微创小切口单眼外直肌后徙联合内直肌缩短术治疗基本型间歇性外斜视的疗效观察

Surgical outcomes of the minimally invasive small incision unilateral recession-resection for intermittent exotropia

目的评价微创小切口单眼外直肌后徙联合内直肌缩短术(R&R)治疗基本型间歇性外斜视(IXT)的疗效。方法收集2018年3月至2019年4月于北京大学人民医院眼视光中心的患者52例(52只眼)进行回顾性研究。其中,男性24例(24只眼),女性28例(28只眼);年龄3~16岁,平均年龄(7.3±3.1)岁。按照斜视度的不同,将患者分为小角度斜视组和大角度斜视组。检查并记录全部患者术前与术后6个月的远视力、屈光度、同视机融合功能及近立体视功能等指标;检查并记录全部患者术前、术后1周、术后1个月、术后3个月及术后6个月的远近斜视度。患者的发病年龄、病程、术龄、屈光度及斜视度以均数±标准差表示,采用t检验进行组间比较;两组的眼位正位率和近立体视提高率以百分率表示,采用卡方检验进行比较;术前与术后同视机融合功能的比较,采用配对t检验。结果本研究纳入的52例(52只眼)基本型IXT患者,平均发病年龄为(4.7±3.2)岁,术前平均斜视度为(-38.56±14.96)个三棱镜度(PD)。两组患者性别比的比较,差异无统计学意义(χ^2=1.15,P>0.05);两组患者发病年龄、病程、平均年龄、术眼及非术眼屈光度的比较,差异无统计学意义(t=0.07,0.02,0.08,0.27,0.28;P>0.05)。两组术前平均斜视度的比较,差异有统计学意义(t=6.49,P<0.05)。行R&R术的患者中采用"退5缩4"、"退6缩3"、"退6缩4"、"退7缩4"及"退7缩5"术式者分别有24例(24只眼)、8例(8只眼)、8例(8只眼)、12例(12只眼)、2例(2只眼)及6例(6只眼)。术后6个月时,小角度斜视组和大角度斜视组患者眼位正位率分别为82.1%和79.2%。经卡方检验,两组差异无统计学意义(χ^2=0.07,P>0.05)。两组患者术后从第1周开始逐渐发生外斜漂移,并且术后1个月之前外斜漂移发展较快,之后眼位趋于稳定。患者术前与术后6个月融合范围的绝对值分别为(14.56±9.53)°和(21.79±6.93)°。经t检验,两者的差异有统计学意义(t=4.02,P<0.05)。小角度斜视组和大角度斜视组患者近立体视功能的提高率分别为53.6%和75.0%。经卡方检验,两组的比较差异无统计学意义(χ^2=2.56,P>0.05)。结论对斜视度为-20 PD^-85 PD的基本型IXT患者行微创小切口单眼R&R术,术后6个月患者的眼位正位率较高,融合功能及近立体视功能均得到明显改善。该术式对于小角度和大角度斜视患者均具有较好疗效。因此,该术式可作为治疗基本型IXT的手术选择。

Objective The aim of this study was to investigate the surgical outcomes of the minimally invasive small incision unilateral recession-resection(R&R)for basic-type intermittent exotropia(IXT).Methods 52 patients(52 eyes)with basic-type IXT(-20 PD^-85 PD)who underwent the minimally invasive small incision R&R from March 2018 to April 2019 in Center of Optometry,Peking University People′s Hospital were analyzed retrospectively.Among of them,there were 24 male patients(24 eyes)and 28 female patients(28 eyes),aged 3 to 16 years-old with the average age of(7.3±3.1)years-old.According to the severity of exotropia,patients were divided into small angle group(A group)and large angle group(B group).Ophthalmologic and orthoptic examination were carried out,including visual acuity,cycloplegic refraction,motility evaluation,near stereoacuity and fusion function,anterior segment and fundus examination before and after operation for 1 week,1 month,3 months and 6 months.The age of onset,course of disease,operation age,diopter and strabismus angle were represent by means±standard deviation and t-test was used to compare;the orthotopic rate and increased rate of near stereoacuity were represented by percentage and chi-square test was used for comparison.The preoperative and postoperative fusion range was used to compare by t-test.Results Among of 52 cases(52 eyes)with basic-type IXT,the mean age of patients was(4.7±3.2)years-old,and preoperative exotropia angle was(-38.56±14.96)prism diopter(PD).There was no significant difference in sex ratio(χ^2=1.15,P>0.05)and the mean age of patients,course of disease,the average age and cycloplegic refraction between them(t=0.07,0.02,0.08,0.27,0.28;P>0.05).The preoperative average strabismus of 2 groups were significant difference(t=6.49,P<0.05).Among of patients with R&R,there were 24 cases(24 eyes),8 cases(8 eyes),8 cases(8 eyes),12 cases(12 eyes),2 cases(2 eyes),and 6 cases(6 eyes)by the lateral rectus 5 mm-medial rectus4 mm(LR5-MR4),LR6-MR3,LR6-MR4,LR7-MR4 and LR7-MR5,respectively.After opeartion for6 months,the successful rate of postoperative ocular alignment in A and B group was respectively 82.1%and 79.2%with non-significant difference between them(χ^2=0.07,P>0.05).Patients gradually developed exotropia drift from the first week after operation.And the speed of exotropia drift was faster before postoperative 1 month,and then slow down.The preoperative and postoperative fusion range was respectively(14.56±9.53)°and(21.79±6.93)°with significant difference between them(t=4.02,P<0.05).The increased rate of near stereoacuity in A and B group was respectively 53.6%and 75.0%with non-significant difference between them(χ^2=2.56,P>0.05).Conclusions For basic-type IXT patients with exotropia angle from-20 PD to-85 PD,application of the minimally invasive small incision R&R could achieve a high orthotopic rate,and the fusion function and near stereoacuity were significantly improved after operation.Thus,this surgery could be used as a new choice for basic-type IXT patients.