视网膜脱离外路手术后斜视患者的临床特点、手术方案和斜视度常见相关因素的探讨

Discussion on clinical characteristics surgical program and common factors related to deviation angles of strabismus following external approach for retinal detachment

目的观察视网膜脱离外路手术后继发斜视患者的临床特点和斜视手术方案,探讨影响斜视度的常见相关因素。方法收集视网膜脱离外路手术后继发斜视并行手术矫正者25例,随访5~41个月。术前对患者进行详细的眼部检查,通过术中探察及术前、术后斜视度和眼球运动等情况来观察患者的临床特点,并探讨视网膜脱离手术次数、术后矫正视力及直肌悬吊后徙术对斜视度的影响。结果斜视术前所有患者均有眼球运动受限,复视者8例,术中发现受累眼外肌均有瘢痕粘连。手术方式单纯行眼外肌减弱术者7例,直肌减弱联合加强术者18例,其中共10例行悬吊后徙术。术后1周及末次随访时正位眼者分别为21例和15例,欠矫者分别为4例和9例,眼球运动明显受限者分别为5例和7例,复视者分别为2例和1例。视网膜脱离手术次数多于1次较1次者术中可见更严重的瘢痕粘连,且术前及术后1周斜视度差异均有统计学意义(P=0.01、0.00)。视网膜脱离术后视力<0.5与≥0.5者术后随访期末斜视度差异有统计学意义(P=0.03)。直肌悬吊后徙术使用与否对术后1周及末次随访时斜视度均无影响(P=0.26、0.63)。结论视网膜脱离手术后斜视患者的主要临床特点为眼球运动受限、复视和眼外肌瘢痕粘连。视网膜脱离手术次数、术后矫正视力可影响患者斜视度,悬吊后徙术为安全有效的斜视手术方法。

Objective To observe the clinical characteristics and surgical methods of strabismus following external approach for retinal detachment,and explore the common factors related to deviation angles of strabismus.Methods Twenty-five cases of secondary strabismus following external approach for retinal detachment underwent strabismus surgery were recruited,and the follow-up time was from 5 months to 41 months.Ophthalmic examinations were performed before operation.Clinical characteristics of these cases were observed by intraoperative exploration including preoperative and postoperative eye position and ocular movement（at 1 week and further follow-up）.The preoperative and postoperative deviation angles of strabismus were evaluated according to the times of retinal detachment operation postoperative BCVA and the surgery procedure of hang-back recession.Results Before strabismus operation,all cases underwent abnormal eye-movements,8 cases suffered from diplopia,and scar adhesions were observed in all involved ocular muscles during operation.Seven cases underwent weakening procedure of extraocular muscle,18 cases underwent weakening procedure plus strengthening procedure.Ten cases underwent hang-back recession among them.At 1 week and the final follow-up,the eyeball in 21 cases and15 cases were in position 4 cases and 9 cases were in undercorrection 5 cases and 7 cases were in limitation,and 2 cases and 1 case were in diplopia.The more operations were performed in retinal detachment,the more scar adhesions were presented,and statistical significance existed with the mean deviation angles before and after operation（in a week） between cases that had one-time and over-one-time of retinal detachment surgery（P = 0.01,0.00）.N o difference of mean deviation angles was found at one week after operation and at follow-ups between the cases with and without hang-back recession（P = 0.26,0.63）.Conclusion Abnormal eye-movements,diplopia and scar adhesion are the most common clinical characteristics of strabismus following retinal detachment surgery.Times of retinal detachment operation and postoperative BCVA can influence the deviation angles of strabismus,and hang-back recession seems the safe and effective method of strabismus surgery.