斜视手术后短期屈光状态改变及其影响因素分析

Analysis of short-term refractive status changes after strabismus surgery and its influence factors

目的探讨斜视矫正术对术眼短期矫正视力及屈光状态的影响。设计前瞻性临床研究。研究对象北京同仁医院2013年12月-2017年8月间进行斜视矫正术治疗的斜视患者321例(475眼)。患者平均年龄(12.21±15.12)岁(年龄范围3~58岁)。方法根据斜视手术方式将术眼分为5组:1组为单条直肌后退术组(n=222),2组为单条直肌后退术联合单条直肌截除术组(n=93),3组为单条直肌后退联合单条直肌改良线状折叠术(n=99),4组为单条直肌后退联合单条斜肌后退术(n=37),5组为2条直肌手术联合单条斜肌后退术(n=24)。对术前及术后1个月患者的最佳矫正视力(BCVA)及等效球镜(SE)、散光度进行测量并比对分析(12岁以下患者为麻痹睫状肌验光)。主要指标 BCVA、SE及散光度。结果 5个组术前BCVA、SE及散光度组间比较无统计学差异(P=0.75、0.56、0.39)。术后1个月5个组间BCVA比较无统计学差异(P=0.29),术后1个月第5组SE为(-1.09±1.16)D,散光度为(1.39±2.05)D,较其他4组均大(P=0.02、0.01);5个组SE手术前后改变前4组无明显差异,第5组手术前为(-0.67±2.34)D,手术后为(-1.09±1.16)D,近视增加;5个组手术前散光度依次为(0.52±0.83)D、(0.74±0.52)D、(0.73±1.19)D、(0.61±1.67)D、(0.71±1.41)D,术后散光度依次为(0.81±0.88)D、(1.12±1.55) D、(1.14±2.30)D、(1.06±1.69)D、(1.39±2.05)D,均较术前增加(P均<0.01)。结论 5种手术方式对患者术后1个月手术眼的矫正视力无明显影响,对等效球镜影响较小,但会对散光度数有增加作用,其中3条肌肉手术眼较2条肌肉和1条肌肉手术眼变化更大。

Objective To investigate changes in best corrected visual acuity (BCVA) and refractive status short-term after strabismus surgery. Design Prospective clinical study. Participants 321 cases (475 eyes) were collected from December 16, 2013 to August 31, 2017 in Beijing Tongren hospital with a mean ageof 12.2±15.1 years (range 3-58). Methods All surgery eyes were divided into five groups: Group 1 had one rectus recession;Group 2 had one rectus recession combined with rectus resection on the antagonistic muscle;Group 3 had one rectus recession combined with improved rectus linear tucking on the antagonistic muscle;Group 4 had one rectus recession combined with one oblique recession and Group 5 had two rectus combined with one oblique recession. Main Outcome Measures The BCVA and refractive status before surgery and 1 months after surgery (Patients under 12 years old were done under ciliary muscle paralysis). Results There were no significant differences in preoperative BCVA, spherical equivalent (SE), or astigmatism among the five groups (P=0.75, 0.56, 0.39). There were no significant differences in BCVA among the five groups at one months(P=0.29). There were no significant differences in BCVA before and 1month after surgery. There were no significant differences in SE before and 1month after surgery in group 1-4. In group 5, SE significantly decreased after surgery, from -0.67±2.34 D to -1.09±1.16 D. Before surgery astigmatism in group 1 was 0.52±0.83 D, in group 2 was 0.74±0.52 D, in group 3 was 0.73±1.19 D, in group 4 was 0.61±1.67 D, in group 5 was 0.71±1.41 D. 1 month after surgery astigmatism in group 1 was 0.81±0.88 D, in group 2 was 1.12±1.55 D, in group 3 was 1.14±2.30 D, in group 4 was 1.06±1.69 D and in group 5 was 1.39±2.05 D, The astigmatism increased at one months in all groups compared to preoperative levels (all P<0.01). Conclusion The strabismus surgery increases astigmatism in early stage. Increased number of operated muscles may lead to more spherical equivalent and astigmatism diopter change.