硅胶带部分直肌肌腹联结术治疗重度高度近视眼固定性内下斜视的疗效

Effect of Silicone Band Partly Loop Myopexy in the Treatment of Severe Myopic Strabismus Fixus

目的:观察硅胶带部分直肌肌腹联结术同时联合内直肌后退术治疗重度高度近视眼固定性内下斜视(MSF)的安全性和有效性。方法:回顾性系列病例研究。收集2017年3月至2021年4月在空军军医大学西京医院眼科行单眼或双眼硅胶带联结上直肌颞侧1/2和外直肌上1/2部分肌腹且同时联合内直肌后退术的重度MSF患者8例(12眼)。年龄30~80(53.8±15.6)岁;等效球镜度为-26.00~-13.50(-20.41±4.12)D;B超测量眼轴长度26.34~35.30(30.16±2.51)mm。术后随访时间6个月~3年。对比分析患者手术前后内斜视、下斜视、眼球外转和上转受限程度改变,以及眼球脱位角度(AGD)的改变。采用配对样本t检验以及Wilcoxon符号秩和检验进行数据处理。结果:8例(12眼)患者内斜度由术前(+101±13)PD减为术后的(+3±5)PD,下斜视度由术前30(25,34)PD减为术后的0(0,0)PD,外转受限由术前的-5(-5,-5)降为术后的-2(-3,-1),上转受限由术前-5(-5,-5)降为术后的-2(-2,-2),差异均有统计学意义(均P<0.01)。手术前后影像学资料完整的5例(8眼),AGD由术前的(185±28)°减为术后(121±19)°,差异有统计学意义(t=8.96,P<0.001)。术前有代偿头位患者3例,术后头位均明显改善或消失。术后有3例患者术眼有异物感,3周后消失。结论:硅胶带上直肌和外直肌部分肌腹联结术联合内直肌后退术治疗重度MSF安全有效,可以显著矫正重度内下斜视和改善眼球运动。

Objective:To investigate the safety and efficacy of silicone band partly loop myopexy combined with medial rectus recession in the treatment of severe myopic strabismus fixus(MSF).Methods:Retrospective analysis of 8 patients(12 eyes)with severe MSF who underwent monocular or binocular silicone band partly loop myopexy to unite the temporal 1/2 of superior rectus muscle and superior 1/2 of lateral rectus muscle,meanwhile combined with medial rectus recession in the Department of Ophthalmology,Xijing Hospital,Fourth Military Medical University from March 2017 to April 2021.The age ranged from 30 to 80 years,with an average of 53.8±15.6 years.The spherical equivalent was-26.0--13.50 diopter(D),with an average of-20.41±4.12 D.The axial length measured by B-ultrasound was 26.34-35.30 mm,with an average of 30.16±2.51 mm.The postoperative follow-up was 6 months to 3 years.The esotropia,hypotropia,limitation of abduction and elevation,and the change of angle of globe dislocation(AGD)were analyzed before and after operation.The data differences were compared and analyzed by paired t test and Wilcoxon signed-rank test.Results:After surgery,the mean of esotropia decreased from+101±13 PD to+3±5 PD.hypotropia decreased from 30(25,34)PD to 0(0,0)PD.Mean abduction limitation decreased from-5(-5,-5)to-2(-3,-1),and mean limitation of elevation decreased from-5(-5,-5)to-2(-2,-2).These were statistically significant differences(P<0.01).Both the preoperative and postoperative imaging data of 8 eyes of 5 patients were available.The mean AGD decreased from 185°±28°before operation to 121°±19°after operation(t=8.96,P<0.001).There were 3 patients with compensatory head position before surgery,and the head position significantly reduced or disappeared after surgery.Three patients had foreign body sensation in the eyes after surgery which disappeared 3 weeks later.Conclusion:Silicone band partly loop myopexy to unite 1/2 superior rectus and 1/2 lateral rectus combined with medial rectus recession,is a safe and effective operation for severe MSF,which can obviously correct serious ocular deviation and improve ocular motility.