改良Kestenbaum术式治疗婴儿型眼球震颤综合征疗效观察

Effect of modified Kestenbaum procedure on patients with INS

目的探讨应用改良Kestenbaum术式治疗婴儿型眼球震颤综合征的疗效。方法对2012年1月至2013年11月在山东省立医院眼科就诊的40例婴儿型眼球震颤综合征（INS）患者，结合其临床表现特点进行不同的手术设计并予以治疗。手术设计时综合考虑患者双眼视的状态、注视眼、视力是否平衡、斜视度、代偿头位、休止眼位与集合阻滞，在此基础上进行矫正。结果手术后随访3-12个月，平均6个月。术后头位：32例有代偿头位患者中，头位消失16例（50％，16／32）；好转14例（44％，14／32），残余头位〉15°者2例（6％，2／32），均〈20°。斜视矫正：18例合并斜视患者中，术后正位15例，外斜欠矫3例。部分双眼视功能有所改善。视力较术前提高2行以上者32例，无变化者8例。正前方眼球震颤基本消失12例（30％，12／40），好转28例（70％，28／40）。结论应用改良Kestenbaum术式，采用合理的手术设计，治疗INS可获得较好手术效果。

Objective To evaluate the clinical effect of modified Kestenbaum procedure on patients with infantile nystagmus syndrome （INS）. Methods From January 2012 to November 2013, 40 patients with INS were admitted into the Department of Ophthalmology of Shandong Prov- ince-owned Hospital for treatment, according to their clinical features different operation and treatment were given. Surgical procedures were designed according to binocular visual function, fixation, binocular visual acuity, deviation of strabismus, abnormal head posture, static position and set block. Results The postoperative follow-up time ranged from 3 to 12 months and averaged 6 months. there were 32 cases of compensatory head posture in patients during the first visit, who disappeared in 16 cases （50%）, improved in 14 cases （44%）, of which only 2 cases （6%） had abnormal head posture ranged from 15°to 20°, 18 patients with squint eyes, 15 patients were orthotropia and 3 cases were undercorrected exotropia. The binocular vision function was improved in some cases after operation. The postoperative binocular best optically corrected acuity increased two lines or greater in 32 cases of 40 cases, 8 cases remained unchanged. Elimination in nystagmus was found in 12 patients, other 28 patients were improved. Conclusions Modified Kestenbaum procedure is a successful surgical approach to treatment for patients with INS.