下斜肌不等量切除前转位术治疗伴有非对称性下斜肌功能亢进的分离性垂直斜视

Anterior transposition of inferior oblique muscle with unequal excision for segregated vertical strabismus with asymmetric inferior oblique hyperfunction

摘要:

目的：探讨下斜肌不等量切除前转位术在伴有非对称性下斜肌功能亢进的分离性垂直斜视治疗中的应用。

方法：回顾性分析2015-06/2017-06在我院行下斜肌不等量切除前转位术治疗伴有非对称性下斜肌功能亢进的分离性垂直斜视病例22例28眼，男10例，女12例，年龄3～28(平均12.32±6.81)岁，从术后双眼视功能恢复情况、DVD疗效、下斜肌功能亢进疗效、眼位及代偿头位、并发症等方面观察，术后随访6～18(平均10.05±3.87)mo。

结果：术后双眼视功能恢复情况：无双眼视功能者11例(50%)； 恢复Ⅰ级视功能者6例(27%)； 恢复Ⅱ级视功能者3例(14%)； 恢复Ⅲ级视功能者2例(9%)。DVD疗效：满意17例(77%)，好转5例(23%)，无效0例。下斜肌功能亢进疗效：治愈13例(59%)，好转9例(41%)，无效0例。术后眼位及代偿头位：(1)水平眼位：外斜矫正术后水平眼位欠矫1例，内斜矫正术后水平眼位欠矫1例，过矫0例，正位20例；(2)垂直眼位：垂直斜视度≤5^△者13例，5^△<垂直斜视度<10^△者9例，平均5.55^△±2.35^△，垂直眼位无过矫；(3)代偿头位：术后6例代偿头位消失，1例代偿头位明显改善。并发症：1例患者发生轻微抗上转综合征，1例患者发生轻微睑裂缩窄，睑裂缩窄量<1mm。

结论：下斜肌不等量切除前转位术治疗伴有非对称性下斜肌功能亢进的分离性垂直斜视患者疗效满意，规范的术前检查、个性化手术设计以及手术技巧至关重要。

Abstract:

AIM: To explore the application of anterior transposition of inferior oblique muscle with unequal excision in treatment of segregated vertical strabismus with asymmetric inferior oblique hyperfunction.

METHODS: A total of 22 patients(10 males and 12 females, 28 eyes in all)who underwent anterior transposition of the unequal excisional inferior oblique muscle for dissociated vertical deviation with asymmetric inferior oblique muscle overaction were studied retrospectively. The patients were admitted from June 2015 to June 2017,with mean age at 12.32±6.81 years old(ranging from 3 to 28 years old). The binocular vision, the curative effect of DVD, the curative effect of inferior oblique muscle overaction, eye position and compensatory head posture, complications were examined postoperatively, follow-up survey was conducted at 6 to 18mo, meanly at 10.05±3.87mo.

RESULTS: Recovery of binocular vision: 11 cases did not have binocular vision(50%); 6 cases recovered to the first level of binocular vision(27%); 3 cases recovered to the second level of binocular vision(14%); 2 cases recovered to the third level of binocular vision(9%). The curative effect of DVD shows: 17 cases with satisfaction(77%), 5 cases with improvement(23%), and 0 case with no avail. The curative effect of inferior oblique muscle overaction shows: 13 cases with cured(59%), 9 cases with improvement(41%), and 0 case with no avail. Postoperative eye position and compensatory head posture: 1)Horizontal eye position: 1 case of under correction after exotropia correction surgery, 1 case of under correction after esotropia correction surgery, 0 case of overcorrection, 20 cases of correction; 2)Vertical eye position: 13 cases show vertical strabism deviation less than 5^△, 9 cases show vertical strabism deviation between 5^△ to 10^△ meanly at 5.55^△±2.35^△, vertical eye position without overcorrection; 3)Compensatory head posture: 6 cases were disappeared, 1 case was improved. Complications: Mild anti-elevation syndromeoccurred in 1 case, narrowed palpebral fissueoccurred in 1 case, and narrowed quantity less than 1mm.

CONCLUSION: In general, the curative effect of anterior transposition of the unequal excisional inferior oblique muscle for dissociated vertical deviation with asymmetric inferior oblique muscle overactionis satisfactory, standard preoperative examination, individualized surgical design and surgical techniques are necessary.