外斜视V征手术疗效分析

Analysis of surgical treatment for V-style exotropia

目的探讨外斜视V征的手术方法及疗效。方法分析2006年1月至2014年12月在济宁京华眼科医院行手术治疗的72例外斜视V征患者，其中男40例，女32例，年龄12～35（平均23．5）岁；术后随访时间为6个月至5年。术前行同视机检查有双眼单视功能者12例。手术根据有无斜肌异常和V征的程度，在水平斜视矫正的同时，选择下斜肌断腱术加直肌附着点垂直移位同时倾斜、只做水平直肌垂直移位同时倾斜二种术式。结果有斜肌异常的采用下斜肌断腱术加直肌附着点垂直移位同时倾斜、无斜肌异常的只做水平直肌附着点移位及倾斜均取得满意效果；下斜肌断腱术加直肌附着点垂直移位同时倾斜适应于下斜肌亢进的外斜V征，垂直肌移位同时倾斜术适应因无下斜肌亢进的外斜V征。术后第一眼位正位者68例，V征消失者64例，双眼视功能恢复者达32例。结论A—V综合征是一种亚型水平性斜视，而外斜视V征是一种常见的斜视类型。发病原因以斜肌功能异常为主，可根据病因选择不同手术方式，手术不仅可以矫正眼位，而且有利用双眼单视功能的建立。

Objective To study the surgical methods of V-style exotropia and outcomes. Methods Medical records of 76 patients with V-style exotropia who received surgical treatment from January 2006 to December 2014 in our hospital were analyzed. There were 40 males and 32 females with an average of 23.5 years （ranged 12-35 years）. The follow-up period was from 6 months to 5 years. Twelve patients had binocular vision function examined by synoptophore preoperatively. According to whether the oblique abnormality and the degree of V syndrome, two surgical methods were chosen. Disinsertion of the inferior oblique muscle combined with vertical displacement and incline of rectus insertion point were performed in patients with oblique abnormality. Displacement and incline of the horizontal muscle insertion was performed in patients without oblique abnormality. Resuits Two surgical methods were both achieved satisfactory results. Disinsertion of the inferior oblique muscle combined with vertical displacement and incline of rectus insertion point apply for V-style exotropia with inferior oblique overaction. Displacement and incline of the horizontal muscle insertion apply for V-style exotropia without inferior oblique overaction. After surgery, orthophoria of the primary eye position in 68 patients, disappearance of V-pattern in 64 patients, and 32 patients had obtained binocular vision. Conclusions A-V syndrome is a subtype of horizontal strabismus. V-style exotropia is a common type of strabismus. Vertical muscle dysfunction is the major cause. Different operation modes can be selected according to the cause of the disease. The eye position could be corrected and binocular visual function could be established after surgery.