下斜肌转位术对间歇性外斜视手术的影响
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摘要
目的探讨外直肌后徙术联合下斜肌转位术治疗间歇性外斜视的疗效及下斜肌转位术后对水平斜视度的影响。方法回顾外直肌后徙术联合或不联合下斜肌转位术治疗的间歇性外斜视132例。根据是否行下斜肌转位术分为A组外直肌后徙术联合下斜肌转位术31例;B组单纯外直肌后徙术101例。对患者末次回访时情况进行回顾性分析,比较A、B两组患者的手术效果。以美国眼科学会推荐的外直肌后徙量作为患者预计矫正斜视度(对照组),比较A组术后视近(33cm)和视远(5m)处的斜视度数变化量与对照组的差异,分析下斜肌转位术对水平斜视度数的影响。结果 A组正位23例、欠矫8例、过矫0例;B组正位78例、欠矫23例、过矫0例(χ~2=0.12,P=0.73)。A组31例患者中,23例行单眼下斜肌转位术患者较对照组视近、视远分别多矫正1.5±4.3PD(P=0.48)和-1.0±3.2PD(P=0.52)。8例行双眼下斜肌转位术患者较对照组视近和视远分别多矫正1.1±4.8PD(P=0.58)和0.6±8.3PD(P=0.97)。结论下斜肌转位术对治疗间歇性外斜视合并下斜肌功能亢进效果良好;外直肌后徙术联合下斜肌转位术治疗外斜视时,可不考虑下斜肌转位术对水平斜视度数的影响。
Objective To evaluate the effect of anterior transposition of inferior oblique muscle combined with rectus muscle recession procedure for intermittent exotropia.To quantity the efficacy of anterior transposition of inferior oblique muscle for horizontal deviations.Methods Cases who underwent a simultaneous procedure of lateral rectus muscle recession as well as anterior transposition of inferior oblique muscle were categorized as group A(31cases) and those who underwent lateral rectus muscle recession as a sole operation were categorized as group B(101cases).Surgical outcomes among the two groups were evaluated and compared.Guidelines of the American Academy of Ophthalmology(AAO) were applied for surgical amounts of exotropia and set as control group.The corrected horizontal amounts at near and distance in group A were compared with control group.Results When the rate of horizontal orthophoria between group A and group B was compared, no significant difference was identified(P=0.73).Compared to control group, 23 patients in group A who underwent unilateral anterior transposition of inferior oblique muscle displayed an overcorrection of 1.5±4.3PD(P = 0.48)and-1.0±3.2PD(P= 0.52) at near and distance, respectively.This figure for patients who underwent bilateral operation(n = 8) was 1.1±4.8 PD(P=0.14) at near and 0.6±8.3PD(P = 0.97) at distance.Conclusions Anterior transposition of inferior oblique muscle appears to be a safe and decent procedure for patients of intermittent exotropia with IOOA.The efficacy of anterior transposition of inferior oblique muscle for horizontal deviations is negligible in planning a simultaneous horizontal muscle surgery and setting the surgical amount.
Objective To evaluate the effect of anterior transposition of inferior oblique muscle combined with rectus muscle recession procedure for intermittent exotropia.To quantity the efficacy of anterior transposition of inferior oblique muscle for horizontal deviations.Methods Cases who underwent a simultaneous procedure of lateral rectus muscle recession as well as anterior transposition of inferior oblique muscle were categorized as group A(31cases) and those who underwent lateral rectus muscle recession as a sole operation were categorized as group B(101cases).Surgical outcomes among the two groups were evaluated and compared.Guidelines of the American Academy of Ophthalmology(AAO) were applied for surgical amounts of exotropia and set as control group.The corrected horizontal amounts at near and distance in group A were compared with control group.Results When the rate of horizontal orthophoria between group A and group B was compared, no significant difference was identified(P=0.73).Compared to control group, 23 patients in group A who underwent unilateral anterior transposition of inferior oblique muscle displayed an overcorrection of 1.5±4.3PD(P = 0.48)and-1.0±3.2PD(P= 0.52) at near and distance, respectively.This figure for patients who underwent bilateral operation(n = 8) was 1.1±4.8 PD(P=0.14) at near and 0.6±8.3PD(P = 0.97) at distance.Conclusions Anterior transposition of inferior oblique muscle appears to be a safe and decent procedure for patients of intermittent exotropia with IOOA.The efficacy of anterior transposition of inferior oblique muscle for horizontal deviations is negligible in planning a simultaneous horizontal muscle surgery and setting the surgical amount.
引文
[1]Govindan M,Mohney B G,Diehl N N,et al.Incidence and types of childhood exotropia:a population-based study[J].Ophthalmology,2005,112(1):104-108.
[2]KW W.Color atlas Of strabismus surgery[M].New York:Springer Science+Business Media 2015.
[3]KW W.2014-2015 Basic and Clinical Science Course,Section 06:Pediatric Ophthalmology and Strabismus[M].American Academy of Ophthalmology,2014.
