外眼手术后继发性斜视56例临床分析

Clinical analysis of secondary heterotropia after operation for outer eyes in 56 cases

目的探讨外眼手术后继发性斜视的原因和防治策略。方法以外眼手术后继发斜视患者56例(56眼)为研究对象,其中翼状胬肉切除术18例,眼外肌外伤修复术15例,上睑下垂矫正术10例,结膜囊肿摘除术8例,结膜脂肪瘤摘除术5例。对其斜视原因和防治方法进行回顾性分析。结果翼状胬肉切除术后斜视患者中,14例可自行缓解或经药物治疗缓解,手术探查发现斜视原因主要为眼肌止端移位或瘢痕形成;眼外肌外伤修复术后斜视主要原因为瘢痕组织及粘连,13例患者在6个月内斜视自行缓解或经药物、矫正训练缓解或消失,2例经矫正手术后斜视消失;上睑下垂矫正术后斜视主要因上直肌纤维化,8例经药物或矫正训练斜视症状缓解或消失,2例经斜视矫正术后斜视消失;结膜囊肿或脂肪瘤摘除术后斜视原因主要为瘢痕形成及粘连,10例患者经药物或矫正治疗缓解,3例行矫正手术后斜视消失。结论外眼手术继发性斜视的原因主要为眼肌移位、瘢痕形成或粘连、眼肌纤维化等,眼科医师应高度重视,尽量避免术后继发性斜视的发生。外眼手术继发性斜视可经手术矫正。

Objective To discuss the causes and prevention strategies of secondary heterotropia after operation for outer eyes. Methods Fifty six patients with secondary heterotropia after operation for outer eyes were selected as subjects. Among them, 18 ones received excision of pterygium; 15 ones did prothesis for injury of extraocular muscle; 10 ones did correction of upper eyelid ptosis; 8 ones did excision of conjunctival cyst; 5 ones did excision of conjunctiva lipoma. Retrospective analyses were made in causes of heterotropia and prevention methods. Results Among those with heterotropia after the excision of pterygium, 14 cases were relieved by themselves or by medical treatment. The operation research discovered that the main causes were shifting of muscular apparatus ending or scar formation. The main causes for secondary heterotropia after prothesis for injury of extraocular muscle were scar tissue and conglutination. Thirteen cases were relieved or recovered by themselves or medicine and rectificative training within 6 months, and 2 ones were recovered by rectificative operation. The main cause of heterotropia after correction of upper eyelid ptosis was fibrosis of superior rectus. Eight cases were relieved or recovered by themselves or rectificative training, and 2 ones were recovered by rectificative operaion. The causes for heterotropia after excision of conjunctival cyst or lipoma were scar formation and conglutination. The illness in 10 patients was relieved by medicine or rectificative treatment, and 3 ones were recovered by rectificative operation. Conclusion The main causes for secondary heterotropia after operation for outer eyes were shifting of muscular apparatus, scar formation or conglutination, and fibrosis of muscular apparatus, etc. The ophthalmologist should pay more attention to prevent the occurrence of postoperative secondary heterotropia. The postoperative secondary heterotropia can be corrected by operation.