眼前节相干光断层成像术在水平性残余性斜视手术设计的应用  

The application of anterior segment optical coherence tomography in residual strabismus surgery

作　　者：侯立杰[1] 吴晓敏[1] 卓然[1] 张芳[1] 吕帆[1] 

机构地区：[1]温州医科大学附属眼视光医院杭州院区小儿眼科,310020

出　　处：《中华眼科杂志》2016年第8期568-573,共6页Chinese Journal of Ophthalmology

摘　　要：目的 探讨眼前节相干光断层成像术（ASOCT）在水平性残余性斜视手术设计中的应用.方法 回顾性系列病例研究.收集温州医科大学附属眼视光医院2009年1月至2011年1月共20例水平性残余性斜视患者的临床资料,其中残余性外斜视13例,残余性内斜视7例.术前应用ASOCT测量其眼外肌附着点,完成眼外肌ASOCT图像检测与常规斜视检查,并且术中测量眼外肌附着点,根据眼外肌附着点离角膜缘的间距来决定再次后徙量及合理设计各种残余性斜视矫正术式.采用配对t检验法比较术中眼外肌附着点与ASOCT检测的眼外肌附着点的一致性,分析再次斜视手术后的斜视治愈率.结果 眼外肌位置术中量规测量值（7.8＆#177;1.1）mm与ASOCT测量值（7.7＆#177;1.7） mm比较,两组差异无统计学意义（t=-1.37,P=0.19）.根据ASOCT眼外肌图像提示,行单纯眼外肌再次后徙术4例,水平直肌再次后徙联合拮抗肌截除术10例,对侧眼水平直肌后徙联合拮抗肌截除术6例,20例手术均顺利,术中及术后早期无严重并发症.斜视治愈16例,治愈率为80％.结论 在ASOCT引导下可合理选择水平性残余性斜视手术的肌肉,正确设计斜视手术量,减少不必要的手术操作,优化手术矫正效果.Objective To evaluate the application of anterior segment optical coherence tomography （ASOCT） in surgical design for residual horizontal strabismus patients.Methods This article was a retrospective case series analysis.Total 20 residual strabismus patients （13 with residual exotropia and 7 with residual esotropia） in Eye Hospital of Wenzhou Medical University from Jan 2009 to Jan 2011 were studied.Routine strabismus examinations were completed preoperatively.The distance between insertion of horizontal rectus muscles and corneal limbus were measured with ASOCT preoperatively and calipers intraoperatively.Reoperational amount and method for residual strabismus patients were designed according to the limbus-insertion distance.The paired t test was used to compare the agreement between two methods of measurement of limbus-insertion distance.The cure rates of reoperation were analyzed.Results No statistical significance was observed between the measurements with ASOCT （7.7 ＆#177; 1.7） mm and calipers （7.8＆#177; 1.1）mm （t=-1.37,P=0.19）.According to ASOCT image,the second surgical method was re-recession muscle for 4 patients;re-recession of original performed muscle combined with antagonist muscle resection for 10 patients and antagonist muscle resection combined with horizontal rectus muscle recession in fellow eye for 6 patients.All the surgical processes went on successfully,no severe intraoperative and postopereative complications were noted.Sixteen cases were cured （80%）.Conclusions Horizontal rectus muscle evaluation with ASOCT preoperatively may benefit the choice of performed muscle,calculation of surgical amount,reduction of unnecessary surgical procedure and optimization second surgical design for residual strabismus patients.

关 键 词：斜视 眼前半段 体层摄影术 光学相干 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]