下斜肌功能亢进及其合并V征眼球客观旋转状态的临床研究

Clinical analysis of ocular torsion during inferior oblique overaction in strabismus patients with or without V-pattern exotropia

目的 分析下斜肌功能亢进（IOOA）及其合并V征外斜视患者术前及术后主导眼和非主导眼的眼球客观旋转状态,并分别与正常人进行比较.方法 前瞻性研究.选取30例无斜视的正常人作为对照组,51例伴有外斜视的IOOA患者根据有或无V征分成IOOA组（21例）和IOOA合并V征组（30例）,予下斜肌减弱术及水平斜视矫正手术治疗后随访1个月,观察术前术后患者主导眼和非主导眼的黄斑中心凹-视盘中心夹角度数（FDA）,分别与对照组比较.数据采用方差分析、Fisher确切概率法进行分析.结果 所有患者术后1个月下斜肌功能均无明显亢进,IOOA合并V征组患者术后V征均消失.IOOA合并V征组术前主导眼FDA与对照组比较,差异有统计学意义（P＜0.05）,IOOA组术前主导眼FDA与对照组比较,差异无统计学意义（P＞0.05）,2组术后主导眼FDA与对照组比较,差异无统计学意义（F=0.610,P＞0.05）;2组术前及术后非主导眼FDA与对照组比较,差异无统计学意义（F=1.007、1.383,P＞0.05）.IOOA组和IOOA合并V征组内旋例数增多,近方立体视锐度提高,分别为57％和60％,2组之间立体视提高率差异无统计学意义.结论 下斜肌功能亢进合并V征患者主导眼较正常入主导眼外旋转倾向更明显.单纯下斜肌功能亢进患者主导眼及非主导眼FDA较正常人无明显的外旋转倾向.

Objective To objectively analyze ocular torsion during inferior oblique overaction （IOOA） with or without V-pattern exotropia and to explore the role of master eye and slave eye and the difference between them.Methods In this prospective study,based on whether V-pattern strabismus occurred,an experimental group of 51 exotropic patients with IOOA were divided into two groups：21 cases of IOOA and 30 cases of IOOA with V-pattern.Thirty cases for study of the foveal disc torsional angle （FDA） of the master eye and slave eye without strabismus were selected as the control group.All of the patients in the experimental group underwent inferior oblique weakening and horizontal strabismus surgery and were followed up postoperatively for one month.The FDAs of the master eye and slave eye of the two groups were compared with those of the control group.Data were analyzed using ANOVA and Fisher＇s exact test.Results One month after surgery,the IOOA of the 51 patients with exotropia was no longer apparent,and V-pattern strabismus disappeared in all the patients.There were statistically significant differences in the FDAs of the master eyes between the group with IOOA with V-pattern exotropia and the control group preoperatively （P＜0.05）,but no statistically significant differences between the group with IOOA and the control group preoperatively （P＞0.05）.There were no statistically significant differences in the FDAs of the master eye between the two groups and the control group postoperatively （F=0.610,P＞0.05）.There were no statistically significant differences in the FDAs of the slave eye between the two groups and the control group before or after the operation （F=1.007,1.383,P＞0.05）.The case of encyclovergence in two groups was increasing.The improvement ratio of near distance stereoscopic is 57％ in IOOA group,and 60％ in IOOA with V-pattern group.There was no statistically significant difference between two groups （P＞0.05）.Conclusion Excyclovergence in the master eye with IOOA with V-pattern strabismus can be more apparent than in the normal persons.Excyclovergence in the slave eye in IOOA is not as obvious.