成人共同性外斜视的临床特点与手术疗效影响因素分析

Clinical Characteristics and Factors Influencing Effectiveness of Surgery in Adults with Concomitant Exotropia

目的探讨成人共同性外斜视的临床特点和影响手术疗效的主要因素。方法采用前瞻性研究方法,将2003年1月～2005年1月在我院就诊,需要手术治疗的成人共同性外斜视患者完善各项检查后予以手术治疗。随访观察1～5年后,结合患者的临床特征分析影响手术疗效的因素。结果本研究共纳入120名患者,研究发现成人外斜视患者手术时年龄、性别、术前视力、斜视的类型、有无弱视及A、V征以及双眼单视的存在与否等对手术预后(眼正位)影响不大(P>0.05)。术前大角度斜视(r2=0.26,P<0.01)、屈光不正等值球镜度数趋向正视化(r2=0.04,P<0.05)与术后眼位矫正效果不佳相关。结论成人共同性外斜患者,由于具有术前斜视度偏大,多无双眼视等临床特点,在决定实施手术之前,应该充分考虑术前斜视度的大小、屈光不正等因素,选择正确的手术术式及手术量,方能获得良好的矫正效果。

Objective To analyze the clinical characteristics of exotropia in adults and to identify the preoperative factors which influence the effectiveness of strabismus surgery in adults with exotropia. Methods This was a prospective, noncomparative intervention study. It was enrolled of adult exotropia patients from January 2003 to January 2005 who met the study requirements and would like to accept surgery treatment and at least one year follow-up. Condition factors included patient age at surgery, gender, visual acuity, preoperative deviation, refractive errors（in average spherical equivalent）, amount of surgery performed, presence of amblyopia, presence of an A- or a V-pattern, type of exotropia （intermittent or constant）, and binocular single vision before surgery. Surgical outcome was expressed in postoperative deviations. Results The study included 120 participants： 54 males and 66 females; mean patient age at surgery was （25.9 ± 7.8） years old; mean preoperative deviations was （ 48.4 ± 10. 2） pd; mean refractive errors was （ -0. 6 ± 2. 1 ） D;mean amount of surgery was （ 12. 4 ± 2.4） mm. Patient age at surgery, gender, visual acuity, presence of amblyopia, presence of an A- or a V-pattern, type of exotropia （intermittent or constant）, and existence of binocular single vision had little effect on the surgical outcome of adults with exotropia. Preoperative deviation and refractive errors were proved to be the significant factors for surgical outcome in adults with exotropia （r2 =0. 26,P 〈 0.01 ; r2 =0. 04, P 〈 0.05 ,respectively）. Conclusions Adults with exotropia usually have larger preoperative deviations and are short of binocular single vision. To have a favorable outcome, special care should be paid to the preoperative deviation and myopia refractive error before performing surgery.