知觉性斜视948例的病因和常见合并症及手术方法分析  

The causative diseases, common comorbidities and surgical procedures of 948 cases of horizontal sensory strabismus

作　　者：尹玲[1] 陈霞[1] Yin Ling;Chen Xia.(Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Hospital and Institute, Tianjin Key Lab. of Ophthalmology and Visual Science, Tianjin 300020, Chin)

机构地区：[1]天津市眼科医院天津医科大学眼科临床学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》2018年第4期283-287,共5页Chinese Journal of Ophthalmology

摘　　要：目的 观察分析知觉性斜视的常见病因、视力障碍发生年龄以及合并症,寻求矫正知觉性斜视及其合并症的有效手术方案.方法 回顾性研究.收集2005年至2015年在天津市眼科医院接受手术治疗的知觉性斜视患者948例,包括822例知觉性外斜视和126例知觉性内斜视.评估参数主要包括导致视力障碍的病因、视力障碍发生年龄、水平和垂直斜视度、眼球运动、手术方法等.年龄、斜视度等参数使用描述性统计分析方法;两独立样本秩和检验方法观察内斜视与外斜视视力障碍发生年龄的平均值差异以及水平和垂直平均斜视度在知觉性内、外斜视中的差异;卡方检验方法观察不同年龄段内外斜视发病率差异及AV型斜视、眼球震颤、垂直分离斜视（DVD）和斜肌功能亢进在内外斜视中的检出率差异.结果 引起知觉性斜视患者视力障碍的常见病因为先天性或外伤性白内障、屈光参差、视神经萎缩、角膜瘢痕及视网膜脱离.知觉性内斜视的视力障碍发生平均年龄（2.3±4.2）岁,外斜视视力障碍发生平均年龄（8.8±9.0）岁,内、外斜视组发生视力障碍的平均年龄差异有统计学意义（t=-8.00,P＜0.01）.知觉性斜视常可合并存在AV型斜视、眼球震颤、垂直分离斜视（DVD）以及斜肌功能亢进.100例（10.5％）患者检出A型或V型斜视,42例（5.1％）患者检出眼球震颤,57例（6％）患者合并DVD,134例（14.1％,包括54例A型或V型斜视）患者检出斜肌功能亢进,其中AV型斜视和斜肌功能亢进在知觉性内、外斜视组中的检出率差异无统计学意义（x2=0.13,0.04;P＞0.05）,眼球震颤以及DVD在内、外斜视组中的检出率差异有统计学意义（x2=48.33,12.04;P＜0.01）.结论 导致知觉性斜视视力障碍的最常见病因为白内障,内斜视组患者视力障碍的发生时间普遍早于外斜视组且较外斜视组更易合并发生DVD和眼球震颤,治疗前应�Objective To investigate the common causes,onset age of vision impairment and complications of sensory strabismus,and to explore the effective surgical methods for sensory strabismus and associated complications.Methods In this retrospective study,there were 948 cases of surgical treatment for sensory strabismus from 2005 to 2015 in Tianjin Eye Hospital,including 822 cases of sensory exotropia and 126 cases of sensory esotropia.Causative disease,onset age of vision impairment,eye movement,horizontal and vertical deviation and surgical methods were evaluated.Statistical methods included independent samples t test,Mann-Whitney U test and chi-squared test.Results Congenital or traumatic cataract was the most common cause of sensory strabismus.Anisometropia,optic atrophy,corneal opacity and retinal detachment were also primary reasons.The mean onset age of vision impairment was （2.3±4.2） years in the sensory esotropia group and （8.8±9.0） years in the exotropia group,and a positive correlation was found between the two groups （t=-8.00,P〈0.01）.Sensory strabismus occurred with A-or V-pattern in 100 cases （10.5%）,nystagmus in 42 cases （5.1%）,DVD in 57 cases （6%） and oblique overaction in 134 cases （14.1%;including 54 cases with A-or V-pattern）.No statistically significant difference existed between the relevance ratio of A-or V-pattern,oblique overaction and the type of strabismus （x2=0.13,0.04;P〉0.05）,but significance difference existed between the relevance ratio of nystagmus,DVD and the type of strabismus （x2=48.33,12.04;P〈0.01）.Conclusions The leading cause of sensory strabismus was cataract.The onset age of vision impairment was earlier in the sensory esotropia group than the exotropia group.Patients were more likely to suffer from DVD and nystagmus in the sensory esotropia group than the exotropia group.Surgeons should make a comprehensive assessment before surgery to design a rational surgical procedure.

关 键 词：斜视 视知觉 视觉障碍 眼震 病理性 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]