眼底照相法在下斜肌亢进诊断和疗效评估中的应用

Application of fundus photography in the diagnosis and curative effect evaluation of inferior oblique muscle overaction

目的以眼底照相为客观性定量检查方法,结合临床观察下斜肌功能异常(原发性下斜肌亢进,继发于先天性上斜肌麻痹的下斜肌亢进)患者手术前后的客观旋转状态,探讨其在诊断和疗效评估中的作用。方法使用日本Canon眼底照像机拍摄眼底像,使用Auto CAD R14绘图软件测量黄斑中心凹-视盘中心夹角度数(forea-disc angle,FDA)。其中正常人70例(140眼),下斜肌功能亢进患者29例(58眼)。结果本研究中正常人的FDA为:右眼5.24°±2.63°,左眼6.68°±2.86°,双眼总FDA为11.92°±4.24°,双眼之差为3.11°±2.11°。18例先天性上斜肌麻痹患者中16例(占89%)的FDA超出正常值范围,11例原发性下斜肌亢进患者中9例(占82%)的FDA超出正常值范围,表现为外旋转斜视。V征与外旋转有关。斜肌手术后眼底的FDA均趋于正常。下斜肌亢进的程度越强,V现象越明显,眼底照相显示的FDA超出正常值越多,术后改善得越明显。结论眼底照相技术可以客观描述旋转斜视患者的眼球旋转状态,为临床诊断提供了可靠的依据,对手术方式的选择有指导意义,也可对手术效果做出评价。

Objective To use fundus photography to investigate the clinical significance of the objective status of ocular torsion in abnormal oblique muscles before and after surgery; to discuss its diagnosis and evaluate its effect on overacting inferior oblique muscles. Methods Objective cyclodeviations were assessed with fundus photography before and after surgery. The photograph was trans-ferred to a computer, and the fovea-to-disc angle （FDA） was measured with picture software （Auto CAD R14） Objective cyclodeviations were measured in 70 normal persons （140 eyes） without stra-bismus and 29 patients （58 eyes） with congenital superior oblique muscle palsy （CSOP）, and primary inferior oblique muscle overaction （IOOA）. Results The fovea-to-disc angle of normal people was 5.24°±2.63° in the right eye, 6.68°±2.86° in the left eye, and 11.92°±4.24° when combined. The difference between the left and right eyes was 3.11°＋2.11°. Sixteen of eighteen patients with CSOP and nine out of eleven patients with IOOA showed exocy-clotropia, with a V pattern related to exocyclotropia. Objective cy- clodeviations became normal after surgery. A greater overaction of the inferior oblique muscle and a more obvious significant V pattern can result in a better outcome from surgery to improve the fovea-to-disc angle in patients with CSOP. Conclusion Fundus photography can objectively describe the status of ocular torsion in cyclodeviation, which provides credible evidence for clinical diagnosis, providing guidance in choosing surgical technique as well as evaluating the results of surgery.