下斜肌前转位术治疗双眼先天性上斜肌麻痹临床观察

Effects of surgery of inferior oblique anterior transposition for bilateral superior oblique paralysis

目的:探讨下斜肌前转位术治疗双眼先天性上斜肌麻痹伴下斜肌亢进的临床疗效。方法:对28例双眼垂直偏斜角为15△～30△的先天性上斜肌麻痹患者行下斜肌前转位手术治疗,合并水平斜视者同期手术矫正,观察手术前后其原在位垂直斜视度、头位变化、下斜肌亢进程度。结果:患者26例垂直偏斜角为15△～25△的患者行下斜肌前转位术,全部治愈,代偿头位消失。1例双眼垂直偏斜角为>25△的患者行双下斜肌前转位术后,残余部分双下斜肌功能亢进,欠矫度为7.8△,行二期双下直肌后徙术后,垂直斜视好转,代偿头位明显改善。1例伴外斜视患者同时行水平肌手术后出现眼球外展轻度受限,能过中线。结论:对伴双眼下斜肌功能亢进,原在位垂直斜视度较大的先天性上斜肌麻痹患者,行双眼下斜肌前转位手术矫正有操作简便、疗效显著、复发率低等优点,且适用于双眼不等量下斜肌功能亢进患者,值得推广。

AIM： To evaluate the correction of inferior oblique anterior transposition （IOAT） in the treatment of bilateral superior oblique paralysis with inferior oblique overaction （IOOA）. METHODS： Totally 28 patients with bilateral IOOA underwent equal bilateral IOAT; the horizontal deviation was corrected at the same operation. The amount of vertical deviation in primary position and inferior oblique overaction pre- operation and post- operation was measured. Curative effects of surgical method were analyzed. RESULTS： For 26 patients with vertical deviations in primary position in the range of 15A -25A, clinical effect of cure was observed with disappearance of head position. Vertical deviations in primary position decreased from 〉 25 to 7. 8% for the patient who underwent bilateral IOAT combined with contralateral inferior rectus recession. Head position was improved and IOOA was eliminated for all patients with no eye movement restriction after surgery. CONCLUSION： IOAT is an effective method for correcting large vertical deviation in patients of bilateral superior ob elimination advantage effective. ique paralysis with IOOA, especially of unequal bilateral IOOA. It has of easy to operating, low recurrence in the and effective.