连续性外斜视的病因及手术效果短期观察

Etiology and short-term efficacy of surgical treatment for consecutive exotropia

目的分析连续性外斜视的发生原因并探讨个性化设计的手术方式的术后效果。设计回顾性病例系列。研究对象北京同仁医院17例诊断为连续性外斜视并进行外斜视矫正术的患者。方法对上述患者临床病历资料进行回顾,分析患者发现内斜视的年龄、屈光度、矫正视力、实施内斜视矫正术年龄、手术方式,以及发生连续性外斜视年龄、斜视角度、眼球运动、屈光度、双眼视觉、实施外斜视矫正术年龄、手术方式与手术效果等。主要指标发病年龄、屈光度、斜视角度、眼球运动、手术方式、手术效果。结果本组17例患者中,11例1岁以前发现内斜视;实施内斜视矫正术年龄2~19岁,平均(6.79±5.39)岁(中位数年龄4岁);连续性外斜视发病年龄为3~21岁,平均(9.00±4.97)岁(中位数年龄8岁)。屈光度为-1.0^+2.0 D者9例(52.9%),>+2.0 D者7例(41.2%),1例(5.9%)为高度近视(-10.0 D)。4例伴有单眼弱视;13例无双眼视功能;平均外斜视角度看近为45△(15△~95△),看远为50△(20△~105△);5例(29.4%)内转受限。3例行内直肌复位术,14例行内直肌复位术+外直肌后徙术。术后眼位14例(82.4%)正位,欠矫3例,1例术后半年眼位发生外斜漂移现象;术后三级视功能较术前有不同程度提高。结论本组连续性外斜视与内斜视发病年龄小,内斜视矫正手术实施年龄小,常伴有单眼弱视、无双眼视功能等多种因素有关;对连续性外斜视进行个性化的手术设计,效果较好。

Objective To analyze the etiology of consecutive exotropia （XTc） and discuss the effects of different operation meth- ods. Design Retrospective case series. Participants 17 XTe patients diagnosed and operated in Beijing Tongren Hospital. Methods The clinic information of 17 XTc patients was reviewed. The presence age and operative age of esotropia, refraction, corrected visual acuity, operation method for correcting esotropia, as well as the onset age and operative age of XTc, angle of deviation, eye movement, refrac- tion, binocular vision, operation methods for correcting exotropia and their effects were analyzed. Main Outcome Measures Onset age, refraction, angle of deviation, eye movement, operation method and the effect of surgical treatment. Results In all the 17 cases, there were 11 cases who were diagnosed as esotropia at the age of less than one year. The average age of esotropia operation was 6.79±5.39 years old （2-19 years）. The average onset age of XTc was 9.00-＋4.97 years old （3-21 years）. The refraction was -1.0±.0 D in 9 eases （52.9%）, larger than ＋2.0 D in 7 cases （41.2%）, and 1 case （5.9%） was high myopia （-10.0 D）. Four eases were combined with single- eye amblyopia. Thirteen cases had no binocular vision. The average exotropia angle was 45△（15°～95°） for near view and 50A （20A- 105A） for distant view, respectively. Five cases （29.4%） had limited adversion, medial rectus reductions were underwent in 3 cases, and medial rectus reduction plus lateral rectus recessions were underwent in 14 cases. After exotropia sugery, 14 cases （82.4%） were or- thophoria, 3 cases had residual exotropia, and lease was found exotropia drift half a year after surgery. The binocular function was im- proved after surgery. Conclusion The development of XTc is associated with the younger age of esotropia onset and esotropia sugery, combined with amblyopia, and absence of binocular function, etc. Personalized designed XTc surgery can provide better effect for the correction of the XTc.