下斜肌肌腹前转位联合上直肌后徙术治疗下直肌缺如上斜视  

Treatment of large hypertropia following absence of inferior rectus by integrated anteriorization of inferior oblique combined with recession of superior rectus

作　　者：杨士强[1] 郭新[1] 

机构地区：[1]天津市眼科医院、天津市眼科学与视觉科学重点实验室、天津市眼科研究所、天津医科大学眼科临床学院,300020

出　　处：《中华眼科杂志》2015年第6期424-428,共5页Chinese Journal of Ophthalmology

摘　　要：目的 探讨下斜肌肌腹前转位术联合上直肌后徙手术治疗下直肌缺如的临床疗效.方法 回顾性系列病例研究.收集2007年10月至2010年7月应用下斜肌肌腹前转位联合上直肌后徙术治疗的5例下直肌缺如继发上斜视的患者资料.分别比较患者手术前后眼位、眼球运动、代偿头位的变化,并做长期随访观察,随访时间6～18个月,平均10.8个月.结果 术后4例正前方眼位正位,1例过矫10个视乳头直径,眼球运动下转受限平均由-3.0改善为-1.6,上转出现不同程度受限平均为-2.0.2例患者术前有代偿头位,术后代偿头位均消失.5例患者术前术后眼底照相检查无明显旋转斜度变化.5例患者均对外观的改善满意,随访结果稳定,未再行其他手术治疗.结论 下斜肌肌腹前转位手术联合上直肌后徙在改善下直肌缺如的上斜视有一定效果,并且手术可一期完成.术中无需切断下斜肌,手术过程较便捷,可减小术中出血的危险.Objective To evaluate the effect of integrated anteriorization of inferior oblique muscle combined with recession of superior rectus to treat large hypertropia following absence of inferior rectus.Methods It was a retrospective case series study.Integrated anteriorization of inferior oblique muscle means transposing inferior oblique muscle 8-10 mm posterior to the insertion directly to original insertion of inferior rectus without myotomy.We reviewed 5 patients with absence of inferior rectus muscle,who treated by integrated anteriorization of inferior oblique muscle combined with recession of superior rectus.The pre and post-operative vertical deviation in primary position,ocular motility,and abnormal head position were compared.The patients were followed up from 6 to 18 months,with average as 10.8 months.Results Postoperatively,4 patients showed orthophoria in primary position and 1 patient had 10 PD hypotropia.The infraduction deficits improved from-3.0 to-1.6.Meanwhile,there had been an average of -2.0 mild supraduction limitation.Abnormal head position （AHP） disappeared in 2 patients with AHP before operation.All the patients showed no change of cyclodeviation on fundus photograph.5 patients were satisfied with the improvement of the appearance,and the follow-up results were stable,no other surgery again.Conclusions Integrated anteriorization of inferior oblique muscle combined with recession of superior rectus was an effective surgical selection to treat hypertropia with absence of inferior rectus muscle.This procedure doesn＆#39;t need to cut off the inferior oblique muscle.The more convenient surgical procedure can reduce the risk of bleeding.

关 键 词：斜视 眼球运动障碍 动眼肌 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]