下斜肌后固定联合部分切除术治疗双眼不对称下斜肌亢进

Posterior fixation combined with partial myectomy of inferior oblique muscle for the treatment of bilateral asymmetric overaction of inferior oblique

目的评价下斜肌后固定联合部分切除术治疗双眼不对称下斜肌功能亢进的效果。方法回顾性分析徐州市第一人民医院2018年11月至2020年12月下斜肌后固定术治疗双眼不对称下斜肌亢进30例的临床资料。所有患者轻侧行下斜肌后固定术,严重侧则行下斜肌部分切除术,观察术后水平、垂直斜视度、V征、双侧下斜肌亢进功能及其不对称性的变化,随访5~10个月。结果30例中有27例(90.00%)治愈,手术后垂直斜视度由术前的(11.70±3.97)PD改善为(1.90±2.30)PD(t=18.326,P<0.001),下斜肌功能亢进严重侧由3.00(3.00,3.25)级减弱为0.00(0.00,1.00)级(Z=-5.106,P<0.001),轻侧由2.00(1.00,2.00)级减弱为0.00(0.00,0.00)级(Z=-4.964,P<0.001),手术后下斜肌功能亢进双眼之差由术前的1.50(1.00,2.00)级减小为0.00(0.00,1.00)级(Z=-5.069,P<0.001)。结论下斜肌后固定术联合下斜肌部分切除术治疗双眼不对称下斜肌亢进效果良好,术后眼球运动趋于对称而协调,原在位垂直斜视矫正好。

Objective To evaluate the efficacy of posterior fixation combined with partial myectomy of inferior oblique muscle in bilateral asymmetric overaction of inferior oblique muscle.Methods The clinical data of 30 cases of bilateral asymmetric inferior oblique muscle(IOM)overaction treated by posterior fixation of IOM from Nov.2018 to Dec.2020 in Xuzhou First People’s Hospital were analyzed retrospectively.All patients underwent posterior fixation of IOM on the mild side and partial myectomy on the severe side.The changes of horizontal and vertical strabismus,V sign,bilateral overaction of IOM and its asymmetry were observed.The follow-up time was 5-10 months.Results Of the 30 patients,27 cases(90.00%)were cured.Vertical strabismus was improved from(11.70±3.97)PD preoperatively to(1.90±2.30)PD postoperatively(t=18.326,P<0.001).The function of the severe side of IOM overaction decreased from level 3.00(3.00,3.25)to level 0.00(0.00,1.00)(Z=-5.106,P<0.001)and the mild side decreased from level 2.00(1.00,2.00)to level 0.00(0.00,0.00)(Z=-4.964,P<0.001).The difference between the bilateral inferior oblique overaction before and after operation decreased from level 1.50(1.00,2.00)to level 0.00(0.00,1.00)(Z=-5.069,P<0.001).Conclusion In the treatment of bilateral asymmetric inferior oblique overaction,the posterior fixation of IOM in the mild side combined with partial myectomy of IOM in the severe side has good efficacy.Postoperative eye movement tends to be symmetrical and coordinated.The vertical strabismus in primary position can be corrected perfectly.