不同类型间歇性外斜视手术前后双眼视功能变化及手术方式探讨

BINOCULAR VISUAL FUNCTION CHANGES IN DIFFERENT TYPES OF INTERMITTENT EXOTROPIA PATIENTS BEFORE AND AFTER OPERATION

目的探讨不同类型间歇性外斜视手术前后双眼视功能的变化及不同手术方式对手术效果的影响。方法将120例间歇性外斜视病人按照斜视类型分为基本型(29例)、集合不足型(80例)、分开过强型(11例),对3种类型病人术后正位率、立体视功能恢复率、融合功能恢复率进行比较。集合不足型80例病人根据手术方式是单或双眼外直肌后徙术,还是单眼外直肌后徙加内直肌缩短术分为A、B两组,比较两组术后正位率、融合功能恢复率、立体视功能恢复率及残余性外斜视、连续性内斜视发生率。结果3种类型间歇性外斜视术后正位率差异均无显著性(P>0.05)。集合不足型立体视功能恢复率、融合功能恢复率与其他两型间比较差异均有显著性(χ2=3.86～6.47,P<0.05),而基本型和分开过强型间差异无显著性(P>0.05)。A、B两组术后正位率、术后融合功能恢复率、立体视功能恢复率、残余性外斜视率比较差异有显著性(χ2=4.75～6.70,P<0.05),而连续性内斜视率两组间差异无显著性(P>0.05)。结论集合不足型间歇性外斜视术后双眼视功能恢复差,手术应主要缩短内直肌以加强集合能力,一般选择单眼外直肌后徙加内直肌截除术,以达到术后较高的正位率和恢复一定双眼视功能目的。

Objective To investigate binocuIar visual function changes in patients with different types of intermittent exotropia before and after operation, and assess the impacts of different operative methods in correcting patients＇ vision. Methods This study consisted of 120 cases dividing into basic （29 cases）, convergence insufficiency （80 cases） and divergence excess （11 cases） groups. The rates of orthophoria, convergence recovery and stereopsis recovery after surgery were compared among the groups. The convergence-insufficiency group was further divided into two subgroups according to different operative methods： group A （30 cases） received bilateral or uni-lateral rectus recession; group B （50 cases） received medial rectus resection as well as uni-lateral recession. The orthophoria rate, convergence recovery rate, stereopsis recovery rate, residual exotropia rate and consecutive rate after operation were compared between group A and B. Results There was no signi-ficant difference in the orthophoria among the three different intermittent exotropia types （P〉0. 05）. The differences in convergence and stereopsis recovery between insufficiency type and other two types of exotropia after operation were statistically significant （χ^2= 3.86-6.47 ,P〈0.05）, while such differences between basic type and divergence excess type were not statistically significant （P〉0.05）. There were significant differences in orthophoria rate, convergence recovery rate, stereopsis recovery rate and residual exotropia rate between groups A and B （χ^2 =4.75-6.70,P〈0.05）, however, the difference in consecutive esotropia rate between these two groups was not significant （P〉0.05）. Conclusion The binocular vision recovery after operation in convergence insufficiency exotropia was poor. Uni-lateral rectus recession and medial rectus resection was performed to improve orthophoria rate and binocular vision.