Parks切口眼外肌调整缝线术治疗间歇性外斜视

Adjustable suture surgery via parks cul-de-sac approach for intermittent exotropia

目的观察Parks切口眼外肌调整缝线术治疗间歇性外斜视的临床效果。方法采用Parks结膜切口（近穹隆部结膜切口）联合眼外肌后徙调整缝线术治疗间歇性外斜视37例，术后随访3-8个月。结果（1）眼位：37例患者中11例术后未达到预期效果、眼位不正，欠矫2例，过矫9例，术后24h内表麻下采用调整缝线术进行眼位调整，11例均将眼位调整至预期效果。最终随访眼位结果：未调整者欠矫2例，分别欠矫-15^△、-20^△，过矫15^△ 1例。调整眼位者欠矫3例，分别欠矫-12^△、15^△、-25^△。余31例正位。（2）结膜切口愈合情况：所有患者结膜切口均于术后5—8d完全愈合，睑裂部无明显瘢痕。（3）并发症：5例患者调整缝线结对应的结膜面局部结节状隆起水肿，给予0．1％氟美瞳眼水点眼后消退。未见切口感染、缝穿巩膜、肌肉滑脱等并发症。结论采用Parks结膜切口眼外肌后徙调整缝线术可于24h内对间歇性外斜视术后眼位不正者进行有效眼位调整，避免了角膜缘梯形结膜切口的缺点。

Objective To observe the ophthalmologic outcome of adjustable suture surgery via parks cul-de-sac approach for intermittent exotropia. Methods Review of 37 patients with intermittent exotropia treated with adjustable suture technique via parks cul-de-sac approach. Postoperatively, they were followed up for 3-8 months. Results （1）Ocular alignment： eleven of the 37 patients were not initially in desired alignment, two patients showed an undercorrection and nine overcorrection. In the first 24 hours after surgery, eleven patients had adjustment, they were all in desired alignment after adjustment. Final ocular alignment： of the patients without adjustment, two were extropic and one esotropic. Of patients adjusted, three were extropic. Thirty-one of the 37 patients were orthotropic. （2）Healing of conjunctival incision： all conjunctival wounds were healed 5-8 days after surgery. There was no obvious conjunctival scarfing in lid fissure. （3） Postoperative complications ： five patients had local swelling chemosis above suture tie and cured with topical corticosteroid. We did not encountered any muscle slippage、infection and scleral perforation Conclusion In the first 24 hours after surgery, adjustable suture technique with parks cul-de-sac approach is an effective method for ocular realignment in patients with intermittent exotropia and disadvantages of limbal conjunctival approach are avoided.