进行性限制性斜视13例特征及处理

A clinical analysis of 13 cases with progressive restrictive strabismus and clinical management

目的 对住院行手术治疗的进行性限制性斜视病例进行临床总结,以加深对此病的认识.方法 回顾性病例分析.对2003年3月至2013年3月在天津市眼科医院就诊的13例进行性限制性斜视患者的临床病历资料进行回顾性总结和分析.结果 在13例患者中,男9例、女4例;发病年龄1个月至3岁;进展时间1个月至2年.上斜、下斜、内下斜各2例,分别占15.4％ （2/13）;外斜及外上斜各3例,分别占23.1％ （3/13）,外下斜1例,占7.7％ （1/13）.手术方式：根据斜视方向及肌肉限制情况选择行受累肌肉减弱术;10例术后斜视改善,其中5例获得正位;1例垂直斜视改善水平斜视过矫,2例再次手术时因探查发现广泛粘连无法手术.结论 进行性限制性斜视是一种少见的后天性进行性限制性斜视,婴幼儿期发病,常单眼受累,在短时间内迅速进展形成稳定的大角度限制性斜视.目前病因不清,受累肌肉不同、斜视性质各异,手术操作困难,预后依病情而定.

Objective To analyze the clinical manifestations and the effects of surgical management on progressive restrictive strabismus acquired in infancy.Methods Thirteen cases with progressive restrictive strabismus acquired in infancy were retrospectively summarized.Results In the 13 cases,the gender ratio was 2.25：l,the onset of age was 1 month to 3 years and the progressive course was 1 month to 2 years.There were 2 eyes hypertropia （15.4% （2/13））; 2 eyes hypotropia （15.4% （2/13））; 2 eyes esotropia and hypotropia （15.4% （2/13））; 1 eye was exotropia and hypotropia （7.7% （1/13））; 3 eyes were exotropia （23.1% （3/13））; 3 eyes were exotropia and hypertropia （23.1% （3/13））.All 13 cases had no family history of strabismus.The methods of surgical were weakened affected muscles including recession,hang-back or severed.The clinical manifestations were improved in 10 eyes after surgery.Conclusions Progressive restrictive strabismus is an rare acquired strabismus,often involve monocular,with severely restricted motility and large angle restrictive unilateral strabismus developing over a period of a few times in infancy in otherwise normal children who has normal eye alignment and movements at birth.The etiology is unknown currently.Surgical treatment of these eases is difficult and outcomes are variable according to the condition.