边缘切开治疗不对称性下斜肌功能亢进115例临床效果观察

Clinical observation of the marginal myotomy to treat asymmetric inferior oblique overaction on 115 cases

目的探讨下斜肌边缘切开治疗不对称性下斜肌功能亢进的效果。方法回顾性分析本院行手术矫正的不对称性下斜肌功能亢进115例患者的临床资料,一侧下斜肌功能正常或亢进+1级,行下斜肌边缘切开术。另一侧下斜肌亢进+2～+4级,行下斜肌切断和(或)同侧上直肌后徙术。手术前后分别观察患者的双眼下斜肌功能、V征、代偿头位、双眼视功能。术后随访3～18个月。结果术后下斜肌功能正常105例,未出现下斜肌功能不足。内斜V征第一眼位平均斜视角由术前64.5△降至术后5.8△,外斜V征第一眼位平均斜视角由术前-63.6△降至术后5.4△。术前30例有代偿头位,术后25例代偿头位消失,5例代偿头位好转。术前双眼视功能25例,术后双眼视功能65例。结论下斜肌边缘切开是治疗不对称下斜肌功能亢进中下斜肌功能正常及亢进+1级一侧眼的有效术式。

Objective To investigate the curative effect of surgical treatment of inferior oblique marginal myotomy on the patients with bilateral asymmetric inferior oblique overaction. Methods The clinical date of 115 patients with bi- lateral asymmetric inferior oblique overaction were retrospectively studied admitted to the hospital;Inferior oblique overaetion before surgery were of grade ＋1 in one eye and ＋2 or ＋4 in the other.The degrees of inferior oblique over- action,V pattern,degrees of fundus torsion binocular sight and abnormal heads were analyzed in all patients before and after surgery.The patients were fol lowed-up for 3 to 18 months after the surgery. Results Under oblique muscle func- tion after surgery for 105 cases of normal,did not appear under oblique muscle function.Oblique V in the first an aver age from 64.5 prism diopters （PD） preoperatively squint angle fell to 5.8 PD,postoperative external oblique V sign at first glance a average squint angle by preoperatively to 63.6 PD dropped to 5.4 PD.30 patients with preoperative compensatory head,25 cases of postoperative compensatory head disappear,5 cases of compensatory head better.25 cases of preoperative binocular visual function binocular visual function after surgery for 65 cases. Conclusion Oblique muscle under the cut edge is asymmetric under oblique muscle function normal inferior oblique muscle function and the effective operation for hyperthyroidism ＋ 1 level on one side of the eye.