下斜肌肌腹转位术治疗轻度下斜肌亢进伴小度数垂直斜视

Inferior oblique belly transposition in the treatment of mild inferior oblique overaction with small angle vertical strabismus

目的:观察下斜肌肌腹转位(IOBT)术在单眼下斜肌轻度亢进伴小度数垂直斜视中的应用效果。方法:回顾性分析2019-09/2021-08在我院行IOBT术的患者,纳入标准为单眼下斜肌轻度亢进(2+及以下),并伴有轻度非共同性垂直斜视(4~9PD)。水平斜视按照常规手术量和方式设计,同期单侧下斜肌亢进眼行单眼IOBT术。观察手术前后水平斜视度、垂直斜视度、侧方注视位垂直斜视度、黄斑视盘夹角及下斜肌亢进程度等。结果:纳入病例共16例16眼,年龄4~39岁。1例为先天性内斜视术后5a,单眼上斜肌轻度麻痹继发下斜肌功能亢进,余15例均为原发性下斜肌功能亢进伴水平斜视。随访时间为3~6mo。术前和术后平均下斜肌亢进程度分级分别为+2.00(2.00,2.00)级和0.00(0.00,0.00)级(Z=-3.704,P<0.001),平均改善2.00(1.25,2.00)级;水平斜视度从术前69.13±25.86PD减少到术后2.75±2.59PD(t=9.929,P<0.001);第一眼位垂直斜视从术前7.44±1.32PD减少到术后1.00±1.21PD(t=22.335,P<0.001),平均矫正上斜视为6.44±1.15PD;侧方注视垂直斜视从术前12.44±2.73PD减少到术后3.00±2.13PD,平均矫正9.44±2.73PD(t=13.819,P<0.001)。黄斑中心凹-视盘中心夹角度数(FDA)术前为-8.85°±6.53°,术后为-6.49°±7.01°(t=-2.384,P<0.001),平均减少2.36°。未见术后过矫及下斜肌功能不足等并发症。结论:IOBT术对矫正单侧轻度下斜肌亢进伴小度数垂直斜视是安全有效的。

AIM:To observe the effect of inferior oblique belly transposition(IOBT)in unilateral mild inferior oblique overaction with small angle vertical stabismus.METHODS:The data of patients who underwent IOBT in our hospital from September 2019 to August 2021 were analyzed retrospectively.Inclusion criteria targeted patients with mild inferior oblique overaction(2+and below)and small angle incomitant vertical strabismus(4-9PD).The horizontal deviation and vertical deviation in both primary and lateral gazes were measured,and the degree of inferior oblique overaction and fovea-disc angle(FDA)were also evaluated preoperatively and postoperatively.RESULTS:A total of 16 cases(16 eyes)were included,aged 4-39 years.One case was 5a postoperative congenital esotropia with secondary unilateral inferior oblique overaction by mild superior oblique palsy,whereas 15 patients had monocular primary inferior oblique overaction with horizontal strabismus.The follow-up was 3-6mo.The mean improvement of inferior oblique overaction was 2.00(1.25,2.00)grade from+2.00(2.00,2.00)preoperatively to 0.00(0.00,0.00)postoperatively,the difference was statistically significant(Z=-3.70,P<0.001).The horizontal strabismus decreased from 69.13±25.86PD preoperatively to 2.75±2.59PD postoperatively(t=9.929,P<0.001).The vertical strabismus in the primary position decreased from preoperative 7.44±1.32PD to 1.00±1.21PD postoperatively(t=22.335,P<0.001),mean corrected hypertropia 6.44±1.15PD,and vertical strabismus in lateral gazes decreased from preoperative 12.44±2.73PD to 3.00±2.13PD postoperatively,mean corrected hypertropia 9.44±2.73PD,these differences were statistically significant(t=13.819,P<0.001).The FDA decreased from-8.85°±6.53°preoperatively to-6.49°±7.01°postoperatively,the difference was statistically significant(t=-2.384,P<0.001),with a mean reduction of 2.36°.No postoperative complications such as postoperative overcorrection or inferior oblique underaction were observed.CONCLUSION:IOBT is safe and effective in correcting unilateral mild inferior oblique overaction with small angle vertical strabismus.