共同性斜视再次手术的术式和手术矫正量

Surgical method and extent of reoperation in patients with concomitant strabismus

目的:分析共同性斜视过矫或欠矫后,再次手术的术式和手术矫正量。方法:共同性斜视术后过矫或欠矫计96例,男41例,女55例;平均年龄21.90±14.70岁。术前行斜视常规检查,共同性内斜视过矫者23例,欠矫者15例;共同性外斜视过矫者28例,欠矫者30例。术式选择主要依据斜视角的大小、远近斜视角的不同、原来的术式及双眼视力等情况而定。结果:共同性内斜视过矫者:后徙的内直肌行前徙9例,矫正量(5.51±2.63)△/mm;内直肌前徙+外直肌后徙9例,矫正量(6.25±1.59)△/mm;内直肌截除+外直肌后徙3例,矫正量(4.26±1.04)△/mm;仅行外直肌后徙2例,矫正量(4.21±1.91)△/mm。共同性内斜视欠矫者:行外直肌截除6例,矫正量(4.03±0.98)△/mm;外直肌截除+内直肌后徙6例,矫正量(6.86±1.32)△/mm;内直肌后徙3例,矫正量(4.33±0.29)△/mm。共同性外斜视过矫者,行外直肌前徙16例,矫正量(5.37±1.56)△/mm;内直肌后徙6例,矫正量(6.29±3.68)△/mm;外直肌前徙+内直肌后徙5例,矫正量(5.46±1.78)△/mm;外直肌截除1例,矫正量5.00△/mm。共同性外斜视欠矫者,行内直肌截除12例,矫正量(4.47±0.54)△/mm;行外直肌后徙+内直肌截除16例,矫正量(5.11±0.75)△/mm;外直肌后徙2例,矫正量(2.65±0.42)△/mm。结论:共同性内外斜视过矫者,通常对做过手术的水平肌行加强或/和减弱术,其手术矫正量偏大、且不甚稳定。欠矫者,通常对未行手术的水平肌行加强或/和减弱术,其手术矫正量同常规量。

AIM：To investigate the surgical method and extent of reoperation in the concomitant strabismus patients with surgical under-correction and over-correction. METHODS： Ninety - six concomitant strabismus patients with surgical under - correction and over -correction were recruited in this study, which included 41 males and 55 females, aged 21. 90±4. 70. All individuals underwent routine eye examinations for strabismus before the surgery. Among the cases with concomitant esotropia, there were over-correction in 23 cases, under-correction in 15 cases. Among the cases with concomitant exotropia, there were over-correction in 28 cases, under - correction in 30 cases. The method of reoperation were based on angle of deviation, the method of original operation and acute visual acuity of patients. RESULTS：In over - correction cases with concomitant esotropia, medial rectus muscle of 9 cases were advanced, the corrective extent was （5. 51±. 63） △ / mm;9 cases were performed advance of medial rectus muscle and recession of lateral rectus muscle, the corrective extent was （6. 25±. 59） △ / mm; 3 cases were performed resection of medial rectus muscle and recession of lateral rectus muscle, the corrective extent was （4. 26±. 04） △ /mm; only 2 cases were performed recession of lateral rectus muscle, the corrective extent was （4. 21±. 91） △ /mm. In under - correction cases with concomitant＆amp;nbsp;esotropia, 6 cases were performed resection of lateral rectus muscle, the corrective extent was （4. 03±. 98） △ /mm; 6 cases were performed resection of lateral rectus muscle and recession of medial rectus muscle, the corrective extent was （6. 86 ±1. 32） △ / mm; 3 cases were performed recession of medial rectus muscle, the corrective extent was （ 4. 33 ±0. 29 ）△/ mm. In over -correction cases with concomitant exotropia, 16 cases were performed advance of lateral rectus muscle, the corrective extent was （5. 37 ±1. 56） △ / mm; 6 cases were performed recession of medial rectus muscle, the corrective extent was （6. 29 ±3. 68） △ / mm; 5 cases were performed advance of lateral rectus muscle and recession of medial rectus muscle, the corrective extent was （5. 46±. 78） △ / mm; 1 case were performed resection of lateral rectus muscle, the corrective extent was 5. 00△ / mm. In under - correction cases with concomitant exotropia, 12 cases were performed resection of medial rectus muscle, the corrective extent was （4. 47 ±0. 54） △ / mm; 16 cases were performed recession of lateral rectus muscle and resection of medial rectus muscle, the corrective extent was （ 5. 11 ±0. 75 ） △ / mm; 2 cases were performed recession of lateral rectus muscle, the corrective extent was （2. 65±. 42） △ / mm. CONCLUSION： In reoperation of concomitant strabismus patients with over-correction, weakening or/and strengthening the horizontal muscle which were performed surgery before has a greater and more unstable surgical corrective extent. While In reoperation of concomitant strabismuspatients with under -correction, weakening or/ and strengthening the horizontal muscle which were not performed surgery has a normal corrective extent as usual.