对水平斜视合并小度数垂直斜视患者术后垂直眼位变化的探讨

Postoperative vertical eye position in patients with combined horizontal and mild vertical strabismus

目的：探讨水平斜视合并小度数垂直斜视患者术后垂直眼位的变化。方法回顾性分析本院2013年6月至2014年6月收治的48例（68只眼）术前水平斜视合并小度数垂直斜视患者的临床资料，其中内斜视22例（32只眼），外斜视26例（36只眼），患者均行缩短及水平后徒手术，未行垂直肌及水平肌垂直移位手术。术后对患者随访6～12个月，观察垂直眼位的变化。结果内斜视患者术前平均垂直斜视角为（7．10±2．12）°，术后平均垂直斜视角为（3．45±1．24）°，垂直斜视角减少量为（3．82±1．04）°，手术前后垂直斜角比较有统计学意义（ P ＜0.05）。外斜视患者术前平均垂直斜视角为（7．05±2．09）°，术后平均垂直斜视角为（2．52±1．22）°，垂直斜视角减少量为（4．52±1．12）°，手术前后垂直斜角比较有统计学意义（ P ＜0.05）。内外斜视患者术后垂直斜角减少量与术前垂直斜角大小均呈正相关（ P ＜0.05）。内、外斜视患者术前黄斑中心凹与视盘几何中心相对角度（ FDA）手术前后比较均无统计学差异（ P ＞0.05）。结论水平斜视合并小度数垂直斜视患者行水平肌手术治疗后能改善垂直眼位，且改善效果与患者术前垂直斜视角呈正相关。

Objective To investigate the changes of postoperative vertical eye position in patients with combined horizontal and mild vertical strabismus.Methods Clinical data were analyzed for 48 strabismic patients （68 eyes） who were treated between June 2013 and June 2014.There were 22 esotropia （32 eyes） and 26 exotropia （36 eyes）.Patients underwent surgeries for horizontal rectus muscles shortening and recess.Patients were followed for 6 to 12 months to observe changes in the vertical eye position.Results Mean vertical deviation was 7.10 ±2.12°before treatment and became 3.45 ±1.24°after surgery.Average reduction in vertical deviation was 3.82 ±1.04 and was significant （P〈0.05）.Vertical deviation in exotropia patients reduced from 7.05 ±2.09°to 2.52 ±1.22°, and the average reduction was 4.52 ±1.12°, which was statistically significant （ P 〈0.05） .The degree of deviation reduction was correlated to preoperative deviation （P〈0.05）.There was no significant changes in the angle between fovea and geometric center of the optic disc （FDA）. Conclusions Horizontal strabismus combined with mild vertical deviation can be treated with surgeries that correct hori-zontal rectus positions.Vertical deviation will improve after the surgery, and the improvement is correlated to preoperative vertical deviation.