A-V综合征106例手术情况分析

Surgical analysis for 106 cases with A-V patterns strabismus

目的: 分析A-V型斜视的病因,了解A-V综合征的手术矫正效果。方法: 收集2011-01/2012-12我科住院接受手术的A-V综合征106例,斜肌异常者70例,行斜肌减弱手术解决A-V征,无斜肌及上下直肌异常且V征斜视上下转相差>20△、A型斜视上下转>15△者26例,行水平直肌垂直移位半个至一个肌腱。而对于无明显斜肌及垂直肌异常且V征斜视上下转相差≤20△、A型斜视上下转斜视度相差≤15△者10例,仅行常规水平直肌手术。结果: 术后观察A-V征消失情况,无A-V征为正位;A-V征>10△为过矫或欠矫。106例患者,V征消失75例,过矫5例,欠矫4例;A征消失15例,过矫3例,欠矫4例。水平斜视>±10△为过矫或欠矫,正位85例,欠矫11例,过矫10例。结论: A-V征主要由眼外肌方面的原因造成的,对于A-V征伴有斜肌运动异常患者,行斜肌手术,无斜肌运动异常及垂直肌异常者,行水平直肌移位术均能很好地矫正A-V现象,术后远近立体视恢复好。双眼斜肌减弱术能改变原在位眼位,对于伴有斜肌异常的A-V型斜视设计水平斜视手术量时应予以考虑。

·AIM： To analyze the causes and evaluate the surgical effect of A-V patterns strabismus. ·METHODS： Clinical data of 106 caseswith A-V patterns strabismus in our hospital from January 2011 to December 2012 were retrospectively analyzed. Seventy patients with oblique muscle overaction were performed weakening oblique muscle surgery to treat A-V pattern. Twenty-six patients with no abnormality of oblique muscle and superior and inferior rectus muscle, and with 〉 20△ between gaze up 25△ and down 25△ in V pattern and with 〉 15Abetween gaze up 25△ and down 25△ in A pattern were performed horizontal rectus muscle transposition to half to one muscle tendon. While ten patients with no obvious abnormality of oblique muscle and vertical rectus muscle, and with △〈20A between gaze up 25△ and down 25△ in V pattern and with △〈15A between gaze up 25△and down 25△ in A pattern were only performed horizontal rectus muscle surgery. ·RESULTS. No A-V patterns was defined asnormotopia and A-V patterns 〉10△ was defined as overcorrection or undercorrection after surgery. In 106 cases, V pattern was corrected in 75 cases, overcorrected in 5 cases, undercorrected in 4 cases. A pattern was corrected in 15 cases, overcorrected in 3 cases, undercorrected in 4 cases. Horizontal strabismus 〉±10△ was defined as overcorrection or undercorrection after surgery. Eighty- five cases were corrected, 11 cases were undercorrected, and 10 cases were overcorrected. ·CONCLUSION; A-V patterns strabismus was caused mainly by abnormal extraocular muscle. A-V patternswith abnormal oblique movement were treated by oblique surgery and A-V patterns with normal oblique and vertical rectus movement were treated by horizontal rectus muscle transposition, both which corrected A- V patterns. Patients had good distance and near stereopsis postoperation. Binocular weakening oblique muscle surgery can correct primary ocular position, so surgical design of horizontal deviation about A- V patterns strabismus with abnormal oblique muscle was considered.