单侧内直肌后徙术与双侧内直肌后徙术治疗青少年急性共同性内斜视的疗效对比

Comparison of the Effect of Unilateral Internal Rectus Retraction and Bilateral Internal Rectus Retraction in the Treatment of Acute Concomitant Esotropia in Adolescents

目的:探讨单侧内直肌后徙术与双侧内直肌后徙术对内斜视青少年视功能、斜视度及眼外肌、血清中胰岛素样生长因子-1(Insulin like growth factor 1,IGF-1)水平的影响。方法:选取笔者医院2020年1月-2022年1月收治的60例急性共同性内斜视(Adolescent patients with acute concomitant esotropia,AACE)青少年患者作为研究对象,按照随机数字表法分为观察组(30例,采用单侧内直肌后徙术治疗)和对照组(30例,采用双侧内直肌后徙术治疗),术后随访半年。观察两组患者治疗效果、Base-out恢复点参数、视功能、斜视度(N-D值),眼外肌、血清中IGF-1水平。结果:术后6个月,观察组患者正位率高于对照组患者,过矫率低于对照组患者(P<0.05)。术后6个月,观察组患者Base-out恢复点参数与Base-in(BI)恢复点与对照组比较差异无统计学意义(P>0.05)。术后6个月,观察组患者正常视近立体视比例高于对照组患者(P<0.05)。术后6个月,观察组患者斜视度与对照组比较差异无统计学意义(P>0.05)。术后6个月,观察组患者眼外肌、血清中IGF-1水平均高于对照组(P<0.05)。结论:单侧内直肌后徙术与双侧内直肌后徙术相比,其能提升内斜视青少年正位率,改善视功能情况,有利于临床推广。

Objective To investigate the effect of unilateral medial rectus recession and bilateral medial rectus recession on visual function, strabismus, and insulin like growth factor 1(IGF-1) levels in extraocular muscle and serum of adolescents with esotropia. Methods Sixty patients with adolescent acute concomitant esotropia(AACE) admitted to the author's hospital from January 2020 to January 2022 were selected as the study subjects. They were divided into an observation group(30 cases,treated with unilateral medial rectus recession) and control group(30 cases, treated with bilateral medial rectus recession) by using the random number table method. All the patients were followed up for six months after surgery.The treatment effect,Base-out recovery point parameters, visual function, strabismus(N-D value), and IGF-1 levels in the extraocular muscle and serum were observed in the two groups of patients. Results At 6 months after treatment, the orthosis rate of the observation group patients was higher, and the overcorrection rate was lower(P<0.05). There were no differences in the Base-out recovery point parameters and BI recovery point between the observation group and the control group(P>0.05). At 6 months after treatment, the normal near stereoacuity of the observation group was higher(P<0.05). There was no difference in strabismus between the observation group and the control group at 6 months after surgery(P>0.05).The levels of IGF-1 in the extraocular muscle and serum at 6 months after surgery were higher in the observation group(P<0.05). Conclusion Compared with bilateral medial rectus recession, unilateral medial rectus recession can better enhance the orthosis rate and improve the visual function in adolescents with esotropia, and the latter one is beneficial for clinical promotion.