斜视复视多学科联合诊疗的必要性

The necessity of multidisciplinary dignosis and treatment of strabismus and diplopia

目的:讨论复杂的斜视和复视患者多学科联合诊疗的必要性。方法:回顾性分析2017年10月至2019年12月浙江大学医学院附属金华医院复杂的斜视和复视患者共103例。经多学科专家联合会诊,统一制定诊疗方案,治疗后随访1~12个月。结果:本组患者包括先天及后天麻痹性斜视52例,共同性斜视15例,肌性视疲劳所致复视7例,甲状腺相关性眼病所致的限制性斜视6例,继发性斜视3例,重症肌无力3例,眶壁骨折所致限制性斜视2例,同时排除假性斜视15例。治疗方法包括:10例行斜视手术,6例压贴三棱镜矫正小度数斜视,5例屈光矫正及视疲劳治疗,其余82例进行全身病治疗同时斜视保守治疗。结论:开展斜视和复视多学科联合诊疗,最大限度地发挥各学科专家的技术优势,运用综合诊疗模式,使斜视和复视疑难病例的诊疗更加便捷和精准。

Objective To discuss the necessity of multidisciplinary diagnosis and treatment for complex strabismus and diplopia patients.Methods A total of 103 cases of complex strabismus and diplopia patients from Oct.2017 to Dec.2019 in Affiliated Jinhua Hospital of Zhejiang University School of Medicine were analyzed retrospectively.A multidisciplinary expert consultation was carried out for each patient to make a unified diagnosis and treatment plan.All patients were followed up for 1 to 12 months after treatment.Results There were 52 cases of paralytic strabismus caused by congenital or postnatal diseases,15 cases of concomitant strabismus,7 cases of diplopia caused by muscular asthenopia,6 cases of restrictive strabismus caused by thyroid-associated ophthalmopathy,3 cases of secondary strabismus,3 cases of myasthenia gravis and 2 cases of restrictive strabismus caused by orbital fracture.The other 15 cases of pseudostrabismus were excluded.The therapies included strabismus surgery in 10 cases,prescription with prism glasses in 6 cases of mild strabismus,refractive correction and fatigue treatment in 5 cases,and received systemic treatment in combination with conservative treatment of strabismus in other 82 cases.Conclusion For optimal decision making for the complicated strabismus and diplopia patients with the help of experts majoring in different disciplines,multidisciplinary diagnosis and treatment are needed to make a more informed judgement with the advantages of convenience and accuracy.