共同性斜视再次手术的术式和手术矫正量
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Surgical method and extent of reoperation in patients with concomitant strabismus
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    摘要:

    目的:分析共同性斜视过矫或欠矫后,再次手术的术式和手术矫正量。

    方法:共同性斜视术后过矫或欠矫计96例,男41例,女55例; 平均年龄21.90±14.70岁。术前行斜视常规检查,共同性内斜视过矫者23例,欠矫者15例; 共同性外斜视过矫者28例,欠矫者30例。术式选择主要依据斜视角的大小、远近斜视角的不同、原来的术式及双眼视力等情况而定。

    结果:共同性内斜视过矫者:后徙的内直肌行前徙9例,矫正量(5.51±2.63)/mm; 内直肌前徙+外直肌后徙9例,矫正量(6.25±1.59)/mm; 内直肌截除+外直肌后徙3例,矫正量(4.26±1.04)/mm; 仅行外直肌后徙2例,矫正量(4.21±1.91)/mm。共同性内斜视欠矫者:行外直肌截除6例,矫正量(4.03±0.98)/mm; 外直肌截除+内直肌后徙6例,矫正量(6.86±1.32)/mm; 内直肌后徙3例,矫正量(4.33±0.29)/mm。共同性外斜视过矫者,行外直肌前徙16例,矫正量(5.37±1.56)/mm; 内直肌后徙6例,矫正量(6.29±3.68)/mm; 外直肌前徙+内直肌后徙5例,矫正量(5.46±1.78)/mm; 外直肌截除1例,矫正量5.00/mm。共同性外斜视欠矫者,行内直肌截除12例,矫正量(4.47±0.54)/mm; 行外直肌后徙+内直肌截除16例,矫正量(5.11±0.75)/mm; 外直肌后徙2例,矫正量(2.65±0.42)/mm。

    结论:共同性内外斜视过矫者,通常对做过手术的水平肌行加强或/和减弱术,其手术矫正量偏大、且不甚稳定。欠矫者,通常对未行手术的水平肌行加强或/和减弱术,其手术矫正量同常规量。

    Abstract:

    AIM:To investigate the surgical method and extent of reoperation in the concomitant strabismus patients with surgical under-correction and over-correction.

    METHODS: Ninety-six concomitant strabismus patients with surgical under-correction and over-correction were recruited in this study, which included 41 males and 55 females, aged 21.90±14.70. All individuals underwent routine eye examinations for strabismus before the surgery. Among the cases with concomitant esotropia, there were over-correction in 23 cases, under-correction in 15 cases. Among the cases with concomitant exotropia, there were over-correction in 28 cases, under-correction in 30 cases. The method of reoperation were based on angle of deviation, the method of original operation and acute visual acuity of patients.

    RESULTS:In over-correction cases with concomitant esotropia,medial rectus muscle of 9 cases were advanced, the corrective extent was(5.51±2.63)/mm; 9 cases were performed advance of medial rectus muscle and recession of lateral rectus muscle, the corrective extent was(6.25±1.59)/mm; 3 cases were performed resection of medial rectus muscle and recession of lateral rectus muscle, the corrective extent was(4.26±1.04)/mm; only 2 cases were performed recession of lateral rectus muscle, the corrective extent was(4.21±1.91)/mm. In under-correction cases with concomitant esotropia, 6 cases were performed resection of lateral rectus muscle, the corrective extent was(4.03±0.98)/mm; 6 cases were performed resection of lateral rectus muscle and recession of medial rectus muscle, the corrective extent was(6.86±1.32)/mm; 3 cases were performed recession of medial rectus muscle, the corrective extent was(4.33±0.29)/mm. In over-correction cases with concomitant exotropia, 16 cases were performed advance of lateral rectus muscle, the corrective extent was(5.37±1.56)/mm; 6 cases were performed recession of medial rectus muscle, the corrective extent was(6.29±3.68)/mm; 5 cases were performed advance of lateral rectus muscle and recession of medial rectus muscle, the corrective extent was(5.46±1.78)/mm; 1 case were performed resection of lateral rectus muscle, the corrective extent was 5.00/mm. In under-correction cases with concomitant exotropia, 12 cases were performed resection of medial rectus muscle, the corrective extent was(4.47±0.54)/mm; 16 cases were performed recession of lateral rectus muscle and resection of medial rectus muscle, the corrective extent was(5.11±0.75)/mm; 2 cases were performed recession of lateral rectus muscle, the corrective extent was(2.65±0.42)/mm.

    CONCLUSION:In reoperation of concomitant strabismus patients with over-correction, weakening or/and strengthening the horizontal muscle which were performed surgery before has a greater and more unstable surgical corrective extent. While In reoperation of concomitant strabismuspatients with under-correction, weakening or/and strengthening the horizontal muscle which were not performed surgery has a normal corrective extent as usual.

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谢小华,吕露,杜东成,等.共同性斜视再次手术的术式和手术矫正量.国际眼科杂志, 2016,16(7):1394-1396.

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  • 收稿日期:2016-03-01
  • 最后修改日期:2016-06-07
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  • 在线发布日期: 2016-06-29
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