单眼外直肌后徙术治疗儿童间歇性外斜视的疗效  

Surgical outcome of unilateral lateral rectus recession for treatment of intermittent exotropia in children

作　　者：吴其正[1] 王晓明[1] 王利华[1] 马鲁新[1] 孔冬[1] 

机构地区：[1]山东大学附属省立医院眼科中心,济南 250021

出　　处：《中华眼视光学与视觉科学杂志》2012年第1期34-37,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的探讨单眼外直肌后徙术对中、小度数儿童间歇性外斜视的疗效。方法回顾性系列病例研究。2009年4月至2010年3月期间行单眼外直肌后徙术治疗、斜视度为15^△-35^△的间歇性外斜视儿童69例。采用三棱镜加交替遮盖法测定患儿注视6m和33cm的斜视度，根据看远斜视度定量行7-10mm单眼外直肌后徙术。随访时间≥6个月。手术前后采用Worth四点灯检查中心和周边融合，采用Titmus立体视图测定立体视锐度。疗效评价标准以眼位-8^△-0^△为正位；第一眼位与侧向注视的斜视度相差≥10^△为非共同性阳性。采用X^2检验对数据进行分析。结果术后1-3d和≥6个月随访正位率分别为81％和62％，欠矫率分别为12％和36％。斜视度为30^△、35^△（外直肌后徙9．5-10mm）者欠矫率较高。术前与术后远期随访比较，具有正常中心融合和周边融合者比例的差异有统计学意义（X^2=21．9，P〈0．01；X^2=14．0，P〈0．01），术后明显高于术前；具有正常立体视功能者比例的差异有统计学意义（X^2=15．0，P〈0．01），术后明显高于术前。术后远期随访未见眼位非共同性阳性者。结论单眼外直肌后徙术治疗斜视度为15^△-25^△的儿童间歇性外斜视安全、有效。Objective To investigate the long-term surgical outcome of unilateral lateral rectus recession for small-to-moderate angle intermittent exotropia in children. Methods Sixty-nine children with intermittent exotropia （15^△-35^△） who underwent unilateral lateral rectus recession during April 2009 to March 2010 were retrospectively reviewed. The exodeviations were measured by the alternate prism cover test at both distance （6 m） and near （33 era） with fixation on accommodative targets. An amount of 7-10 mm unilateral lateral rectus recession was performed according to the quantity of distance deviation. The Worth 4-Dot test was employed both at distance and near fixation to assess central and peripheral fusion, respectively. The Titmus stereo test was used to assess stereoacuity. A successful alignment was defined as -8^△-0^△ in primary gaze while viewing distant and near targets. There was a minimum of 6 months follow-up period. Incomitance was defined as a change of more than 10^△ from primary to lateral gaze. The data were analyzed with a chi-square test. Results The successful rates in alignment at 1-3 days postoperative and final follow-up periods were 81% and 62%, and the undercorrection rates were 12% and 36%, respectively. The patients who underwent an amount of 9.5 mm and 10 mm unilateral lateral rectus recession had a higher undercorrection rate at the final followup. The number of patients with normal central fusion, peripheral fusion and stereoacuity at final examination increased statistically compared to the preoperative number （X^2=21.9, 14.0, 15.0, P〈0.01）. None of the patients had clinically significant lateral incomitance at the final followup. Conclusion Unilateral lateral rectus recession is a safe and effective treatment for intermittent exotropia in children with exodeviation measuring 15^△ to 25^△.

关 键 词：外斜视 间歇性 眼外科手术 治疗结果 外直肌后徒术 单眼 

分 类 号：R779.6[医药卫生—眼科]