Ⅲ型急性共同性内斜视的临床特征及手术疗效探讨  

Clinical Characteristics and Surgical Effects of Type Ⅲ Acute Acquired Concomitant Esotropia

作　　者：姚爱霞 王成虎[1] Aixia Yao;Chenghu Wang(The Affiliated Eye Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]南京医科大学附属眼科医院,210009

出　　处：《中华眼视光学与视觉科学杂志》2020年第8期618-622,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:探讨Ⅲ型急性共同性内斜视(AACE)的临床特征及手术疗效。方法:回顾性病例自身对照研究。收集2016年7月至2019年7月于南京医科大学附属眼科医院接受常规斜视矫正术的Ⅲ型ACCE患者31例,年龄14~39岁。收集患者发病时间、双眼的屈光度、每日近距离用眼时间及术中测得的内直肌附着点、术前与术后的斜视度、融合范围、远近立体视等资料,随访时间6~12(7.4±2.6)个月。采用Wilcoxon符号秩和检验分析患者手术前后斜视度、融合范围的差异,采用传统配对卡方检验分析患者术前与术后远立体视的变化,采用增强配对卡方检验分析患者术前与术后近立体视锐度的变化。结果:31例Ⅲ型AACE患者中,高度近视3例(10%),中度近视25例(81%),低度近视2例(6%),正视1例(3%)。所有患者每日近距离用眼时间为(6~10)(7.8±1.1)h,内直肌附着点距离角膜缘的平均距离为(4.9±0.1)mm。术前患者看近(33 cm)的斜视度的中位数为35 PD,看远(6 m)的斜视度的中位数为40 PD,二者差异有统计学意义(Z=-3.136,P=0.002)。本研究中所有患者手术均一次成功,最后一次随访结束时,术后患者看近与看远的斜视度的中位数均为0 PD;与术前相比,术后患者看近、看远的斜视度均比术前明显减小,手术前后斜视度的差异均有统计学意义(均Z=-4.865,均P<0.001)。患者术前融合范围的中位数为14°,术后融合范围的中位数为19°,二者差异有统计学意义(Z=-3.149,P=0.002)。与术前相比,术后有16例(84%)患者恢复了远立体视,19例(95%)患者恢复了近立体视功能,术前与术后的远立体视功能(χ^2=14.063,P<0.001)、近立体视功能(χ^2=24.000,P=0.001)的差异均有统计学意义。结论:长时间近距离工作、内直肌附着点靠前、中度近视可能是Ⅲ型ACCE发病的重要危险因素。按照常规手术量行斜视矫正术能有效改善Ⅲ型ACCE患者的斜视度、融合范围和远近立体视。Objective:To investigate the clinical characteristics and surgical effects in typeⅢacute acquired concomitant esotropia(AACEⅢ).Methods:This was a retrospective self-control study.Thirty-one AACEⅢpatients,aged 14 to 39 years,who underwent routine strabismus surgery at the Affiliated Eye Hospital of Nanjing Medical University,were enrolled from July 2016 to July 2019.The following data were collected:Onset time,binocular ametropia,time of near work,the attachment point of the internal rectus muscle,pre-and postoperative deviation,fusion range,and distance and near stereopsis.The followup period ranged from 6 months to 12 months(7.4±2.6 months).A Wilcoxon signed rank test was used to compare the difference in esodeviation and binocular fusion range before and after strabismus surgery.Preand postoperative distance stereopsis were analyzed by the traditional paired Chi square test,while pre-and postoperative near stereopsis was analyzed by the enhanced paired Chi square test.Results:Among the 31 patients with AACEⅢ,3 patients(10%)had high myopia,25 patients(81%)had moderate myopia,2 patients(6%)had low myopia,and only one patient(3%)had emmetropia.All patients had performed nearwork with an average time of 7.8±1.1 hours per day.The average distance between the attachment point of the internal rectus muscle and the corneal limbus was 4.9±0.1 mm.The median pre-operative esodeviation at near(33 cm)was 35 PD,and at distance(6 m)was 40 PD.The difference between them was statistically significant(Z=-3.136,P=0.002).In this study,all patients underwent a successful strabismus operation and at the time of the final follow-up,whether it was at 33 cm or 6 m,the median degree of postoperative strabismus was 0 PD.Compared with the pre-operative degree of strabismus at the same distance,the postoperative degree was significantly smaller(both Z=-4.865,both P<0.001).The median of pre-and postoperative binocular fusion range was 14°and 19°,respectively,and the difference between them was statistically significant(Z=-3.

关 键 词：Ⅲ型急性共同性内斜视 手术 融合功能 立体视 

分 类 号：R779.6[医药卫生—眼科]