白内障术后斜视的临床分析

Clinical analysis of strabismus after cataract surgery

探讨白内障术后斜视的临床表现、发生机制及预后。方法 :对白内障人工晶体术后斜视的患者除常规眼部检查外 ,还进行屈光、眼肌运动、复视像检查 ,并用三棱镜及同视机检查眼位和偏斜度 ,部分患者行眼肌牵拉试验。结果 :15例斜视患者受累眼肌多为术眼垂直肌 ,1例为对侧眼上斜肌麻痹 ,5例合并上睑下垂 ,3例牵拉试验呈阳性反应。 9例患者 3个月内治愈 ,1例经手术矫正眼位而改善症状。结论 :白内障人工晶体术后部分患者合并眼肌运动障碍性复视 ,其发病机制可能与药物的肌毒性作用有关 ,大部分患者可恢复正常。

Purpose:To analyze the clinical features and outcomes of strabismus presenting after cataract extraction with intraocular lens(lOL)implantation,and to determine the causative factors of this strabismus.Methods:We analyzed 15 consecutive cases with acquired strabismus after cataract extraction with lOL implantation.To evaluate the outcomes and the causative factors of the strabismus,all the cases received ophthalmologic examinations of refraction,eye movements,diplopia,and visual axis deviation besides routine examinations,Part of the cases had forced duction test.Results:In this series of 15 cases,most of them had impairment of vertical rectus muscles in operative eyes,five of them having ptosis.One had palsy of superior oblique muscle in the fellow eye.Three showed positive results of forced duction test.Strabismus of nine cases resolved completely three months later and one improved by the surgical treatment with position alignment of the eye.Conclusion:Strabismus may developed in part of the patients with cataract extraction and IOL implantation,characterized by restricted extraocular muscle involvement.This strabismus was possibly the result of toxic interaction to extraocular muscles by anesthetics.Most of these cases may get resolution.