧州眼科医院,061000

出　　处：《中华眼外伤职业眼病杂志》2011年第7期515-517,共3页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的探讨先天性内斜视的手术治疗时机、手术方法及临床疗效。方法回顾分析40例先天性内斜视，年龄6个月～7岁，平均（4．47±1．52）岁。戴镜均不能矫正眼位。其中合并下斜肌亢进者16例（40．00％，单眼9例，双眼7例）；合并DVD的9例（22．5％，单眼5例，双眼4例）；合并隐性眼球震颤者6例（15．00％）。高A／C且斜视角在＋30°以内者行单眼内直肌后徙术；存＋40°～＋60°之间者行双眼内直肌后徙术；＋61°～＋80°者行单眼内直肌后徙联合外直肌缩短术；大于＋80°者行双眼内直肌后徙联合非主导眼外直肌缩短术；合并下斜肌亢进者一并手术解决；合并DVD者先行内斜视矫正术，3个月后观察眼位，冉行垂直斜视手术矫正。术后随访6～48个月，平均21个月。结果术后正位32例（≤＋10°），正位率80．00％，欠矫8例（≥＋10°），欠矫率20．00％，无过矫者，无任何并发症。15．00％患者不同程度的恢复了双眼视功能。结论先天性内斜视早期诊断，早期手术治疗，有利于视功能的恢复。Objective To evaluate the timing, surgical methods and clinical curative effect of surgical treatment for congenital esotropia. Methods From Feb. 2007 to Apr. 2010,40 cases of congenital esotropia in our hospital were analyzed retrospectively aging from 6 mo - 7 years, the average （4.47 ±1.52） years whose eye position can not be corrected by wearing glasses. Sixteen patients （40%） of them combined with inferior oblique hyperfunction, including unilateral in 9 cases （22.5%） , bilateral in 7 cases （ 17.5 % ） ; 9 patients of them combined with DVD, including unilateral in 5 cases （ 12. 5% ） , bilateral in 4 cases （ 10% ） ;6 patients of them combined with latent nystagnms（ 15.00% ） ,respectively. The patients with high AC/A and angle of strabismus less than ＋ 30^△ underwent adducens oculi muscle retracted surgery in one eye; ＋40^△- ＋60^△ of them underwent adducens oculi muscle retracted surgery in both eyes; ＋60^△ - ＋ 80^△ of them underwent adducens oculi muscle retracted surgery and external rectus muscle shortening in one eye ;larger than ＋ 80^△ of them underwent adducens oeuli muscle retracted surgery in both eyes and external rectus muscle shortening of non-dominant eye;The cases combined with inferior oblique hypeffunction could be corrected by surgery together;The cases combined with DVD underwent inner squint correction firstly, then underwent vertical squint correction according to the eye position 3months after surgery. All patients were followed up for 6 - 48months . Results 32 cases （ ≤＋ 10A ） were orthotopic after surgery. Orthotopic rate was 80%. 8 cases （ ≥ ＋ 10^△ ） were undereorreced. Undercorrected rate was 20%. There were no overcorrection complications. 15% of patients recovered binocular vision with different degrees. Conclusion Congenital esotropia should be diagnosed, surgical treamtnet earlier as soon as possible, which is conducive to the reeovery of visual function.

关 键 词：内斜视 先天性 早期 手术 

分 类 号：R779.6[医药卫生—眼科]