目的：初步探讨直肌移植优化术在伴有下直肌限制且原在位垂直斜视度较大由双上转肌麻痹导致的难治性单眼上转不足中的应用。

方法：回顾性分析本院2015-01/2019-01收治的双上转肌麻痹病例6例6眼，经保守治疗无效后采用直肌移植优化术，观察术前与术后眼位、垂直斜视度、麻痹眼上下转的运动功能以及假性上睑下垂和代偿头位的改善情况。

结果：患者6例解除下直肌限制后行直肌移植优化术，术前，术后1、6mo的原在位垂直斜视度分别是49.83±6.55、2.67±2.07、1.83±2.40PD，术前斜视度与术后1、6mo比较均有差异(P<0.001)，术后1mo与6mo垂直斜视度比较无差异(P=0.899)。所有患者术后原在位眼位均正位，麻痹眼上转功能显著改善； 术前4例假性上睑下垂和2例有代偿头位者，术后假性上睑下垂和代偿头位基本消失。

结论：直肌移植优化术适合伴有下直肌限制的单眼上转不足，可有效改善患眼的上转功能且疗效稳定。

METHODS: Retrospective analysis was performed on 6 cases of double superior muscle palsy admitted to our hospital from January 2015 to January 2019. After the failure of conservative treatment, rectus muscle transplantation optimization was adopted to observe the improvement of preoperative and postoperative eye position, vertical strabismus, motor function of upper and lower rotation of paralytic eye, as well as the improvement of pseudo ptosis and compensated head position.

RESULTS: After the restriction was lifted, rectusmuscle transplantation optimization was performed. The original in situ vertical strabismus degree before surgery, one month and six months after surgery were(49.83 ± 6.55)PD,(2.67±2.07)PD, and(1.83±2.40)PD. There was a significant difference in vertical strabismus before and after 1mo and 6mo of operation(P<0.001). There was no significant difference in the comparison of vertical strabismus between 1mo and 6mo of operation(P=0.899). All patients had the orthotopic position in postoperative position, and the paralysis function of the paralyzed eyes improved significantly after the operation; Pseudopterygoptosis in four cases and compensatory head position in two cases before operation were significantly improved after operation.

CONCLUSION: Optimization of rectus muscle transplantation is suitable for unilateral superior rotation deficiency with limitation of inferior rectus, which can effectively improve the superior rotation function of affected eye with stable curative effect.