眼上直肌、外直肌肌腹联合术矫正16例高度近视限制性斜视的临床效果分析

Efficacy of Superior Rectus and Lateral Rectus Muscle Belly Union Surgery for Myopic Strabismus Fixus

目的评估上直肌、外直肌肌腹联合术治疗高度近视限制性内、下斜视的临床效果。方法回顾性分析16例27只高度近视限制性斜视眼患者的病例资料,所有患者患眼采用上直肌、外直肌肌腹联合术。随访时间3~12月,比较手术前、后患者的斜视度及眼球运动度。结果所有患者术前患眼均有不同程度的上转和外转受限,术前平均内斜视度为(92.50±18.17)△,平均下斜视度为(21.88±5.74)△,眼球外转受限程度为-3.19±0.62,眼球上转受限程度为-2.85±0.82;术后患者眼球外转(外转受限程度为-1.15±0.52)、上转(上转受限程度为-0.78±0.51)均有明显提高,与术前比较,差异有统计学意义(P<0.01),内斜视度[平均为(9.19±4.39)△]及下斜视度[平均为(2.38±3.10)△]明显减小,与术前比较,差异有统计学意义(P<0.01),除术前斜视度较大的个别患者外,总体效果较为满意(包括获得较为满意的外观)。结论上直肌、外直肌肌腹联合术能矫正高度近视引起的限制性内下斜视,获得较为满意的外观。

Objective To evaluate the effectiveness of superior rectus （SR） and lateral rectus （LR） union suture without scleral fixation for the treatment of myopic strabismus fixus. Methods A retrospective review was performed on 27 eyes of 16 patients who underwent lateral part of SR and superior part of LR muscle belly union between January 2010 and October 2015. We collected the ocular data including： best corrected visual acuity, axial length, CT or MRI images, orthoptic measurements （by prism test）, and eye movements pre- and postoperatively. Results The follow up time varied from 3-12 months. All of the patients got satisfactory results except two severe cases. A statistical change of prism test value and eye movement was noticed （ P〈0.01）. Orthoptic measurements showed that the mean esotropia was improved from （92.50±18.17）△ preoperatively to （9.19±4.39）△ postoperatively （ P〈0.01）. In regards for the vertical deviation, the mean residual hypotropia was （2.38±3.10）△ postoperatively compared to （21.88±5.74）△ preoperatively （ P〈0.01）. At the last follow-up, mean abduction limitation was improved from -3.19±0.62 to -1.15±0.52 （ P〈0.01）, mean elevation limitation was improved from -2.85±0.82 to -0.78±0.51 （ P〈0.01）. No special complications were noted. Conclusion Muscle belly suture of SR and LR was an effective surgery to correct ocluar misalignment and motility in myopic strabismus fixus.