单眼外直肌后徙术治疗儿童间歇性外斜视的疗效观察

发布时间：2018-04-26 22:24

  本文选题：外斜视 + 斜视手术　； 参考：《山东大学》2011年硕士论文

【摘要】：研究背景和目的：间歇性外斜视是儿通最常见的外斜视类型。在间歇性外斜视发生的初期,患儿大部分时间可以控制外斜视,但是通常随着年龄增长,间歇性外斜视患儿的斜视频度增加、时间延长、斜视度增加,需要实施手术矫正眼位。间歇性外斜视的传统手术方式主要包括双眼外直肌对称性后徙术或单眼外直肌后徙联合内直肌截除术。一般认为,应用双眼外直肌后徙术治疗间歇性外斜视,术后早期眼位过矫有利于远期眼位正位,但由于在儿童期其视知觉系统发育尚未成熟,如果术后持续过矫产生小度数的续发性内斜视,则可能会形成弱视、丧失正常的立体视觉。近年来已有应用单眼外直肌后徙术治疗间歇性外斜视的文献报告,但是对这一术式的临床应用尚存在争议,主要顾虑为该术式可能会造成术后眼球运动的非共同性。本文旨在探讨单眼外直肌后徙术对中、小度数儿童间歇性外斜视的长期疗效。 方法：回顾性病例系列研究。2009年4月至2010年3月期间,于我院行单眼外直肌后徙术治疗、斜视度为15-35PD的间歇性外斜视儿童69例。所有病例术前均行视力、屈光状态、眼球运动及眼科常规检查。斜视度测量采用三棱镜加交替遮盖法,测定患儿戴镜注视6m视标时第一眼位及左、右侧向注视(25。)的斜视度和注视33cm视标时第一眼位的斜视度。采用手电筒式Worth四点灯检查患儿中心融合(距离2m)和周边融合(距离33cm)功能,采用Titmus立体视图测定患儿立体视锐度。根据看远斜视度定量行7～10mm单眼外直肌后徙术,所有手术均由同一医生完成。随访时间≥6月。疗效评价标准以眼位一8-0PD为正位；第一眼位与侧向注视的斜视度相差≥10 PD为眼位非共同性阳性。 结果：(1)术后1-3天和≥6月随访正位率分别为81.2%和62.3%,欠矫率为11.6%和36.2%,过矫率为7.2%和1.5%。手术年龄、术前等效球镜屈光度与术后远期眼位正位无相关性(P=0.159；P=0.174)；术后远期眼位正位与术前斜视度有相关性(P=0.006,r=-0.328)。(2)术前与术后远期随访比较,具有正常中心融合和周边融合者的差异有统计学意义(χ2=21.9,P=0.00;χ2=14.0,P=0.00)；具有正常立体视者的差异有统计学意义(χ2=15.0,P=0.00)。一部分患儿行单眼外直肌后徙术后双眼单视功能较术前得到了明显改善。(3)69例中,术后1-3天眼位非共同性阳性者6例,发生率为13.0%。术后远期随访未发现眼位非共同性阳性者。 结论：(1)对斜视度为15-35PD的间歇性外斜视患儿行单眼外直肌后徙术,术后1-3天和≥6月随访的眼位正位率分别为81.2%和62.3%；(2)单眼外直肌后徙术改善了间歇性外斜视患儿的融合功能及立体视功能,促进了双眼单视功能的恢复；(3)单眼外直肌后徙术后远期,患儿无眼球运动的非共同性。因此,单眼外直肌后徙术是治疗斜视度为15-35PD的儿童间歇性外斜视的安全、有效术式。
[Abstract]:Background and objective: intermittent exotropia is the most common type of exotropia. In the early stage of intermittent exotropia, most of the time, the children can control exotropia, but usually with the increase of age, the frequency of strabismus increases, the time prolongs, the strabismus increases, and surgery is needed to correct the eye position. The traditional surgical methods of intermittent exotropia include bilateral rectus symmetric recession or unilateral rectus recession combined with internal rectus amputation. It is generally believed that the treatment of intermittent exotropia with bilateral rectus rectus recession is beneficial to long-term orthotropia in the early postoperative period, but the visual perception system is not mature in childhood. If continuous overcorrection produces small degrees of recurrent esotropia, amblyopia may result and normal stereoscopic vision may be lost. In recent years, there have been reports on the treatment of intermittent exotropia with unilateral rectus surgery. However, the clinical application of this procedure is still controversial, and the main concern is that it may lead to the non-concomitant of postoperative eye movements. The purpose of this study was to investigate the long-term effect of single-eye rectus rectus recession on intermittent exotropia in children with middle and small degrees. Methods: from April 2009 to March 2010, 69 cases of intermittent exotropia with 15-35PD were treated with unilateral rectus muscle recession in our hospital. All patients underwent preoperative visual acuity, refraction, eye movement and routine ophthalmic examination. The strabismus was measured by prism and alternating shading. The first eye position, left and right fixation were 25. Strabismus and the squint of the first eye position when looking at the 33cm visual scale. The functions of central fusion (distance 2 m) and peripheral fusion (distance 33 cm) were examined by flashlight Worth four point lamp. The stereoscopic acuity of children was measured by Titmus stereoscopic view. The unilateral rectus muscle recession of 7~10mm was performed quantitatively according to the degree of far strabismus. All the operations were performed by the same doctor. The follow-up time was more than 6 months. The standard of evaluation of curative effect was eye position-8-0PD, and the difference of strabismus between the first eye position and lateral fixation was 鈮，

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