儿童水平斜视矫正术后眼球屈光状态的变化

Changes in refraction after horizontal strabismus surgery on children

目的:探讨儿童水平斜视矫正术后眼球屈光状态的变化,决定术后首次散瞳验光时机。方法:前瞻性临床研究。对2009-01/2010-12在南昌大学第二附属医院儿童眼科接受水平斜视矫正术的3～8岁儿童进行随访,搜集资料完整、无失访的患儿178例318眼。分为四组,分别为外直肌后徙术(Ⅰ组),内直肌后徙术(Ⅱ组),内直肌后徙+外直肌缩短组(Ⅲ组),外直肌后徙+内直肌缩短组(Ⅳ组)。排除全身重大疾病及眼部器质性病变。进行术前1mo,术后1wk,1,2,4,8mo的眼部检查、弱视相关检查、散瞳检影检查。结果:术后1wk,Ⅲ和Ⅳ组患儿散瞳检影球镜屈光度与术前比较有明显差异(P<0.05),术后1mo各组与术前比较已无明显差异(P>0.05),术后8mo各组的球镜屈光度较术前出现一定程度下降(P<0.05)。术后1wk各组柱镜屈光度与术前比较存在明显差异(P<0.05)。术后1mo,Ⅲ和Ⅳ组柱镜屈光度与术前比较仍有明显差异(P<0.05)。术后2mo后各组与术前比较均无明显差异(P>0.05)。术后各时段与术前比较,散光的循规性及散光轴基本保持不变。结论:儿童水平斜视手术后短期内的屈光度确实存在变化,但在一定时间内多可恢复至术前水平。总的来说,不同术式对术后屈光度变化的影响并无明显差异。一般情况下,患儿散瞳验光配镜可于术后2mo以后进行,最迟不应超过4mo。

· AIM： To study refractive changes after horizontalrectus muscles surgery on children and determine time interval of the first mydriatic optometry after surgery. · METHODS： In a prospective interventional case series, 318 eyes of 178 patients aged of 3-8 years in the Second Affiliated Hospital of Nanchang University from January, 2009 to December, 2010 were evaluated in 4 groups： （Ⅰ） 48 patients （83 eyes） who underwent external rectus muscle（s） recession; （Ⅱ） 43 patients （79 eyes） who underwent internal rectus muscle （s） recession ; （Ⅲ） 45 patients （81 eyes） who underwent internal rectus muscle（s） recession combined external rectus muscle（s） resection; （Ⅳ） 42 patients （75 eyes） who underwent external rectus muscle（s） recession combined internal rectus muscle（s） resection. Full ophthalmic examination and mydriatic optometry was carried out 1 month before surgery, as well 1 week and 1 month, 2, 4, 8 months after surgery. · RESULTS： In group Ⅲ and Ⅳ, compared with preoperation, there were statistically significant changes in spherical equivalent at 1 week （P 〈 0. 05）, and no significant changes happened in all 4 groups at 1 month.Significant decrease was found in all groups at month 8 P〈0.05）. In all groups, there were statistically significant changes in cylinder equivalent at 1 week （ P〈 0.05）. At month 1 post-operation, same result was detected in group Ⅲ and Ⅳ. No significant changes in cylinder equivalent happened in all 4 groups at month 2 （P〉0.05）. Astigmatic axis shift was little in all groups at any time point （P〉0.05）, and rule of eyes astigmatism were kept coincidence with pre-operation very well （P〉0.05）. · CONCLUSION ： Refractive changes are assured in shortterm after horizontalrectus muscle surgery, while generally speaking, refractive statues can recover to the level of pre-operation in a certain duration. No significant variation is found between different surgery methods. It does not seem necessary to perform cycloplegic refraction early than 2 months after surgery; however, considered about emmetropia proceeding in children, a precise refraction in all cases of strabismus should not be deferred later than 4 months.