高度近视性固定性内斜视眼外肌影像特征与改良Yokoyama手术疗效分析  

Analysis of extraocular muscle imaging characteristics and the efficacy of the modified Yokoyama procedure in myopic strabismus fixus

作　　者：马润庭 周炼红[1] 李文萍 李沅瑾 胡蝶文杰 易贝茜 Ma Run-ting;Zhou Lian-hong;Li Wen-ping(Department of Ophthalmology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院眼科中心,430060

出　　处：《中国斜视与小儿眼科杂志》2023年第2期9-13,4,I0008,共7页Chinese Journal of Strabismus & Pediatric Ophthalmology

基　　金：湖北省重点研发计划项目(2022BCA044);湖北省中央引导地方科技发展专项(2019ZYYD058)。

摘　　要：目的 分析高度近视性固定性内斜视患者的临床特征,探讨改良Yokoyama手术疗效。方法 回顾性研究,收集2020年6月至2022年12月于武汉大学人民医院手术的MSF患者共20例(26眼)资料。对所有患者行CT/MRI,眼球A/B超。分析MSF患者术前眼外肌影像学特征。对26只患眼行改良Yokoyama术。收集末次随访数据,对比患者手术前后的内斜视度与眼球运动改善。采用配对/两样本t检验斜视度与错位角的组间差异。Wilcoxon秩和检验和卡方检验分析眼球运动组间差异。结果 20例MSF患者平均眼轴30.57±1.77mm。术前冠状面眼外肌错位角为197.22°±24.78°。眼轴超过30mm的患者,其内斜度(63.46°±10.88°VS.48.85°±5.46°)、错位角(214.09°±17.95°VS.180.35°±18.35°)明显大于眼轴短于30mm的患者。术后,26只患眼内斜视度由术前的56.15°±11.25°下降为术后的4.42°±6.53°。外展受限评分由术前-5 (-6~-4)改善为术后-2 (-3~-2)。上转受限评分由术前-5 (-5~-4)改善为术后-2 (-3~-2)。以上指标改善差异均具有统计学意义(P<0.05)。结论 MSF以固定性内斜为特点,伴有眼轴过长。影像学特征为上直肌向鼻侧移位,外直肌向下侧移位。改良Yokoyama手术是治疗MSF相对安全和有效的手段。Objective To analyze the clinical characteristics of patients with MSF and to investigate the effect of a modified Yokoyama procedure.Methods A retrospective study.The data of a total of 20 cases(26 eyes)with MSF opera-ted at Wuhan University People's Hospital from June 2020 to December 2022 were retrospectively analyzed.CT/MRI scans and ocular A/B ultrasound were performed on all patients.Preoperative EOM imaging features of MSF patients were ana-lyzed.A modified Yokoyama procedure was performed in 26 affected eyes.Data were collected at the end follow-up to com-pare esotropia deviation and eye movement before and after surgery.Paired/two-sample t-tests were used to test for group differences in esotropia deviation and dislocation of the globe.Wilcoxon rank sum test and chi-square test were used to ana-lyze the group differences in eye movements.Results The mean axis length(AL)of the 20 MSF patients was 30.57±1.77mm.The preoperative dislocation of the globe was 197.22°±24.78°.Patients with AL over 30 mm had significantly greater esotropia deviation(63.46°±10.88°vs.48.85°±5.46°)and dislocation of the globe(214.09°±17.950 VS.180.35°±18.35°)than those with AL shorter than 30 mm.After surgery,the esotropia deviation decreased from 56.15°±11.25°preoperatively to 4.42°±6.53°postoperatively in 26 eyes.The abduction limitation score improved from-5(-6~-4)preoperatively to-2(-3~-2)postoperatively.The elevation limitation score improved from-5(-5~-4)preoperatively to-2(-3~-2)postoperatively.The difference in improvement of the above indicators is statistically significant(P<0.05).Conclusions MSF is characterized by fixed esotropia,with excessive AL.The imaging features are nasal displacement of the superior rectus and inferior displacement of the lateral rectus.Modified Yokoyama procedure is a relatively safe and effective means of trentinr MCF.

关 键 词：高度近视性固定性内斜视 重眼综合征 改良Yokoyama术式 内斜视 

分 类 号：R779.6[医药卫生—眼科]