[4]Wang L,Nelson L B.Outcome study of unilateral lateral rectus recession for small to moderate angle intermittent exotropia in children[J].Journal of Pediatric Ophthalmology&Strabi-smus,2009,47(4):242-247.
[5]Choi J,Chang JW,Kim SJ,et al.The long-term survival analysis of bilateral lateral rectus recession versus unilateral recession-resection for intermittent exotropia[J].American Journal of Ophthalmology,2012,153(2):343-351.
[6]戴鸿斌,龚淑贤,喻长泰,等.单眼外直肌后徙内直肌缩短术与双眼外直肌后徙术之比较[J].中国斜视与小儿眼科杂志,2008,16(2):67-69.
[7]余新平,麦光焕,余焕云,等.V征斜视的临床特点和手术治疗的远期效果[J].中华眼科杂志,2005,(7):585-589.
[8]胡风云,封利霞,陶黎明.伴有下斜肌功能亢进的水平斜视合并V征的手术治疗[J].中国斜视与小儿眼科杂志,2010,(4):153-155.
[9]闫瑾,王利华.下斜肌减弱术对儿童青少年外斜视手术疗效的影响[J].中华眼视光学与视觉科学杂志,2015,17(4):217-220.
[10]Stager DR,Parks MM.Inferior oblique weakening procedures.Effect on primary position horizontal alignment[J].Archives of Ophthalmology,1973,90(1):15-16.
[11]Ha SG,Na GH,Kim S H.A Valid indication and the effect of bilateral inferior oblique transposition on recurrent or consecutive horizontal deviation in infantile strabismus[J].Korean Journal of Ophthalmology Kjo,2017,31(2):138-142.
[12]Diamond GR,Parks MM.The effect of superior oblique weakening procedures on primary position horizontal alignment[J].J Pediatr Ophthalmol Strabismus,1981,18(18):35-38.
[13]郑加庆,刘桂香,于淼,等.下斜肌断腱联合部分切除术对原在位水平斜视影响[J].中国实用眼科杂志,2014,32(6):750-753.
[14]Davis G,Mcneer KW,Spencer RF.Myectomy of the inferior oblique muscle[J].Archives of Ophthalmology,1986,104(6):855-858.
[15]Yoo JH,Kim SH,Seo JW,et al.Self-grading effect of inferior oblique recession[J].J Pediatr Ophthalmol Strabismus,2013,50(2):102-105.
[2]KW W.Color atlas Of strabismus surgery[M].New York:Springer Science+Business Media 2015.
[3]KW W.2014-2015 Basic and Clinical Science Course,Section 06:Pediatric Ophthalmology and Strabismus[M].American Academy of Ophthalmology,2014.
[4]Wang L,Nelson L B.Outcome study of unilateral lateral rectus recession for small to moderate angle intermittent exotropia in children[J].Journal of Pediatric Ophthalmology&Strabi-smus,2009,47(4):242-247.
[5]Choi J,Chang JW,Kim SJ,et al.The long-term survival analysis of bilateral lateral rectus recession versus unilateral recession-resection for intermittent exotropia[J].American Journal of Ophthalmology,2012,153(2):343-351.
[6]戴鸿斌,龚淑贤,喻长泰,等.单眼外直肌后徙内直肌缩短术与双眼外直肌后徙术之比较[J].中国斜视与小儿眼科杂志,2008,16(2):67-69.
[7]余新平,麦光焕,余焕云,等.V征斜视的临床特点和手术治疗的远期效果[J].中华眼科杂志,2005,(7):585-589.
[8]胡风云,封利霞,陶黎明.伴有下斜肌功能亢进的水平斜视合并V征的手术治疗[J].中国斜视与小儿眼科杂志,2010,(4):153-155.
[9]闫瑾,王利华.下斜肌减弱术对儿童青少年外斜视手术疗效的影响[J].中华眼视光学与视觉科学杂志,2015,17(4):217-220.
[10]Stager DR,Parks MM.Inferior oblique weakening procedures.Effect on primary position horizontal alignment[J].Archives of Ophthalmology,1973,90(1):15-16.
[11]Ha SG,Na GH,Kim S H.A Valid indication and the effect of bilateral inferior oblique transposition on recurrent or consecutive horizontal deviation in infantile strabismus[J].Korean Journal of Ophthalmology Kjo,2017,31(2):138-142.
[12]Diamond GR,Parks MM.The effect of superior oblique weakening procedures on primary position horizontal alignment[J].J Pediatr Ophthalmol Strabismus,1981,18(18):35-38.
[13]郑加庆,刘桂香,于淼,等.下斜肌断腱联合部分切除术对原在位水平斜视影响[J].中国实用眼科杂志,2014,32(6):750-753.
[14]Davis G,Mcneer KW,Spencer RF.Myectomy of the inferior oblique muscle[J].Archives of Ophthalmology,1986,104(6):855-858.
[15]Yoo JH,Kim SH,Seo JW,et al.Self-grading effect of inferior oblique recession[J].J Pediatr Ophthalmol Strabismus,2013,50(2):102-105.