压贴三棱镜观察眼位法及可调整缝线用于先天性外斜视手术治疗的一年效果观察  

The one-year clinical effect of press-on prism test for eye position observation and adjustable suture of surgery intervention in congenital exotropia

作　　者：刘丽丽[1] 于刚[1] 吴倩[1] 曹文红[1] 樊云葳[1] 崔燕辉[1] 张燕[1] 

机构地区：[1]首都医科大学附属北京儿童医院眼科儿科学国家重点实验室,100045

出　　处：《眼科》2014年第1期57-60,共4页Ophthalmology in China

摘　　要：目的观察压贴三棱镜观察眼位法及可调整缝线用于先天性外斜视手术治疗的一年效果。设计回顾性病例系列。研究对象2008年2月至2012年12月北京儿童医院手术治疗的平均年龄（28．84±16．01）个月（10—67个月）的先天性外斜视患儿25例。其中间歇性外斜视1例，恒定性外斜视24例。伴有v征者4例，伴有DVD者4例，伴有V征及DVD者1例，伴有眼球震颤者1例。方法对于不配合检查的患儿术前应用压贴三棱镜试镜观察眼位并测量斜视度。所有患者行外斜视矫正术，后退肌肉均采用调整缝线技术。术后2周，1、6、12个月随访。主要指标手术前后眼位情况及调线前后斜视度变化。结果不配合检查的患儿术前应用压贴三棱镜试镜观察眼位的方法测量斜视度依从性好。25例患儿术后第1天检查正位20例（80％），4例过矫，1例欠矫；经过缝线调整，25例均在正位；术后2周正位率100％（P〈0．05）。术后半年斜视度变化不明显，术后1年平均斜视度-7．12n±3．24n，手术成功率88％。结论压贴三棱镜试镜观察眼位的方法适用于先天性外斜视患儿的术前斜视度检查；应用可调整缝线明显提高了先天性外斜视的近期正位率。Objective To evaluate the effect of press-on prism test for eye position observation and adjustable suture of recus muscle of early surgical intervention in congenital exotropia. Design Retrospective case series. Participants We reviewed 25 subjects diagnosed with congenital exotropia in Beijing Children Hospital in 2008-2012, aged 10 months to 67 months （28.84±16.01 months）. Of the 25 cases, 1 case of intermittent exotropia, 24 cases of constant exotropia. 4 cases existed with V sign, 4 cases with DVD, 1 case with V sign and DVD, 1 case with nystagmus. Methods Pressure prism test for deviation degree was used in young children before or after surgery. Adjustable suture of recus muscle was used during surgery. The follow-up was performed on 1 day, 2 weeks, 1 months, 6 monihs, and 12 months after surgery. Main Outcome Measures The angle of near and far deviation in primary position. Result Pres- sure prism test has good compliance in young children. On 1 day after operation, 80% patients had a deviation of less than 10 PD, and 2 weeks after adjusting suture 100% patients had a deviation of 〈10 PD （P〈0.05）. On half a year eye position change of strabismus de- gree was not obvious. One year after the operation （-7.12±3.24A） had a tendency to develop in the direction of exotropia with time and surgical success rate was 88%. Conclusion Press-on prism test can be used in congenital exotropia in young children for preoperative strabismus degree examination. Application of adjustable suture obviously increases the success rate of congenital exotropia.

关 键 词：先天性外斜视 夕h科学 压贴三棱镜 可调整缝线 

分 类 号：R779.6[医药卫生—眼科]