斜视矫正手术前后眼屈光状态变化的短期临床观察

Change of refractive error after strabismus surgery in short-term

目的:临床观察涉及不同眼外肌数的斜视矫正术前后术眼屈光状态的短期变化。方法:选取接受斜视矫正术的患者41例64眼,按手术涉及的眼外肌数目分三组:单纯一条水平直肌后徙组(Ⅰ组,25眼),一条水平直肌后徙联合其拮抗肌缩短组(Ⅱ组,32眼),一条水平直肌后徙联合其拮抗肌缩短组及斜肌切断组(Ⅲ组,7眼)。观察斜视患者术前1d,术后1wk,1mo各项屈光状态参数,并进行统计学分析。结果:斜视矫正术后1wk患者的等效球镜屈光度及散光值较术前有所增高(P=0.011、0.013),球镜屈光度、柱镜屈光度、水平与垂直子午线角膜曲率,散光轴位及角膜中央3mm半径光学区内曲率较术前均无显著差异(P>0.05)。而在术后1mo,所有观测值均较术前无统计学差异。比较斜视矫正术所涉不同眼外肌数目对术眼屈光参数的影响,术后1wk,Ⅰ组患者各项屈光参数值均无统计学差异,Ⅱ组患者散光值变化有统计学差异(P=0.035),Ⅲ组患者柱镜屈光度、等效球镜屈光度及散光值较术前均具有统计学差异(P=0.022、0.048、0.014)。而术后1mo,三组患者各项屈光参数较术前均无统计学差异。结论:斜视矫正术后1wk可引起术眼屈光状态变化,术后1mo恢复至术前屈光状态;实施斜视矫正术的眼外肌数目不同,对屈光状态的影响亦不同。

AIM：To investigate the short-term change of refractive error after strabismus surgeries with different extraocular muscles involved in.METHODS：The study included 64 eyes of 41 patients.Patients were divided into three groups：group I（a rectus recession,25 eyes）,group Ⅱ（a rectus recession combined its antagonistic muscle shortening,32 eyes）,group Ⅲ（a rectus recession combined its antagonistic muscle shortening and oblique resection,7 eyes）.Observation on refractive indexes and vector analysis program of spherical equivalent,spherical diopter,cylinder diopter,axis of astigmatism,corneal curvature,dk value and was performed 1d prior to surgeries and 1and 4 wk after surgeries.RESULTS：No significant changes were noted at 1wk postoperative on spherical diopter,cylinder diopter,Kh,Kv,axis of astigmatism,corneal curvature in the centrel area in radius of 3mm,while spherical equivalent and dk value increased significantly（P=0.011;P=0.013）.However,these changes were disappeared at 4wk postoperatively.Among the three groups,no significant changes were observed in group I,while dk value were changed in group Ⅱ at 1wk postoperatively（P=0.035）.Cylinder diopter,spherical equivalent,dk value of groupⅢ significantly increased at 1wk postoperatively（P=0.022;P=0.048;P=0.014）.At 4 wk postoperatively,these changes were disappeared.CONCLUSION：Strabismus surgeries can make reversible changes to the ocular refractive status.With different strabismus surgeries,the changes on the ocular refractive status are different.