先天性内斜视术后远期疗效的研究  

Clinical research on the long-term eficacy after surgery of congenital esotropia

作　　者：刘静[1] 杨先[1] 徐婷婷[1] 王园[1] 孔庆兰[1] 李慧[1] 刘桂波[1] 

机构地区：[1]青岛大学附属医院眼科,青岛266001

出　　处：《中国实用眼科杂志》2015年第3期255-258,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察先天性内斜视患者的临床特征及手术治疗后远期效果。方法回顾性临床病例系列研究。对2008年1月至2013年1月在青岛大学附属医院眼科追踪观察85例先天性内斜视患者的临床特征及手术方法。其具体分为：双侧内直肌后徙术、单侧内直肌后徙术、双侧内直肌后徙联合单侧外直肌缩短术。按手术年龄分为〈4岁组、4-8岁组和〉8岁组，观察术后远期眼位、双眼视功能，分析治疗效果，探讨手术时机及手术效果的影响因素。结果先天性内斜视多为非调节性内斜视；伴有弱视和下斜肌功能亢进可能影响术后远期眼位；年龄〈4岁组术后双眼视功能的改善明显优于4-8岁组和〉8岁组；术后建立的双眼视反应，即粗糙立体视和周边融合可较好地帮助维持术后眼位。结论先天性内斜视患者4岁前手术双眼视功能恢复情况明显优于4岁后手术者，且术后建立的双眼视反应如粗糙立体视和worth四点融合可较好地帮助维持术后眼位。先天性内斜视患者的手术治疗若处于视觉系统发育的关键期内，其远期疗效较好。Objective To observe the clinical features and the long-term efficacy after surgery of congenital esotropia. Methods A retrospective study. Clinical data of 85 cases with congenital esotropia were reviewed and analyzed their clinical features and surgical methods, the surgical meth ods included bilateral medial rectus recession, unilateral medial rectus recession, bilateral medial rectus recession and unilateral lateral rectus resection. According to surgical ages all cases were divided into 〈4,4-8 years old group and 〉 8 groups. Long-term eye position and binocular vision were ob served. The timing and the factors effect were investigated and analyzed postoperatively. Results Congenital esotropia mostly not accommodative esotropia; with amblyopia and inferior oblique overac- tion may influence the postoperative long-term eye position; the recovery of postoperative binocular vision： aged 〈4 groups was obviously better than the 4-8 years old group and 〉8 groups; the binoc ular visual reaction originally settled up after surgery such as Rough vertical and Worth four fusion could help maintain good postoperative eye position. Conclusions In congenital esotropia, the rate of achieving binocular vision in the group of surgery before 4 years old is significantly higher than that of after 4 years old, and the binocular visual reaction such as Rough vertical and Worth four fusion can help maintain good postoperative eye position postoperatively. When cases with congenital esotrooia obtain ooeration in critical oeriod of vision develooment the lonterm efficacy is good.

关 键 词：先天性内斜视 手术 眼位 双眼视功能 

分 类 号：R777.41[医药卫生—眼科]