后天性固定性内斜视两种手术方法的比较

Comparison of two surgical approaches to treat acquired fixed esotropia

目的通过两种手术方法治疗后天性固定性内斜视的临床效果比较,探讨合适的手术设计。方法2007年9月至2013年6月共收治固定性内斜视11例(20只眼),根据患者手术前的专科检查情况,5例(9只眼)采用显微镜下内直肌后徙联合上下直肌部分移位术(直肌移位组),6例(11只眼)采用硅胶带外眦眶骨膜悬吊术(硅胶带组),观察术后远期视力、眼位、眼球运动等情况。结果术后1个月,15只眼矫正视力有提高,两组眼位均有明显改善,18只眼正位,1只眼欠矫(直肌移位组,+20 PD),1只眼过矫(硅胶带组,-18 PD);术后6个月,所有眼矫正视力均有提高,15只眼正位,2只眼欠矫(均为直肌移位组,分别为+20 PD、+18 PD),3只眼过矫(均为硅胶带组,-25 PD、-20 PD、-18 PD),直肌移位组9只眼球能轻度转动,硅胶带组11只眼运动受限固定,随手术时间眼球运动无明显变化。结论后天性固定性内斜视临床表现较为复杂,术前应完善各项检查,选择合适的手术方法,视力和眼位均会有明显的提高和改善,可获得比较满意的手术效果;术后远期效果,直肌移位组易出现欠矫,硅胶带组易出现过矫。

Objective To observe the effects of two different surgical methods to treat acquired fixed esotropia,and to explore appropriate surgical approaches. Methods Seven patients（ 20 eyes） with acquired fixed esotropia were treated in our hospital between September 2007 and June 2013. Five patients（ 9 eyes） received microscope medial rectus recession plus superior and inferior rectus transposition（ rectus transposition group）. Six patients（ 11 eyes） received canthal periorbital silicone band suspension（ silicone band group）. Visual acuity,eye positions,and eye movement were evaluated postoperatively. Results Visual acuity improved in 15 eyes after 1 month. Normal alignment was obtained in 18 eyes,while there was under-correction in 1 eye（ rectus displaced group,＋ 20 PD） and over-correction in 1 eye（ silicone band group,- 18 PD）. Six months after surgery,visual acuity improved in all patients. Fifteen eyes remained normally aligned,and 2 eyes were under-corrected（ rectus displaced group,＋ 20 PD and ＋ 18 PD）,and 3 eyes were over-corrected（ silicone band group,-25 PD,-20 PD,and-18 PD）. Rotational eye movements were limited in 9 eyes treated with rectus transposition and were not observed in 11 eyes received band suspension immediately after surgeries,but were completely recovered in all eyes during the follow-up period. Conclusion Clinical presentation of acquired fixed esotropia could be complicated. Patients should be given careful preoperative examinations to determine the most appropriate surgical approach. Rectus transposition might have higher risk of under-correction while silicone band suspension might cause overcorrection. However,visual acuity and eye alignment can be significantly improved in most patients.