对称下斜肌后徙术治疗原发不对称性下斜肌亢进

Bilateral inferior oblique symmetric recession for asymmetric primary inferior oblique overaction

目的探讨对称的下斜肌后徙术治疗正前方无明显垂直斜视的原发不对称性下斜肌亢进的手术疗效。方法回顾性分析了2004年7月至2010年8月住院行对称下斜肌后徙术的34例原发不对称性下斜肌功能亢进患者，术前一只眼的下斜肌亢进程度为＋1- ＋2；另一只眼的下斜肌亢进程度为＋3～＋4。手术前后分别观察患者的双眼下斜肌功能、A—V征、代偿头位、双眼视功能和旋位。术后随访6个月～12个月。结果术后双眼下斜肌功能正常的30例，所有患者均没有出现下斜肌功能不足；术前24例有V征，术后V征均消失；术前外旋度数为（26．3°±0．5°），术后的外旋度数为（16．2°±3．2°），双眼术后黄斑中心凹一视盘中心夹角度数（FDA）与术前相比有内旋的趋势；术前有双眼视的4例，术后有双眼视的7例；术前6例有代偿头位，术后3例代偿头位消失，2例代偿头位好转。结论对称的下斜肌后徙术对改善下斜肌功能和治疗由原发不对称性下斜肌亢进所引起的v征、旋位、代偿头位以及恢复双眼视功能均安全有效。

Objective To evaluate the effects of bilateral symmetric inferior oblique recession on the patients with bilateral asymmetric primary inferior oblique overaction and without vertical misalignment in the primary position. Methods A retrospective study was carried on 34 patients with bilateral asymmetric inferior oblique overaction admitted to the hospital from July of 2004 to August of 2010; inferior oblique overaction before surgery were of grade -1 or -2 in one eye and -3 or -4 in the other. The degrees of inferior oblique overaction, A-V pattern, degrees of fimdus torsion, binocular sight and abnormal heads were analyzed in all patients before and after surgery. The patients were followed-up for 6 to 12 months after the surgery. Results Symptoms of the inferior oblique overaction disappeared completely in 30 patients, none of the patients showed underaction of inferior oblique muscle function; 24 cases had V strabismus before surgery, their symptoms disappeared after surgery; the degrees of fundus torsion were 26.3° ± 0.5° before surgery and 16.2° ± 3.2° after surgery; the fovea - to- disc angle （FDA） after the surgery had a tendency to incyclotorsion when compared to that before surgery; 4 patients with binocular sight before surgery and 7 patients after surgery; abnormal head position was present in 6 patients before surgery; it disappeared in 3 and improved in 2 after the surgery. Conclusions Compared to primary asymmetric inferior oblique overaction, bilateral symmetric inferior oblique recession may have modifying inferior oblique function and may have a better effect on the V strabismus, degree of fundus torsion, abnormal heads and rebuilt binocular sight function which caused by inferior oblique overaction.