对小度数集合不足型间歇性外斜视手术疗效分析

Analyze effects of surgery for intermittent exotropia oflow-dioptric convergence insufficiency type

【摘要】目的探讨单纯单眼内直肌截除术和2．5～3．0ram单眼外直肌后徙＋单眼内直肌截除术对视近时斜视度在15△～25△之间的小度数集合不足型间歇性外斜视的手术疗效。方法对10例患者行2．5～3．0mm单眼外直肌后徙＋单眼内直肌截除术（A组），15例患者行单纯单眼内直肌截除术（B组），术后分别比较两组患者视远和视近的斜视度以及视远和视近的斜视度的差值，并比较两组患者术后的正位率、恢复双眼视例数和恢复近立体视例数。术后随访6至12个月。结果两组术前和术后视远和视近的斜视度以及视远和视近的斜视度的差值比较经t检验差异均有统计学意义（t=1．73-9．73，19〈0．05），A、B两组术后正位率、术后恢复双眼视的例数和恢复立体视例数经Xz检验差异具有统计学意义（x2=3．84～5．11，P〈0．05）。结论（1）2．5～3．0mm单眼外直肌后徙＋内直肌截除术和单纯单眼内直肌截除术治疗视近时斜视度15△～25△的小度数集合不足型间歇性外斜视均有效。（2）在缩小视近和视远斜视度的差值、术后正位率、恢复双眼视和立体视功能方面，2．5～3．0mm单眼外直肌后徙＋内直肌截除术优于单纯单眼内直肌截除术。

Objective To evaluate the surgical results of unilateral medial rectus muscle resection and 2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection for the intermittent exotropia of the convergence insufficiency type with small-diopter exodeviation of 15 △ to 25 △ at near. Methods Ten cases received 2.5mm-3.0mm unilateral lateral muscle resection with unilateral medial rectus muscle resection （group A）, 15 cases received unilateral medial rectus muscle resection （group B）. The distance and near deviations and differences in the deviations were compared separately for the two groups; besides, the positioning rates, number of patients with restoration of binocular and stereoscopic visions were compared in the two groups after surgery. They were followed-up for 6 to 12 months after surgery. Results There was statistically significant difference （t =1.73-9.73, P 〈0.05） in the angle at near anddistance, the angle near-distance difference. There also was statistically significant difference （x2=-3.84-5.11, P 〈0.05） in the orthophoria rate, biocular vision recovery, stereopsis recovery after operation were compared between group A and B. Conclusions Both of the unilateral medial rectus muscle resectiofi and 2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection are an effect surgical treatment for the intermittent exotropia of the convergence insufficiency type with small-diopter exodeviation of 15△ to 25△ at near. 2.5mm-3.0mm unilateral lateral muscle recession with unilateral medial rectus muscle resection is superior to unilateral medial rectus muscle resection in reducing the angle difference of near-diatance, orthophoria rate, biocular vision recovery, stereopsis recovery.