眼眶减压术后继发垂直斜视复视的手术治疗探讨  

Surgical management of new-onset vertical strabismus and diplopia after orbital decompression surgery

作　　者：张茵 杨士强[2] 张伟[2] 郭新[2] Zhang Yin;Yang Shi-qiang;Zhang Wei(Department of Ophthalmology,Hebei general hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院,050051 [2]天津市眼科医院,天津市眼科学与视觉科学重点实验室,南开大学附属眼科医院,天津医科大学眼科临床学院,天津市眼科研究所

出　　处：《中国斜视与小儿眼科杂志》2021年第4期19-22,共4页Chinese Journal of Strabismus & Pediatric Ophthalmology

摘　　要：目的探讨甲状腺相关眼病眼眶减压术后继发垂直斜视伴复视的斜视矫正手术治疗效果。方法回顾性系列病例研究,选取2017年5月至2020年10月,在天津市眼科医院因TAO行眼眶减压术后继发垂直斜视伴复视行斜视矫正手术的9例患者资料,均为女性,年龄21~48岁,眶减压术后出现垂直斜视,3例合并内斜视,6例为单纯垂直斜视。斜视矫正手术前后检查斜视角、眼球运动、代偿头位、复视情况。手术均在监护下麻醉联合局部麻醉下进行,术中采用调整缝线方法,术后定期随访。结果 9例患者,6例术后第一眼位正位,复视消失,3例明显改善。5例患者术前存在代偿头位,术后头位均消失。9例患者中1例下转受限,行上直肌后徙术;其余8例存在不同程度上转受限,眼球运动术前双眼上转受限分级为(-2.54±1.29),术后为(-0.73±1.01)。9例患者中4例各方向运动协调,复视完全消除;5例第一眼位及常用视野复视消失,日常生活无干扰,未再治疗。术后随访3~36个月,未发现远期过矫或欠矫。结论眼外肌手术可以有效治疗眼眶减压术后新发垂直斜视复视,眼位、复视、眼球运动障碍和代偿头位通过手术均可获得改善。Objective To evaluate the effect of extraocular muscle surgery in treating new-onset vertical strabismus with diplopia after orbital decompression for thyroid-associated ophthalmopathy(TAO).Methods This is a retrospective review of 9 patients who underwent extraocular muscle surgery for vertical deviation and diplopia after orbital decompression in Tianjin Eye Hospital from May 2017 to October 2020.9 Patients were all female,aged 21~48 years,and all the strabismus was developed right after orbital decompression,6 patients had isolated vertical deviation and the other 3 patients had vertical deviation and esotropia.The angle of deviation,ocular movement,compensatory head position and diplopia were compared pre-and postoperatively.All surgeries were performed under the monitored anesthesia care and intraoperative adjustable suture technic was used.All patients were followed up regularly.Results Six of the 9 patients had a complete resolution of vertical deviation after the extraocular muscle surgery and the other 3 cases were significantly improved.There was elimination of compensatory head tilting in 5 patients.Eight of the 9 patients had supra-duction limitation with different level while the remaining patient had mild infra-duction limitation.The limitation of supra-duction was improved from-2.54±1.29 to-0.73±1.01 postoperatively.4 patients got out of diplopia while the other 5 patients had residual diplopia only in extreme peripheral gaze position,there was no further treatment.The results kept stable with no over correction or significant under-correction at the last time follow-up(3 to 36 months).Conclusion Extraocular muscle surgery can effectively treat new-onset vertical strabismus with diplopia after orbital decompression.Vertical deviation,diplopia,ocular movement limitation and compensatory head position can be improved after surgery.

关 键 词：GRAVES眼病 眶减压术 垂直斜视 复视 斜视手术 

分 类 号：R779.6[医药卫生—眼科]