基于马氏杆三棱镜和三棱镜交替遮盖试验的急性共同性内斜视手术疗效比较

Comparison of the Surgical Effects Based on Maddox Prism Test and Prism and Alternative Cover Test for Acute Acquired Comitant Esotropia

目的:比较分别以马氏杆三棱镜度和三棱镜交替遮盖(PACT)斜视度作为急性共同性内斜视(AACE)手术目标量的治疗效果。方法:回顾性系列病例研究。连续收集2020年1月至2022年3月于山东中医药大学附属眼科医院接受斜视矫正术且随诊6个月以上的AACE病例34例,根据手术目标斜视量对应的检查方法分为对照组18例和马氏杆组16例。对照组将PACT斜视度作为手术目标量,马氏杆组术前增加马氏杆三棱镜度检查并作为手术目标量,2组均采用PACT测量术后斜视度。观察比较患者术前与术后斜视度、融合范围、近立体视等资料。手术成功标准为视远和视近斜视度均在-8.0~8.0 PD内,复视消失。采用t检验、Wilcoxon秩和检验和χ^(2)检验对数据进行分析。结果:马氏杆组术前检查显示马氏杆三棱镜度大于PACT斜视度[视远差值(6.0±3.9)PD;视近差值(6.6±2.4)PD],差异均有统计学意义(t=-6.10,P<0.001;t=-11.08,P<0.001)。术后末次随诊时,马氏杆组视远、视近残余斜视度均小于对照组[(1.6±2.1)PD vs.(4.0±2.8)PD;(3.1±2.2)PD vs.(5.9±3.3)PD],差异均有统计学意义(t=2.75,P=0.010;t=2.87,P=0.007)。经1次手术成功者在对照组有14例(78%)、马氏杆组有15例(94%),差异无统计学意义(P>0.05)。对照组和马氏杆组术后融合范围分别比术前增加3.9°±3.6°和4.2°±2.5°,2组间术后融合范围差异无统计学意义(P>0.05)。术后恢复中心凹立体视者在对照组有10例(63%),马氏杆组有10例(77%),差异无统计学意义(P>0.05)。结论:以PACT斜视度和马氏杆三棱镜度作为目标量的斜视手术均能有效改善AACE患者的眼位、融合功能和近立体视,但以马氏杆三棱镜度作为手术目标量术后残余斜视度更少。

Objective:To compare the surgical effects of using maddox prism test and prism and alternative cover test(PACT)as the target angle for acute acquired comitant esotropia(AACE).Methods:In this retrospective case series study,thirty-four patients with AACE underwent surgery at the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine from January 2020 to March 2022,and were followed up for more than 6 months.According to the examination methods corresponding to the surgical target angle,the patients were divided into two groups:control group(18 cases)and maddox group(16 cases).In the control group,the angle of PACT was used as the surgical target angle.In the maddox group,the maddox prism examination was added preoperatively and used as the surgical target angle.Postoperative deviation was measured by PACT in both groups.Clinical data,including pre-and postoperative deviation,fusion range,and near stereopsis,were collected and compared.A successful surgical alignment was defined as the distant and near deviation in the primary gaze within 8 PD and no diplopia.T-test,Wilcoxon rank sum test,and X^(2) test were used for data analysis.Results:In the maddox group,the deviation angle measured by maddox prism was larger than that measured by PACT(6.0±3.9 PD for distance,t=-6.10,P<0.001;6.6±2.4 PD for near,t=-11.08,P<0.001).At the last postoperative followup,the far and near residual strabismus in the maddox group were less than those in the control group(1.6±2.1 PD vs.4.0±2.8 PD,t=2.75,P=0.010;3.1±2.2 PD vs.5.9±3.3 PD,t=2.87,P=0.007).In this study,14 patients(78%)in the control group and 15 patients(94%)in the maddox group achieved successful surgical alignment after one surgery,with no statistically significant difference(P>0.05).The postoperative fusion range in the control and maddox groups increased by 3.9°±3.6°and 4.2°±2.5°,respectively,with no significant difference between the two groups(P>0.05).Postoperatively,10 cases(63%)in the control group and 10 cases(77%)in the maddox group recovered foveal near stereopsis,with no statistically significant difference(P>0.05).Conclusions:Strabismus surgery with PACT and maddox prism as the target angle can effectively improve the ocular alignment,fusion function,and near stereopsis in patients with AACE.However,using maddox prism as the surgical target angle resulted in less postoperative residual deviation.