高度近视所致固定性斜视的手术方法及疗效分析  

Surgical methods and effects on high myopia induced fixed strabismus

作　　者：李莉[1,2] 赵国红[3,4] 焦永红[3,4] 

机构地区：[1]首都医科大学附属北京儿童医院眼科 [2]儿科学国家重点学科,北京100045 [3]首都医科大学附属北京同仁医院北京同仁眼科中心 [4]北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《哈尔滨医科大学学报》2014年第3期243-245,共3页Journal of Harbin Medical University

摘　　要：目的探讨高度近视所致固定性斜视的手术治疗方法及疗效。方法 12例(20眼)高度近视引起的固定性内斜视行手术治疗。20眼均先行超常量的内直肌后退,4眼因外直肌菲薄行上直肌颞侧1/2肌束截除并转位于外直肌上方止端旁,其余16眼行外直肌上方1/2~2/3肌束截除并转位于上直肌颞侧止端旁。转位的部分肌束截除量是8~12 mm。结果 12例(20眼)术前内斜视在90△~120△以上,下斜视30△~50△,术后1周,16眼行内直肌后退联合外直肌部分截除并转位术的患者眼位正位,2眼轻度欠矫(内斜小于15△),下斜视基本矫正,小于10△,眼球运动明显改善,外转时颞侧角膜缘距外眦角2~3 mm,上转过内外眦水平连线;4眼行内直肌后退联合上直肌部分截除并转位术的患者,其中3眼水平眼位矫正,1眼残存20△内斜,4眼均残存15△~30△下斜视,3眼外转可过中线,1眼外转刚到中线,上转可到内外眦水平连线。经3~26月随访未出现明显回退。结论内直肌超常量后退联合外直肌或上直肌部分截除加转位,对治疗高度近视所致固定性内下斜视效果肯定,且减少手术肌肉条数。Objective To discuss the surgical methods and effects on treating high myopia induced fixed strabismus. Methods Correction surgery was applied to 12 cases （20 eyes） of high myopia induced f^xed strabismus. Excessive regression of medial rectus was first intervened to all cases, followed by cutting off 1/2 to 2/3 upside of lateral rectus and then transfered next to the insertion of bitemporal superior rectus except for 4 eyes, in which 1/2 bitemporal superior rectus were cut and transferred next to the upside insertion of lateral rectus due to the thin lateral rectus. Muscles for transfer were cut off 8 - 12 mm. Results Among 12 patients （20 eyes） with 90 ^△- 120^△ esotropia and 30^△-50 ^△ hypotropia preoperatively, the right eye positions were found in 16 eyes which underwent regression of medial rectus plus part excision and transfer of lateral rectus one week after the operation. Slightly insufficient correction （less than 15^△ esotropia and 10^△ hypotropia） was found in 2 eyes which had significantly improved eyeball movement, 2 -3 mm between temporal limbus and outer canthus during abversion and the beyond of horizontal connection between inner and outer canthus when supravergence. Among 4 eyes which underwent regression of medial rectus plus part excision and transfer of superior rectus, horizontal eye positions of 3 eyes were corrected, 1 eye remained 20 ^△esotropia, 4 eyes remained 15^△ -30^△ hypotropia, abversion was beyond the middle line in 3 eyes, abversion just reached the middle line and supravergence can reach the horizontal connection line between inner and outer canthus in 1 eye. There was no obvious regression in 3 - 26 months＇ follow-up after operation. Conclusion The effect of excessive regression of medial rectus plus part excision and transfer of lateral rectus or superior rectus on high myopia induced fixed eso-hypotropia is promised with the advantages of the reduced muscles suffering from the intervention.

关 键 词：高度近视 固定性斜视 内斜视 手术 

分 类 号：R778.11[医药卫生—眼科]