改良Parks切口与直肌线状折叠术联合应用治疗成人共同性斜视

Curative effect of modified Parks incision combined with rectus linear tucking on adults with concomitant strabismus

目的:探究改良Parks切口与直肌线状折叠术联合应用治疗成人共同性斜视疗效及对术后视功能恢复及眼部美观度的影响。方法:以2019-06/2021-06成人共同性水平斜视患者160例为研究对象,根据手术方法的不同分为观察组(改良Parks切口与直肌线状折叠术联合应用,89例)及对照组(角膜缘梯形结膜瓣切口与直肌线状折叠术联合应用,71例)。比较两组临床疗效及手术相关指标;观察两组患者手术前后角膜荧光染色积分、标准干眼症状评估问卷(SPEED)及术后视觉模拟评分法(VAS)、温哥华瘢痕量表(VSS)评分变化情况,并于术后1mo统计患者结膜愈合不良、散光等并发症发生情况。结果:观察组手术总有效率高于对照组,手术切口长度短于对照组(均P<0.05);观察组术后角膜荧光染色积分、干眼症状评分均低于对照组,术后1wk的VAS评分低于对照组(均P<0.05);观察组术后开散性融合范围及视近33cm、视远5m斜视角大于对照组,辐辏性融合范围小于对照组,视近33cm、视远5m立体视低于对照组(均P<0.05);观察组术后泪膜破裂时间长于对照组,泪液分泌量多于对照组,角膜表面规则性指数(SRI)及VSS评分低于对照组(均P<0.05);观察组并发症总发生率低于对照组(P<0.05)。结论:改良Parks切口与直肌线状折叠术联合应用治疗成人共同性斜视,不仅能提高手术疗效,促进视功能及泪膜功能恢复,还能减轻干眼程度及术后疼痛感,提高眼部美观度,并可降低术后并发症发生率。

AIM: To explore the curative effect of modified Parks incision combined with rectus linear tucking on adults with concomitant strabismus and its influences on postoperative recovery of visual function and ocular aesthetics.METHODS: A total of 160 adults with concomitant strabismus were enrolled as the research subjects between June 2019 and June 2021. They were divided into observation group(modified Parks incision combined with rectus linear tucking, 89 cases) and control group(corneal limbal trapezoid conjunctival flap incision combined with rectus linear tucking, 71 cases) according to different surgical methods. The clinical curative effect and surgical related indexes between the two groups were compared. The changes in scores of corneal fluorescence staining, standard patient of eye dryness(SPEED), visual analogue scale(VAS) and Vancouver scar scale(VSS) before and after surgery in both groups were observed. The occurrence of complications such as poor conjunctival healing and astigmatism was statistically analyzed at 1 mo after surgery.RESULTS: The total response rate of surgery in observation group was higher than that in control group, and length of surgical incision was shorter than that in control group(all P<0.05). The scores of postoperative corneal fluorescence staining and dry eye in observation group were lower than those in control group, and VAS scores at 1 wk after surgery were lower than that in control group(all P<0.05). Postoperative divergent fusion range, strabismus angles of short-sighted 33 cm and far-sighted 5 m in observation group were greater than those in control group. Convergent fusion range was smaller than that in control group, and stereopsis of short-sighted 33 cm and far-sighted 5 m was lower than that in control group(all P<0.05). Postoperative break-up time in observation group was longer than that in control group, lacrimal secretion was more than that in control group, and scores of corneal surface regularity index(SRI) and VSS scores were lower than those in control group(all P<0.05). The total incidence of complications in observation group was lower than that in control group(P<0.05).CONCLUSION: The modified Parks incision combined with rectus linear tucking can not only improve surgical effect and promote the recovery of visual function and tear film function in adults with concomitant strabismus, but also relieve dry eye and postoperative pain, improve ocular aesthetics and reduce the incidence of postoperative complications.