上斜肌减弱术矫正伴上斜肌功能亢进A型斜视82例分析

Superior oblique weakening in treatment of 82 A-pattern patients with superior oblique overaction

目的探讨上斜肌减弱（断腱或后徙）术矫正伴上斜肌功能亢进A征的效果及眼球旋转状态的改变。方法收集伴双侧上斜肌亢进的A型斜视82例，断腱术79例，后徙术3例，观察手术前后第一眼位、上下方斜视度及上斜肌亢进程度，于术前和术后1d行双眼眼底照相并测量黄斑-视盘夹角（FDA）。结果（1）断腱组：①术前A征斜度平均为（23．47±9．08）^△；手术减少（25．27±11．79）^△；随访期末残余斜度差为（-1．98±6．60）^△，与术前比较差异有统计学意义。②术前平均FDA，右眼为（9．08±5．40）°、左眼为（12．10±4．77）°、双眼为（20．87±8．49）°；平均减少量，右眼（7．57±4．71）°、左眼（8．28±5．38）°、双眼（15．72±7．01）°；术后第1天FDA右眼（0．90±4．90）°、左眼（3．34±5．33）°、双眼（4．23±7．58）°；双眼FDA手术前、后比较，差异有统计学意义。（2）后徙组3例患者A征消失，手术矫正量为23°、35°、31°，双眼总FDA减少为24．00°、10．80°和11．00°。结论双侧上斜肌减弱术可有效矫正A征和眼球内旋状态。断腱术A征矫正量与术前A征的度数呈正相关，术后内旋转度数减少量与术前客观旋转度数呈正相关。

Objective To investigate tenectomy （ST） and recession （SR）, and their effects in treatment of A pattern, superior oblique overaction, and torsion. Methods Pre- and Post-operative primary eye position, upgaze and downgaze of deviation, superior oblique muscle function, fundus photograph were examined and analyzed in 82 patients of A-pattern deviation with bilateral superior oblique overaction （SOOA）. Results ST （1） Mean A-pattern was （23.47± 9.08）^△ berore and （-1.98± 6.60）^△ after the operation. Mean correction was （25.27± 11.79）^△. （2） The mean pre-operative fovea-disc angle （FDA） of both eyes was （20.87± 8.49）° , with the mean decreasing of （15.72± 7.01）, and the mean FDA was （4.23± 7.58）° 1 day after operation. SR The mean correction of A pattern was 23°, 35°and 31°. The mean correction of total FDA was 24.00°, 10.80° and 11.00°. Conclusions Bilateral superior oblique weakening is effective in correcting A-pattem deviation and incyclodeviation.