单纯下斜肌后徙术后原在位水平斜视度的变化分析

Analysis of variationfor horizontal deviation in the primary position after the inferior oblique muscle weakening

目的：对单纯行下斜肌后徙手术后水平斜视度的变化分析,探讨下斜肌后徙手术对原在位水平斜视度的影响。方法：收集2014-01/09在我院眼科行手术治疗的先天性上斜肌麻痹合并小角度水平斜视及小度数V型斜视患者共30例,仅行下斜肌后徙手术,水平方向小度数斜视未行手术矫正。其中,先天性上斜肌麻痹患者25例,行单眼下斜肌后徙术;V型斜视5例,行双眼下斜肌后徙术。随访3～6mo,术前、术后行33cm和6m三棱镜交替遮盖斜视度检查,同视机检查,Titmus立体图检查,Worth四点灯检查,眼球运动检查,眼底照相检查等,进而比较手术前后远、近水平斜视度变化（双侧者以1/2斜视度计算）。结果：（1）外斜组23例（包括5例外斜V征）手术前后看远、看近水平斜视度变化有统计学意义（P=0.00）,术后分别使原在位外斜减小平均值3.35±2.87△,4.37±2.65△。（2）内斜组7例看远手术前后水平斜视度变化有统计学意义（P=0.02）,术后使内斜减小平均值2.43±1.99△;看近手术前后水平斜视度变化无统计学意义（P=0.089）。结论：下斜肌后徙手术后原在位外斜、内斜度数都有减小,这种变化通过手术后逐步完善、建立的融合功能代偿产生。

AIM： To analyse the variation of horizontal deviation in the primary position after the inferior oblique muscle weakening, and to explore the effect of the inferior oblique muscle recession on horizontal deviations in primary position. METHODS： , In the study, 30 cases in the Department of ophthalmology of our hospital from January 2014 to September 2014 underwent the inferior oblique muscle recession as the sole without horizontal muscles surgery, who were superior obliquer paralysis and V pattern strabismus with small angle of horizontal strabismus, were analyzed. Of the 30 patients, 25 had unilateral inferior oblique muscle surgery, and then 5 had bilateral surgeries, Followed up for three to six too, all patients were received full ophthalmologic and orthoptic examinations, including measurement of the deviation in the diagnostic positions of gaze at near 33cm and at distance 6m by prism and alternate cover test, synoptophore, Titmus stereo graph examination, Worth four lighting inspection, eye movement examination, and fundus photography preoperatively and postoperatively. The changes of horizontal deviations in the primary position after procedures were investigated. RESULT. （1） The comparison of horizontal deviation showed significant difference pre- and post-operation in the exotropia group （ P = 0. 00）. It was postoperative respectively to reduce the original in external oblique average 3.35±2.87△ and 4.37±2.65△. （2） The comparison of horizontal deviation showed significant difference pre- and post-operation in the esotropia group （P= 0.02）, and it decreased postoperatively in average 2.43±1.99△. There was no significant difference for horizontal deviation position between pre- and post-operation （ P= 0. 089）. CONCLUSION： The horizontal deviation in primary position, either exotropia or esotropia, will decrease after the Inferior oblique muscle recession. This change can be compensated by the gradually improving and establishing the fusion function.