继发性外斜视49例发病因素的探讨

The reasons for consecutive exotropia of 49 patients

目的探究影响内斜视术后继发性外斜视发病的相关因素。方法对2006年6月至2011年12月住院的49例内斜视术后继发外斜视的患者进行回顾性病例分析，探讨其发病的相关因素。结果本组49例患者，内斜视的发病年龄为2—72月，平均为18．43月，4岁前发病48例（97．96％），1岁前发病29例（59．18％）；内斜视术前28例患者（96．55％）表现为单眼抑制（5m及33cm）．42例（100％）无立体视；继发性外斜视术前28例患者（57．14％）伴3^△-25^△的垂直斜视，平均为8．54^△（5m）和8．43^△（33em）；内斜视术前10例患者调节性集合／调节（AC／A）比率〈4（28．57％），继发性外斜视术前18例患者AC／A比率〈4（75％），两者问差异具有统计学意义（P〈0．05）；继发性外斜视术前10例患者存在2．00D-5．00D的屈光参差，8例患者合并内转受限；继发性外斜视平均发生于内斜视术后4．08年，其9年内发生率为93．88％。结论内斜视的发病年龄早，立体视功能不健全甚或无立体视，合并垂直斜视，调节性集合减弱，屈光参差及内转受限，是造成继发性外斜视发生的重要影响因素。继发性外斜视可发生于内斜视术后多年，因此术后需长期随访，至少随访4年。

Objective TO investigate the related factors resulting in consecutive exotropia. Methods Forty-nine cases with consecutive exotropia after esotropia in our hospital from June 2006 to September 2011 were analyzed retrospectively. Results In our study, the age at onset of esotro- pia was 2-72 months old, mean 18.43 months, 48 patients （97,96%） appeared esotropia below 4 years of age and 29 patients （59.18%） appeared esotropia below 1 ,year of age; 28 patients （96.55%） had suppression in one eye before esotropia （5m and 33cm）, 42 patients （100%） had no binocular function; 28 patients （57.14%） had vertical deviation from 3^△ to 25^△ before exotropia surgery, mean deviation was 8.54^△（5m） and 8.43A（33cm）; 10 patients, accommodative convergence/accommodation ratio （AC/A ratio） was less than 4 （28,57%） prior to esotropia and 18 patients＇ AC/A ratio was less than 4 （75%） prior to exotropia; 10 patients had anisometropia between 2.00D and 5.00D and 8 pa- tients had limitation of adduction prior to ex0tropia; consecutive exotropia happened 4.08 years after surgery of esotropia and the ＇incidence was 93.88% within 9 years. Conclusions The.important fac- tors related to the development of consecutive exotropia include the early onset of esotropia,bad bin- ocular function or without binocular function; accompaning with vertical deviation, low AC/A, aniso- metropia, limitation of adduction. Since consecutive exotropia may develop many years after esotro- pia surgery, a long-term follow-up period in patients without consecutive exotropia is advised.