儿童外斜视术后继发性内斜视的手术效果短期观察

Short-term efficacy of surgical treatment for consecutive esotropia after exotropia surgery in children

目的探讨儿童外斜视术后继发性内斜视的特点及原因，评价手术治疗效果。设计回顾性病例系列。研究对象17例外斜视术后继发性内斜视并再次手术的患儿。方法总结17例患者既往外斜视手术方法和特点，外斜视术后出现内斜视时间、术后处理、继发性内斜视手术方式以及手术中探查发现。选择间歇性外斜视50例作为对照组，以探讨继发性内斜视的原因。主要指标第一次手术外斜视的类型、手术方法、术后处理，继发性内斜视出现的时间。第二次手术探查发现、是否合并其他类型的斜视、手术方式以及手术后眼位。结果17例患者合并垂直斜视9例（52．9％），其合并中v征2例，合并DVD4例；而对照组合并垂直斜视者9例（18．O％），两者比较差异有统计学意义（x2=6．33，P=0．01）。继发性内斜视出现时间为术后1。12个月，平均2个月。继发性内斜视患者16例为恒定性内斜视，1例为不典型周期性内斜视；17例中外展受限10例，手术探查发现肌肉滑脱2例，粘连综合征3例，3例术后进行缝线调整。17例患者治愈14例（82．3％），2例过矫，1例欠矫。结论继发性内斜视平均在外斜视术后2个月出现，外展受限、粘连综合征、肌肉滑脱以及合并垂直斜视为继发性内斜视可能的病因，合并垂直斜视的复合斜视在手术后更容易出现继发性内斜视。

Objective To investigate the clinical characteristic and causes of consecutive esotropia, and evaluate the surgical management of consecutive esotropia. Design Retrospective case series. Participants 17 patients who accepted surgical correction of consecutive esotropia after exotropia surgery. Methods The indexes of 17 patients as follow： the methods and characteristics of the first strabismus operation, onset time of consecutive esotropia and postoperative treatment after exotropia surgery, estropia operation mode and operative foundings were observed. 50 patients with intermittent exotropia were randomly choosed as control group, in order to ana- lyze the causes of consecutive esotropia. Main Outcome Measures Types of exotropia, exotropia operation method and postoperative management, onset time of consecutive esotropia, estropia operation mode and operative foundings, the position of eyes after estropia operation. Results 9 of 17 cases （52.9%） were complicated with vertical strabismus, including 2 cases of V syndrome and 4 cases of DVD. In control group, 9 cases（18%） were complicated with vertical strabismus. There was significant difference between two groups （A-2=6.33,P=0.01）. Consecutive esotropia appeared 1-12 months after exotropia operation, the average of 2 months after surgery. In 17 cases, 16 cases were constant esotropia, 1 case was atypical periodic esotropia; 10 cases were complicated with the limitation of abduc- tion, including 2 cases of muscle detachment, 3 cases of adherence syndrome, 3 case of suture adjusted; after the surgery, 14 cases （82.3%） were cured, 2 cases were overcorrected and 1 case was undercorrected. Conclusion Consecutive esotropia appears 2 months after exotropia surgery on average. Limitation of abduction, muscle detachment, adherence syndrome and vertical strabismus complicated may be the causes of consecutive esotropia. Compound strabismus combined with vertical strabismus is prone to consecutive esotropia after the surgery.