内直肌超常量后徙治疗婴幼儿内斜视的观察

Transnormal Recessions of Medial Rectus to Treat Congenital Infantile Esotropia

目的探索婴幼儿性内斜视的手术时机和手术方式。方法采用双眼内直肌5～8 mm 后徙的方法对所有6个月～3岁及部分3～5岁的(集合过强型)婴幼儿性内斜视患者进行手术,采用单眼内直肌后徙加外直肌缩短的方法对另外一部分3～5岁的婴幼儿内斜视患者进行手术,两组术后眼位进行比较;并把所有患儿按6个月～2岁和2～5岁分成两个手术组进行远期立体视(术后3年)功能分析比较。结果 6个月～2岁,组较2～5岁组术后正位率差异无显著性意义;施行双眼内直肌后徙5～8mm 组和施行单眼内直肌后徙+外直肌缩短组术后正位率比较,差异无显著性意义;6个月～2岁组立体视发生率为40.74%,2～5岁组12.50%,立体视觉的发生率差异具有非常显著性意义。结论 1.双眼内直肌超常量后徙是婴幼儿内斜视切实可行的手术方式之一;2.婴幼儿内斜视应早期手术治疗,如果有可能应在6个月龄～2岁之间进行,可获得精细立体视觉更高的发生率。

Purpose To explore the time for surgical alignment and the methods of operation for the treatment of infantile esotropia. Methods All the patients at 6 months to 2 years old and part of the patients at 3 - 5 years old with esotropia collected in this hospital were operated on for alignment by recessions of bimedial rectus for 5 - 8 mm. The other part of the patients at 3 - 5 years old with esotropia were operated on for alligment by recessions of single medial rectus plus shorting of lateral rectus. Comparisons of eye position and establishment of stereopsis were made between these two groups. Results There was no significant difference in orthophoric rate after operation between the 6 months to 2 years old and the 3 - 5 years old groups. No difference in orthophoric rate between the bimedial and single medial rectus recession groups. The rate of stereopsis was 40.74% in the 6 months to 2 years old group and 12.50% in the 2 - 5 years old group. Conclusion Excessive recessions of bimedial rectus is a feasible operation for alignment of infantile esotropia. Infantile esotropia should be operated on as early as possible. （Chin J Ophthalmol and Otorhinolaryngology, 2006,6：298 - 299）