单眼直肌手术治疗成人知觉性外斜视临床观察

Clinical observation of monocular rectus surgery for adult sensory exotropia

目的:评估单眼直肌手术治疗成人知觉性外斜视的效果。方法:选取76例76眼Krimsky法度数为-15~△～-160~△(-68.36±30.77)~△的成人知觉性外斜视患者纳入本次研究。分别使用常规量单眼外直肌后徙、常规量单眼内直肌缩短+外直肌后徙和超常量单眼内直肌缩短+外直肌后徙三种术式,对16例、37例以及23例不同斜视度数的患者进行治疗。术后1d,1wk,1、3、6mo进行随访,检测患者眼位情况、单眼运动情况、眼压、裂隙灯和眼底。结果:术后67例(88%)眼位正,9例(12%)欠矫。术后1wk术眼眼压与术前持平(P=0.090),至3mo时眼压下降达峰值(P<0.01),3mo眼压与1mo差异无统计学意义(P=0.092),6mo眼压与3mo差异无统计学意义(P=0.123)。2例(3%)患者在术后1d,1wk随访时出现前节缺血导致的炎症反应,至1mo随访时均痊愈。4例(5%)患者术后1、3、6mo随访时出现眼球外转功能不良。结论:单眼直肌手术对于成人知觉性外斜视患者有较好的治疗效果;离断眼直肌继发的眼压下降现象值得术者警惕;单眼离断2条直肌手术后并发症的发生率较低;超常量眼直肌斜视矫正术治疗知觉性外斜视可能出现术后眼球极度外转的功能受限。

AIM： To evaluate the effect of monocular rectus surgery for adult sensory exotropia.METHODS： Totally 76 cases of adult sensory exotropia of degree-15^△ to-160^△（-68. 36^△ ±30. 77^△） examined through Krimsky method were included into this study. A total of 16 cases,37 cases and 23 cases with different degrees of strabismus were treated separately with routine amount monocular lateral rectus recession,routine amount monocular medial rectus resection plus lateral rectus recession,and exceed constant amount monocular medial rectus resection plus lateral rectus recession. Follow-up was performed at 1 d,1 wk,1,3 and 6 mo after operation. The eye position,monocular movement,intraocular pressure（ IOP）,slit lamp,and fundus of these patients were examined.RESULTS： After surgery,67 cases（ 88%） were positive and 9 cases（ 12%） were undercorrection. The postoperative intraocular pressure of operative eye at1 wk was equal to preoperative（ P = 0. 090）,and IOP decreased to a valley value at 1 mo（ P〈0. 01）,there was no significant difference in intraocular pressure between3 mo and 1 mo（ P = 0. 092）,and no significant difference in intraocular pressure between 6 mo and 3 mo（ P =0. 123）. And 2 cases（ 3%） had inflammatory reaction induced by anterior segment ischemia at 1 d and 1 wk postoperative visits,and they recovered at 1 mo follow-up visit; 4 cases（ 5%） experienced an external dysfunction at the 1,3 and 6 mo follow-up.CONCLUSION： Monocular rectus surgery has a good therapeutic effect on adult patients with sensory exotropia; the decrease in intraocular pressure secondary to the detached rectus is worth the attention of the surgeon; the incidence of complications after detaching monocular of two rectus muscles is comparable low. Exceed constant amount rectus strabismus surgery for sensory exotropia may result in limited function of postoperative ocular hyperextension.