高度近视所致固定性斜视的手术方法及疗效分析

发布时间：2018-06-08 04:18

本文选题：高度近视 + 固定性斜视　；参考：《哈尔滨医科大学学报》2014年03期

【摘要】：目的探讨高度近视所致固定性斜视的手术治疗方法及疗效。方法 12例(20眼)高度近视引起的固定性内斜视行手术治疗。20眼均先行超常量的内直肌后退,4眼因外直肌菲薄行上直肌颞侧1/2肌束截除并转位于外直肌上方止端旁,其余16眼行外直肌上方1/2~2/3肌束截除并转位于上直肌颞侧止端旁。转位的部分肌束截除量是8~12 mm。结果 12例(20眼)术前内斜视在90△~120△以上,下斜视30△~50△,术后1周,16眼行内直肌后退联合外直肌部分截除并转位术的患者眼位正位,2眼轻度欠矫(内斜小于15△),下斜视基本矫正,小于10△,眼球运动明显改善,外转时颞侧角膜缘距外眦角2~3 mm,上转过内外眦水平连线;4眼行内直肌后退联合上直肌部分截除并转位术的患者,其中3眼水平眼位矫正,1眼残存20△内斜,4眼均残存15△~30△下斜视,3眼外转可过中线,1眼外转刚到中线,上转可到内外眦水平连线。经3~26月随访未出现明显回退。结论内直肌超常量后退联合外直肌或上直肌部分截除加转位,对治疗高度近视所致固定性内下斜视效果肯定,且减少手术肌肉条数。
[Abstract]:Objective to investigate the surgical treatment and curative effect of fixed strabismus caused by high myopia. Methods the fixed esotropia caused by high myopia in 12 patients (20 eyes) were treated by operation. The rectus medialis rectus was retreated in 4 eyes because the external rectus muscle was thin and the temporal 1 / 2 muscle bundle of the superior rectus muscle was amputated and turned to the lateral end of the superior rectus muscle. The other 16 eyes were amputated 1 / 2 / 2 / 3 of the superior rectus muscle at the temporal end of the superior rectus muscle. The partial amputation of the transposed muscle bundle was 8 ~ 12 mm. Results the preoperative esotropia was more than 90 ~ 120, and the hypotropia was 30 ~ 50, in 12 cases (20 eyes). One week after operation, 16 eyes underwent partial rectus retraction combined with partial external rectus amputation and transposition. 2 eyes were slightly undercorrected (internal oblique less than 15 掳, inferior strabismus less than 10), eye movement was improved obviously. The temporal limbus was 2mm from the outer canthus, and 4 eyes underwent receding of the medial rectus muscle combined with partial transposition of the superior rectus muscle. Among them, 3 eyes were corrected in horizontal position, 1 eye remained 20 internal oblique deformity, 4 eyes remained 15 times 30 strabismus, 3 eyes turned outward through the midline, 1 eye turned outward to the middle line, and the upturn to the horizontal line of inner and outer canthus. No significant regression was found after 3 ~ 26 months follow-up. Conclusion the extra rectus of medial rectus combined with partial external rectus or superior rectus partial amputation and transposition is effective in the treatment of fixed endotropia caused by high myopia and reduces the number of surgical muscle strips.
【作者单位】：首都医科大学附属北京儿童医院眼科;儿科学国家重点学科;首都医科大学附属北京同仁医院北京同仁眼科中心;北京市眼科学与视觉科学重点实验室;
【分类号】：R779.6

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