AS-OCT对共同性外斜视矫正术后眼外肌止端探查的可行性

Feasibility of AS-OCT measuring rectus muscle insertion after concomitant exotropic corrective surgery

目的评估眼前节光相干断层扫描(AS-OCT)探查共同性外斜视矫正术后水平眼外肌止端位置的可行性。方法采用横断面研究方法,纳入2018年3月至2019年2月在沈阳爱尔眼视光医院就诊的共同性外斜视患者25例25眼,所有患者均接受斜视矫正手术。分别于术前、手术开始、术终、术后2周及术后1、3和6个月测量角膜缘至水平眼外肌止端的距离,手术开始及术终时用卡尺进行测量,术前及术后用AS-OCT进行测量,应用AS-OCT评价斜视矫正术后不同时间点眼外肌止端的位置变化。采用33 cm三棱镜联合交替遮盖法检查术前及术后不同时间点术眼斜视度。结果共测量共同性外斜视患者25眼的44条水平眼外肌,包括外直肌25条和内直肌19条。术后2周和术后1个月AS-OCT对肌止端的检出率低。术终卡尺测量以及术后3个月和6个月AS-OCT测量的角膜缘至外直肌止端的距离分别为(12.30±1.40)、(11.72±1.45)和(11.84±1.27)mm,总体比较差异有统计学意义(F=4.085,P=0.023);术终测量角膜缘至外直肌止端的距离大于术后3个月,差异有统计学意义(P=0.018)。术终卡尺测量及术后3个月和6个月测量的角膜缘至内直肌止端的距离分别为(5.12±0.42)、(5.56±0.61)和(5.28±0.57)mm,总体比较差异无统计学意义(F=3.912,P=0.055)。术后各时间点患者斜视度均明显小于术前,差异均有统计学意义(均P<0.05)。结论AS-OCT可以成功显示共同性外斜视矫正术后水平眼外肌止端位置的纵向变化。

Objective To investigate the feasibility of rectus muscle insertion measurement with anterior segment optical coherence tomography(AS-OCT)after corrective surgery of concomitant exotropia.Methods A cross-sectional study was performed.Twenty-five eyes of 25 patients with concomitant exotropia were included in Shenyang Aier Eye Hospital from March 2018 to February 2019,and all patients received concomitant exotropic corrective surgery.The distance of limbus to rectus muscle insertion was measured before operation,at the beginning and at the end of operation with a caliper and at postoperative 2 weeks,1 month,3 months and 6 months with AS-OCT,respectively.Degree of strabismus was examined by the alternate prism cover test at 33 cm.The research followed the Declaration of Helsinki and the protocol was approved by a Medical Ethics Committee of Shenyang Aier Eye Hospital(No.2017KJB005).Written informed consent was obtained from the patients/custodians prior to any medical examination and treatment.Results A total of 44 rectus muscles of 25 eyes with concomitant exotropia were measured,including 25 lateral rectus muscles and 19 medial rectus muscles.The detection rate of the muscle insertion by AS-OCT was low at 2 weeks and 1 month after surgery.The mean distance of limbus to lateral rectus muscle insertions was(12.30±1.40),(11.72±1.45)and(11.84±1.27)mm at the end of operation and postoperative 3 and 6 months,respectively,showing a significant difference among them(F=4.085,P=0.023),and the distance measured at the end of operation was significantly larger than that at postoperative 3 months(P=0.018).The mean distance of limbus tomedial rectus muscle insertion was(5.12±0.42),(5.56±0.61)and(5.28±0.57)mm at the end of operation,postoperative 3 and 6 months,respectively,and there was no significant difference among the three time points(F=3.912,P=0.055).The degree of strabismus of the patients at various time points after surgery were significantly reduced in comparison with that before surgery(all at P<0.05).Conclusions AS-OCT can track the position of extraocular muscle insertions after concomitant exotropic corrective surgery.