高度近视致固定性斜视的手术治疗

Surgical treatment in highly myopic strabismus fixus

目的探讨高度近视所致固定性斜视的手术治疗方法。方法因高度近视引起的固定性内斜视7例(10眼)行手术治疗。10眼均先行超常量的内直肌后退,1眼行上直肌颞侧1/2肌束截除并转位于外直肌上方止端旁;其余9眼行外直肌上方1/2～2/3肌束截除并转位于上直肌颞侧止端旁。转位的部分肌束截除量是8～12mm。结果术前内斜视在90△～120△以上,下斜视30△～50△,术后随访3～26个月,基本正位8眼,欠矫2眼。眼球运动明显改善。结论内直肌超常量后退联合外直肌或上直肌部分截除加转位,对治疗高度近视所致固定性内下斜视效果肯定,且减少手术肌肉条数。

Objective To report the management of strabismus fixus associated with high myopia. Methods Surgical procedures for 10 eyes of 7 patients with esohypotropia and high axial myopia were retrospectively studied. Extremely large medial rectus recessions were performed in all patients. Half-tendon transpositions of the lateral rectus muscle to the insertion of the superior rectus muscle,coupled with resection of the transposed halves in 9 eyes. Half-tendon transpositions of the superior rectus muscle to the insertion of the lateral rectus muscle in one case. Resection of the transposed halves varied from 9～12 mm. Results Pre-operative deviations of the affected eye were esotropia of 90△～120△,hypotropia of 30△～50△ After 3～26 months of post-operative follow- up,8 eyes were aligned within 15 delta of orthotropia. Ductions were also improved. Conclusion A greater amount of medial rectus recession combined with superior transposition of the half-ten-don of the lateral rectus or temporal transposition of the half-tendon of the superior rectus is ideally suited for strabismus fixus associated with high myopia.