改良Yokoyama术治疗高度近视固定性内下斜视

A modification of Yokoyama＆#39;s technique in the treatment of myopic esotropia

目的 探讨改良Yokoyama术治疗高度近视限制性内下斜视的效果.方法 回顾性病例研究.分析2011-2014年江苏省中医院6例（8眼）高度近视固定性内下斜视的手术效果.术前CT检查眼外肌位置及组织变化.术前、术后9个诊断眼位检查眼运动功能.术前、术中行被动牵拉试验以评估肌肉的限制程度和功能.以改良Yokoyama＋内直肌后徙术对患跟的眼位进行矫正.结果 CT显示患眼眼外肌出现移位.术前被动牵拉患眼内直肌出现挛缩,患眼外上转严重受限.术后观察半年,患眼第一眼位正位,外、上转明显改善,无一例出现眼前节缺血并发症.结论 改良Yokoyama术术后患者眼位及眼球运动均恢复良好,是矫正高度近视固定性内下斜视较好的一种手术方法.

Objective To investigate the effect of a modified Yokoyama＇s technique in the treatment of fixus strabismus with high myopia.Methods A retrospective analysis was conducted on the medical records of 8 eyes of 6 patients with myopic fixus esotropia who underwent the modified Yokoyama＇s surgery between 2011 and 2014.The location of the extraocular muscles was investigated with CT scan.Ocular alignment and motility in the nine diagnostic gaze positions were evaluated pre-and postoperatively.A forced duction test was also performed during the operation.Modified Yokoyama＇s surgery and the medial rectus muscle recession were performed to correct eye position.Results The scans showed that the position of the extraocular muscles had changed,and restricted abduction and elevation were detected by the forced duction test in the affected eye before surgery.The modified Yokoyama＇s surgery was successfully performed on eight eyes of six patients with fixus myopic esotropia.Orthotropia in the primary gaze position was achieved in all operative eyes after 6 months of follow-up.Complications of anterior segment ischemia did not occur.Conclusion The modification of Yokoyama＇s technique is a good surgical choice for treatment of myopic fixus esotropia.