知觉性斜视的临床特征及手术治疗  

Clinical feature and surgery treatment for sensory strabismus

作　　者：郭长梅[1] 王雨生[1] 王为农[1] 张桂鸥[1] 

机构地区：[1]第四军医大学西京医院眼科、全军眼科研究所,陕西西安710032

出　　处：《眼科新进展》2013年第1期60-63,共4页Recent Advances in Ophthalmology

摘　　要：目的观察知觉性斜视的临床特征,并探讨其手术设计原则。方法回顾性分析99例知觉性斜视患者的临床资料,包括视觉障碍发病年龄、病因、知觉性斜视类型、屈光状态;83例患者行斜视矫正手术,手术方式首选偏斜眼超常量手术,外斜视分为预期术毕正位组和预期术毕过矫组。观察手术前后眼位情况。结果 32例知觉性内斜视患者视觉障碍全部发生在出生后5岁内,其中29例(90.63%)患者发生在生后6个月内。67例知觉性外斜视患者生后5岁内发生视觉障碍者43例(64.18%),5岁以后发生视觉障碍者24例,内/外斜视组间差异具有显著统计学意义(χ2=13.24,P=0.000)。53例屈光参差性弱视的屈光状态:知觉性内斜视和外斜视的健眼等效球镜分别为(-0.32±2.52)DS和(-1.31±2.25)DS,患眼等效球镜分别为(0.63±5.60)DS和(-1.78±6.34)DS,两组间差异均无统计学意义(P=0.169,P=0.181)。术后随访6个月～1.2a,27例知觉性内斜视患者末次随访时,正位19例、欠矫7例、过矫1例。知觉性外斜视中预期术毕正位组20例,末次随访时正位11例、欠矫9例;预期术毕过矫组36例,正位27例、欠矫7例、过矫2例,两组间差异有统计学意义(P=0.041)。结论知觉性斜视中屈光参差性弱视为主要原因。知觉性斜视类型与视觉障碍发病年龄有关,5岁以内视觉障碍者宜发生内斜视。知觉性内/外斜视手术设计不同,通过合理的手术治疗可以起到良好的美容效果。Objective To investigate the clinical features and evaluate the surgi- cal procedures of sensory strabismus. Methods Clinical data of 99 sensory strabismus were reviewed retrospectively, including age at onset of vision loss, cause of vision loss, type of strabismus, and refractive diopter. Eighty-three patients were performed cosmet- ic extraocular muscle surgery with the supermaximal rectus recession on the visually poor eye, the patients with exotropia were divided into expectant normotopia group and expectant overcorrection group, and the ocular alignments were observed before and af- ter surgery. Results Of all 32 sensory esotropia, the age at vision impairment was within the first 5 years of life,especially 29 cases（90.63% ）at first 6 months. The age of visual impairment of 43 cases （64.18%） occur in first five years among 67 sensory exo- tropia, while 24 cases occurred after 5 years old. There was significant difference on age at onset vision loss between sensory esotropia and exotropia （X^2 = 13.24 ,P = 0. 000 ）. The refractive status of 53 cases with anisometropic amblyopia：The spherical equivalent of healthy eye of sensory esotropia and exotropia were （ - 0. 32±2. 52 ） DS and （ -1.31± 2.25 ） DS, diseased eye were （ 0.53±5.60） DS and （ - 1.78±5.34） DS, thereto 1.2 years. Of the 27 cases with sensory esotropia, 19 cases were surgical successes,7 cases were under-corrected and 1 case was over-corrected. In 20 cases with sensory exotropia of expectant normotopia group, I 1 cases were surgical succes- ses ,9 cases were under-corrected at the last follow-up ;In 36 cases of expectant overcorrection group ,27 cases were surgical successes,7 cases were under-corrected and 2 cases were over-corrected,there was statistical difference（P = 0.041 ）. Con- clusion The most common cause of sensory strabismus is anisometropia amblyopia. People will tend to become sensory esotropia when age at onset vision loss is less than 5 years. Those with age at onset vision loss more than 5 year

关 键 词：知觉性斜视 内斜视 外斜视 手术 

分 类 号：R777.41[医药卫生—眼科]