后天性外旋转斜视手术前后的立体视觉观察

Stereoacuity before and after surgery in patients with acquired excyclotorsion

目的探讨后天性外旋转斜视患者行上斜肌矢状移位术前、后的立体视觉。方法对14例主述下方注视野旋转复视明显、行上斜肌矢状移位术的后天性外旋转斜视患者资料进行回顾性总结和分析,比较手术前、后患者的眼位、眼球运动、旋转斜视度数及双眼立体视觉情况。结果全部患者术前均主诉下方注视野旋转复视症状明显,术后视物效果自然、清晰。双马氏杆法检查术前上方注视野外旋≤10°,正前方注视野外旋10°～20°,下方注视野外旋15°～20°;术后上方注视野外旋消失、减弱或产生少许内旋(外旋4°～内旋3°),正前方注视野外旋减弱(外旋≤8°),下方注视野外旋减弱(外旋≤14°)。术后全部患者上方、正前方及下方注视野的立体视锐度均由无到有或从粗糙到较精细,立体视锐度从800″到60″呈逐步提高趋势;立体视觉从周边立体视到黄斑立体视,直至正常的黄斑中心凹立体视。手术前、后上方、正前方及下方注视野的立体视觉情况比较,差异均有统计学意义(P<0.05)。结论上斜肌矢状移位术可用于治疗前下方注视野旋转复视症状明显的后天性外旋转斜视;手术不仅使患者消除了实用注视野的旋转复视症状,而且使患者的立体视觉功能得到不同程度提高。

Objective To investigate the stereoacuity before and after superior oblique sagittal transposition in patients with acquired excyclotorsion.Methods 14 cases of acquired excyclotorsion who had complaints of forward and downward torsional diplopia were treated with superior oblique sagittal transposition. All patients were examined with Titmus test prior and after surgery.Results Surgical treatment greatly improved torsional diplopia .The stereoacuity improved gradually from 800 to 60 seconds of arc, peripheral to macular stereoacuity, and even foveal stereoacuity. Conclusion The superior oblique sagittal transposition is an effective method for primary and down gaze acquired excyclotorsion. The operation not only alleviated diplopia in the practical fixation field, but also improved stereoacuity.