下斜肌减弱术后主观旋转的动态变化

The active changes of cyclotropia after weakening of overacted inferior oblique muscles

目的探讨下斜肌减弱手术后主观旋转的动态变化及其影响因素。设计回顾性病例系列。研究对象18例连续性入院行下斜肌减弱手术的V型斜视患者。方法对18例原发性或发病早期的继发性下斜肌功能亢进+2～+3的V征斜视患者,行双眼下斜肌减弱手术,观察术前,术后1天、2天、3天和1周的主观旋转症状;同时行双马氏杆(DMRT)检查第一眼位,上、下注视眼位的旋转度和同视机检查双眼视功能水平。主要指标下斜肌功能亢进程度,主观旋转度,主观旋转症状,双眼视功能状态。结果18例患者术前无主观旋转;术后打开敷料后1小时内均感双眼视物时内旋转,2小时后4例双眼视物旋转,6例单眼视物时旋转;术后2天、3天和1周时视物旋转者减少;术后1周时1例双眼视物时旋转,4例单眼视物时旋转;均为原主斜眼视物旋转;术后8例获得一定双眼视功能者无旋转症状。术后1天DMRT检查,14例内旋,术后2天、3天及1周时DMRT结果渐减小,术后1周时9例内旋;各注视眼位旋转度无明显差别。结论下斜肌减弱术后主观旋转是动态变化过程,术后有旋转症状者均为原主斜眼视物旋转,术后获得一定双眼视功能者能更早代偿旋转改变。(眼科,2008,17:123-126)

Objective To evaluate the active changes of the cyclotropia after the weakening surgery of overacted inferior oblique muscles and to analyze the influence factors of the changes. Design Retrospective case series. Participants Eighteen patients with primary inferior oblique overaction （IOOA） or early onset superior oblique palsy （SOP）. Methods Eighteen patients with primary inferior oblique overaction （IOOA） or early onset superior oblique palsy （SOP） underwent bilateral inferior oblique weakening operation. The cyclotropia diplopia was assessed before surgery, as well as 1 day, 2 days, 3 days and 1 week after surgery. The double Maddox rod test （DMRT） and binocular vision function were examined with the primary position, upward and downward position at the same time. Main Outcome Measures Function of the inferior oblique, cyclotropic diplopia, subjective cyclotropia, binocular visual function. Results All patients were absent of image tilting before surgery. In the 1 hour of occlude removed, all patients showed the incyclotropic diplopia. 2 hours later, 4 patients present with cyclotropic diplopia and 6 patients showed the tilting of the visual environment with one eye covered. 1 patient present with cyclotropic diplopia and 4 patients showed the tilting of the visual environment with one eye covered at the 1 week after surgery. 8 patients with binocular vision post-operative had no cyclotropic diplopia. 14 cases and 9 cases presented with subjective cyclotropia examined by DMRT at 1 day and 1 week after surgery, respectively. The difference between the results of the primary position, upward and downward position was not significant. Conclusion The changes of the cyclotropia after the weakening surgery of inferior oblique muscles is activity. Patients with binocular vision can adapt to the cyclotropic changes earlier.