视网膜脱离术后限制性斜视的特征和手术矫正

Clinical characteristics and surgery of restricted strabismus following retinal detachment surgery

目的探讨视网膜脱离手术后限制性斜视的临床特征和手术效果。方法对17例、20眼视网膜手术后所致的限制性斜视,应用三棱镜加交替遮盖或三棱镜映光法(Krimsky法)测定客观斜视角,并进行眼球运动及复视像检查,观察各类视网膜脱离手术后限制性斜视的特征,并观察该斜视手术的治疗效果。结果①孔源性视网膜脱离术后患者斜视的性质与巩膜外加压物的位置有关;②单纯巩膜局部外加压和环扎联合局部外加压手术后限制性斜视临床特征一致,斜视的方向均与主要牵制肌肉相一致或相反,后者仅限于水平直肌;③限制性斜视手术后可以有效解决原在位斜视,并可以消除或改善复视。结论①视网膜脱离手术后斜视属于限制性斜视,其临床特征有助于指导对运动受限的肌肉做出准确判断和定位并进行斜视手术;②视网膜脱离手术后水平斜视的方向与主要牵制肌肉相反的情况由直肌下过度操作引起;③斜视手术可改善复视症状、矫正眼位。

Objective To investigate the clinical characteristics and evaluate the surgical results in strabismus eyes which had undergone retinal detachment surgery. Methods 17 cases（20 eyes）of restricted strabismus following retinal surgery were examined using prism altemative cover tests or Krimsky tests, and eyeball movement and diplopia analyses before and after strabismus operations. Results The main feature of restricted strabismus was that the direction of strabismus corresponded with the extraocular muscles restricted and opposed to the most position in diplopia and restricted binocular motility. Strabotomy could completely or partly eliminate diplopia, especially it could correct the restricted strabismus in the primary position and in the read location. Conclusion Strabismus following retinal detachment surgery is a restrictive strabismus. Strabotomy is effective in the treatment of restrictive strabismus.