改良下斜肌前转位术治疗大角度上斜视的疗效

Effect of modified anterior transposition of inferior oblique muscle in the treatment of large angle hypertropia

目的观察改良下斜肌前转位术联合上直肌后徙治疗大角度上斜视的临床疗效。方法对2016年1月至2018年1月两年间在我院门诊和住院治疗的资料齐全的大角度上斜视(垂直斜视度>25Δ,下斜肌功能亢进)32例(32只眼),其中,男性19例,女性13例,年龄5~56岁,平均23.5岁,随访3~24个月,平均8~9月。结果手术效果评价:根据中华眼科学会全国儿童弱视斜视学组制定的斜视疗效评价标准,按治愈、改善、未愈进行评价,32例大角度上斜视患者随访后,治愈24例(75%),改善7例(22%),未愈1例(3%)(术中探查发现下直肌发育缺如)。结论改良下斜肌前转位术是治疗大角度上斜视的有效方法,不切断下斜肌肌止端,手术操作简单,安全,并发症少,矫正垂直斜视度大,值得推广应用。

Objective To observe the clinical effect of modified anterior transposition of inferior oblique muscle in the treatment of large angle hypertropia.Methods A total of 32 patients(32 eyes)with large angle hypertropia(vertical deviation≥25Δ,inferior oblique muscle overaction)treated in our hospital and with complete hospitalization data from January 2016 to January 2018 were selected,including 19 males and 13 females with an average age of 23.5 years(range,5~56 years).The patients were followed up for 3~24 months(average 8~9 months).Results According to the evaluation criteria for strabismus efficacy formulated by the National Children's Amblyopia and Strabismus Group of the Chinese Ophthalmology Society,the curative effect was evaluated based on the grades of cure,improvement,and unhealed.At the last follow-up,24 patients(75%)were cured,7 patients(22%)improved,and 1 patient(3%)was unhealed(intraoperative exploration revealed hypoplasia of inferior rectus muscle).Conclusions The modified anterior transposition of inferior oblique muscle combined with recession of the superior rectus is an effective method for correcting large angle hypertropia.This method avoids the need of cutting off the insertion of the inferior oblique muscle,and is simple,safe,with less complications and with a large correction of vertical strabismus,which is worthy of popularization and application.