先天性特发性眼球震颤224例临床特征及手术方法  

Clinical characteristics and surgical treatment of idiopathic congenital nystagmus in 224 patients

作　　者：丁娟[1] 赵堪兴[1] 李月平[1] 马惠芝[1] 陈霞[1] 郭新[1] 朱丽娜[1] 李宁东[1] 张伟[1] 

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

出　　处：《中华眼科杂志》2016年第8期574-578,共5页Chinese Journal of Ophthalmology

摘　　要：目的 探讨先天性特发性眼球震颤（ICN）患者的临床特征及手术方法.方法 回顾性系列病例研究.收集2007年7月至2013年2月于天津市眼科医院诊治的224例ICN患者的临床资料,分析、总结其临床特征和手术方法.结果 224例ICN患者包括男性158例（70.54％）,平均年龄（11.6±8.4）岁;女性66例（29.5％）,平均年龄（11.4±6.4）岁.眼球震颤类型为水平冲动性215例,垂直性3例,混合性6例.214例患者无手术史,10例有手术史.224例患者中有151例患者合并斜视以及屈光不正、眼前节或眼底疾病,占全部患者的67.4％.其中近视患者48例,远视患者30例,斜视患者43例.153例患者仅在水平方向存在代偿头位,以水平面向左、右侧转代偿,其中43例（43/153,28.1％）面向右视线向左,110例（110/153,71.9％）患者面向左视线向右.根据不同的代偿头位方向以及头位扭转角分析手术方式,对于双中间带15例患者,选择经常使用且在此方位视功能较好的位置进行手术设计.对于眼球震颤伴斜视患者,采用主导眼中间带移位术联合斜视眼斜视矫正术.复杂代偿头位患者,选取主要代偿头位进行手术设计.结论 ICN患者以男性为主,临床表现形式多样.具有代偿头位的ICN根据头位以及是否合并斜视进行手术设计,眼外肌的手术方法主要是中间带移位术.Objective To study clinical characteristics and surgical treatment of idiopathic congenital nystagmus （ICN）.Methods A retrospective study was conducted in 224 patients with ICN in Tianjin eye hospital from July 2007 to February 2013.Results There were 224 patients,158 （70.54%） males and 66 （29.5%） females,mean age was （11.6±8.4） years and （11.4±6.4） years separately.Horizontal nystgamus happened in 215 cases,3 cases were vertical type and 6 cases were mixed.214 cases were with no history of operation and 10 patients had ever underwent surgeries before.Furthermore,151 patients combined with strabismus and refractive error,anterior segment or retinal disorders,which accounting for 67.4% of all the patients.48 patients were associated myopia,30 patients with hyperopia,43 patients with strabismus.Among them,153 cases of compensatory head position direction were horizontal with face turn,43 cases （43/153,28.1%） showed face turning to the left,110 cases （110/153,71.9%） showed face turning to the right.Surgeries were designed according to the compensatory head position and head retroversion angle.For 15 patients with double intermediate zones,the position which was often used with good visual function was chosen for operation design.As for the patients with nystagmus and strabismus,the transfer null zone to primary position for the dominant eye and strabismus surgery for the other eye was chosen.And for complicated patients with compensative head position,the dominant head posture were designed for surgery.Conclusions ICN is dominated by male with variable clinical manifestations.Surgical choice for ICN depends on the direction of head position and if there is strabismus accompanying it.The aim of ocular muscle surgery is to transfer null zone to primary position.

关 键 词：眼震 先天性 头部 体位 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]