眼外肌转位改良Yokoyama术治疗高度近视眼限制性内斜视的临床效果

Clinical efficacy of modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia

目的探讨眼外肌转位改良Yokoyama术治疗高度近视眼限制性内斜视的临床效果。方法回顾性病例系列研究。收集2017年2月至2022年2月在山东第一医科大学附属眼科医院就诊,接受眼外肌转位改良Yokoyama术治疗高度近视眼限制性内斜视的患者。术中充分分离上直肌及外直肌,于肌腹中央纵向钝性剖开向后延伸至肌止点后12~14 mm,将上直肌颞侧及外直肌上方1/2肌腹交叉转位固定到对侧肌肉止点,同时联合内直肌后退。于术后1周、1个月、3个月和6个月复诊,记录患者眼位、眼球运动、代偿头位改善情况,同视机检查客观斜视度数,眼眶CT检查眼外肌和眼球位置的改变,同时记录手术并发症。结果共纳入患者5例(8只眼),其中女性4例(7只眼),男性1例(1只眼);年龄(63±11)岁,眼轴长度(34.58±2.25)mm,术中内直肌后退(7.6±2.3)mm。所有患者术前眼位均为内下转位,角膜映光点水平范围为+15~>+45°,垂直范围为+15~+45°;外转及上转明显受限,运动受限程度均为-3(-4~-1)级。3例双眼患病和1例单眼患病患者代偿头位明显,1例单眼患病患者无代偿头位。术前眼眶CT提示上直肌向鼻侧移位、外直肌向下方移位,眼球从肌锥的颞上方疝出。术后6个月,所有患者眼位基本正位,同视机检查客观斜视度数水平范围为-4~+7°,垂直范围为0~+6°。所有患者眼球运动均明显改善,外转运动程度为-1级(-2~-1)、上转运动程度为-2级(-3~-1);代偿头位消失;眼眶CT提示眼球位于肌锥内;无眼前节缺血、肌肉粘连、病情复发、继发性青光眼、球壁刺穿等严重并发症发生。结论眼外肌转位改良Yokoyama术治疗高度近视眼限制性内斜视初步临床效果较好。

Objective To investigate the clinical efficacy of the modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia.Methods A retrospective case series study was conducted.Clinical data were collected from patients who underwent the modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia at Eye Hospital of Shandong First Medical University from February 2017 to February 2022.During the procedure,the superior rectus and lateral rectus muscles were fully separated.A longitudinal blunt incision was made in the central muscle belly extending posteriorly to 12-14 mm from the muscle insertion.The temporal half of the superior rectus muscle and the upper half of the lateral rectus muscle belly were transposed and secured to the contralateral muscle insertion.Simultaneously,medial rectus muscle recession was performed.Follow-up visits were conducted at 1 week,1 month,3 months,and 6 months postoperatively.Patients′ocular alignment,eye movements,improvement in compensatory head posture,objective degrees of strabismus using synoptophore,changes in extraocular muscles and globe position on orbital CT scan were recorded.Surgical complications were also documented.Results Five patients(8 eyes)were included in this study,including 4 females(7 eyes)and 1 male(1 eye),with an average age of(63±11)years and an average axial length of(34.58±2.25)mm.The medial rectus muscle recession during surgery was(7.6±2.3)mm.Preoperatively,all patients had esotropia with a horizontal range of+15°to+45°and a vertical range of+15°to+45°.Significant limitations in lateral and upward gaze were observed,with a degree of restriction ranging from-3(-4 to-1).Three patients with bilateral involvement and one patient with unilateral involvement exhibited significant compensatory head postures.One patient with unilateral involvement had no compensatory head posture.Preoperative orbital CT scans indicated nasal displacement of the superior rectus muscle and inferior displacement of the lateral rectus muscle,with the eyeball herniating from the muscle cone.At the 6-month follow-up,all patients achieved nearly orthophoric alignment.Objective degrees of horizontal strabismus ranged from-4°to+7°,and vertical strabismus ranged from 0°to+6°,as determined by synoptophore examination.Eye movements significantly improved,with a degree of restriction of-1(-2 to-1)for lateral gaze and-2(-3 to-1)for upward gaze.Compensatory head postures disappeared,and orbital CT scans indicated the eyeball was located within the muscle cone.There were no severe complications such as anterior segment ischemia,muscle adhesions,disease recurrence,secondary glaucoma,or globe penetration.Conclusion The preliminary clinical outcomes of the modified Yokoyama procedure with extraocular muscle transposition for high myopic eyes with restrictive esotropia are promising.