双眼外直肌后徙术治疗儿童类似分开过强型间歇性外斜视22例

doi:10.6040/j.issn.1673-3770.0.2014.065

摘要/Abstract

摘要： 目的观察双眼外直肌后徙术治疗儿童类似分开过强型间歇性外斜视的手术疗效。方法回顾性分析行双眼外直肌后徙术治疗儿童类似分开过强型间歇性外斜视22例连续性病例的病历资料。采用三棱镜加交替遮盖法测量患儿，经1 h诊断性遮盖前后注视6 m及33 cm调节性视标第一眼位的斜视度。检查患儿的融合功能和立体视锐度。依据诊断性遮盖后测量的最大看远斜视度，行双眼外直肌对称性定量后徙术。术后1 d、1个月、3个月、6个月检查患儿的斜视度和双眼视功能。疗效评价标准为斜视度≤±8 PD为正位。结果 22例诊断性遮盖前看远与看近斜视度的差值为(17.3±7.9)PD，诊断性遮盖后看远与看近斜视度的差值为(0.5±3.3)PD。双眼外直肌后徙量(7.2±1.2)mm。术后平均随访(8.6±5.4)月。末次随访的正位率为81.8%(18/22)、过矫率为4.5%(1/22)、欠矫率为13.6%(3/22)。手术前后融合和立体视锐度的差异无统计学意义(P>0.05)。结论根据诊断性遮盖后测量的最大看远斜视度行双眼外直肌后徙术，可有效的矫正儿童类似分开过强型间歇性外斜视。

关键词: 外斜视,间歇性, 类似分开过强型, 儿童, 眼外科手术, 外直肌后徙术,双眼, 治疗结果

Abstract: Objective To observe the surgical outcome of bilateral lateral rectus recession in children with simulated divergence excess intermittent exotropia. Methods Twenty-two children with simulated divergence excess intermittent exotropia underwent bilateral lateral rectus recession from December 2010 to August 2013 were recruited in this study. The exodeviations were measured by the alternate prism cover test at both distances (6 m and 33 cm) with fixation on accommodative targets before and after 1-hour diagnostic occlusion test. The Worth 4-Dot test was employed to assess central and peripheral fusion. The Titmus stereo test was used to assess stereoacuity. The target angle for the symmetrically quantitative bilateral lateral rectus recession was determined according to the largest distance deviation before or after diagnostic occlusion test. The examinations were carried out on the first postoperative day, 1 months, 3months and 6 months later. A successful alignment was defined as ±8 PD or less in primary gaze while viewing distant and near targets. Results The average age of patients was 6.3±2.9 years. The disparity between distance deviation and near deviation before and after diagnostic occlusion test was 17.3±7.9 PD and 0.5±3.3 PD, respectively. The amount of bilateral lateral rectus recession was 7.2±1.2 mm. Mean postoperative follow-up period was 8.6±5.4 months. The successful rate, overcorrection rate, undercorrection rate at the end of follow-up was 81.8%(18 in 22), 4.5%(1 in 22), 13.6%(3 in22), respectively. There was no significant difference in fusion and stereoacuity before and after surgery (P>0.05). Conclusion Based on the largest distance deviation before and after diagnostic occlusion test, bilateral lateral rectus recession could effectively treat simulated divergence excess intermittent exotropia in children.

Key words: Exotropia,intermittent, Opthalmologic surgical procedures, Treatment outcome, Lateral rectus recession, bilateral, Child, Simulated divergence-excess type

中图分类号:

R779.7

马翔, 郭敬丽, 王利华. 双眼外直肌后徙术治疗儿童类似分开过强型间歇性外斜视22例[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 62-65.

MA Xiang, GUO Jing-li, WANG Li-hua. Effects of bilateral lateral rectus recession in the treatment of simulated divergence excess intermittent exotropia in children[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2014, 28(5): 62-65.

参考文献

[1] Wright K W, Spiegel P H, Thompson L S. Handbook of Pediatric Strabismus and Amblyopia[M]. New York： NY, 2006: 270.
[2] von Noorden G K, Campos E C. Binocular Vision and Ocular Motility[M]. 6th ed. St. Louis: Mosby, 2002: 361-369.
[3] Burian H M, Spivey B E. The surgical management of exodeviations[J]. Am J Ophthalmol, 1965, 59(5):603-620.
[4] Burian H M. Exodeviations：their classification, diagnosis, and treatment[J]. Am J Ophthalmol, 1966, 62(6):1161-1166.
[5] Kushner B J. Selective surgery for intermittent exotropia based on distance/near differences[J]. Arch Ophthalmol, 1998, 116(3):324-328.
[6] Wang L, Wu Q, Kong X, et al. Comparison of bilateral lateral rectus recession and unilateral recession resection for basic type intermittent exotropia in children[J]. Br J Ophthalmol, 2013, 97(7):870-873.
[7] Chia A, Seenyen L, Long Q B. Surgical experiences with two-muscle surgery for the treatment of intermittent exotropia[J]. J AAPOS, 2006, 10(3):206-211.
[8] Lee S, Lee Y C. Relationship between motor alignment at postoperative day 1 and at year 1 after symmetric and asymmetric surgery in intermittent exotropia[J]. Jpn J Ophthalmol, 2001, 45(2):167-171.
[9] Fiorelli V M, Goldchmit M, Uesugui C F, et al. Intermittent exotropia: comparative surgical results of lateral recti-recession and monocular recess-resect[J]. Arq Bras Oftalmol, 2007, 70(3):429-432.
[10] Choi J, Chang J W, Kim S J, et al. The long-term survival analysis of bilateral lateral rectus recession versus unilateral recession-resection for intermittent exotropia[J]. Am J Ophthalmol, 2012,153(2):343-351.
[11] 全国弱视与斜视防治组. 斜视疗效评价标准[J]. 中国斜视与小儿眼科杂志, 1996,4(4):145. The strabismus and amblyopia treatment group. Evaluation standard of curative effect of strabismus[J]. Chin J Strabismus Pediatric Ophthalmol, 1996, 4(4):145.
[12] 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.
[13] Clarke M P. Intermittent Exotropia[J]. J Pediatr Ophthalmol Strabismus, 2007, 44(3):153-157.
[14] Kushner B J. Exotropic deviations: a functional classification and approach to treatment[J]. Am Orhthopt J, 1988, 38:107-110.
[15] Kushner B J. The distance angle to target in surgery for intermittent exotropia[J]. Arch Ophthalmol, 1998, 116(2):189-194.
[16] Mitchell P R, Parks M M. Concomitant Exodeviations[M]// Tasman W, Jaeger EA, eds. Duane's Clinical Ophthalmology. Philadelphia, PA: Lippincott Williams & Wilkins, 2000:1-17.
[17] Burian HM, Franceschetti A T. Evaluation of diagnostic methods for the classification of exodeviations[J]. Am J Ophthalmol, 1971, 71(1 Pt 1):34-41.
[18] Nelson L B, Olitsky S E. Harley's Pediatric Ophthalmology[M]. 5th ed. New York: Lippincott Williams & Wilkins, 2005: 161-162.
[19] Kim C, Hwang J M. Largest angle to target' in surgery for intermittent exotropia[J]. Eye, 2005, 19(6):637-642.
[20] Wu H, Sun J, Xia X, et al. Binocular status after surgery for constant and intermittent exotropia[J]. Am J Ophthalmol, 2006, 142(5):822-826.

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