双眼外直肌倾斜后徙术治疗集合不足型间歇性外斜视的临床效果

Clinical efficacy of slanted bilateral lateral rectus recession in the treatment of convergence insufficiency type of intermittent exotropia

目的评估集合不足型间歇性外斜视(CI-IXT)行双眼外直肌倾斜后徙术(S-BLRc)的临床效果。方法回顾性病例对照研究。收集2020年1月至2023年1月在安阳市眼科医院治疗的CI-IXT患者64例(128眼)的临床资料。按不同的手术方式将患者分为S-BLRc组和双眼外直肌后徙术(BLRc)组,每组各32例(64眼),术后随访观察6个月。比较术前、术后6个月两组患者的视远斜视度、视近斜视度、远近斜视度差(NDD)、NDD改善量、手术成功率和立体视、屈光状态、上转25°和下转25°斜视度差值、旋转斜视的变化。结果术后6个月,S-BLRc组患者的视远斜视度(-2.84±3.32)三棱镜度(PD)、视近斜视度(-7.32±7.81)PD及NDD(5.07±5.91)PD较术前(-27.53±7.51)、(-38.84±8.85)及(11.37±3.82)PD均下降(t=31.41、44.78、10.31,均P<0.01);BLRc组患者的视远斜视度(-2.62±3.43)PD、视近斜视度(-9.26±5.95)PD及NDD(6.81±7.33)PD较术前(-26.45±8.61)、(-37.75±7.80)及(11.12±3.94)均下降(t=30.29、42.10、7.20,均P<0.01)。术前两组患者的视远斜视度、视近斜视度、NDD比较,差异均无统计学意义(t=-1.43、-1.58、-0.89,P=0.157、0.112、0.376)。术后6个月,两组患者的视远斜视度比较,差异无统计学意义(t=0.30,P=0.763);S-BLRc组的视近斜视度和NDD值均小于BLRc组,差异有统计学意义(t=-2.86、2.60,P=0.006、0.011)。术后6个月,S-BLRc组的NDD改善量为(6.25±6.20)PD,BLRc组为(4.37±5.24)PD,S-BLRc组较BLRc组改善明显,差异有统计学意义(t=-2.42,P=0.018)。术后6个月S-BLRc组的成功率为84.38%(27/32),高于BLRc组53.13%(17/32)。两组患者的术后立体视均改善,未出现旋转斜视,屈光状态、上转25°和下转25°斜视度差值无明显变化。结论S-BLRc可有效降低CI-IXT患者NDD,其手术成功率、NDD的改善均优于BLRc。

ObjectiveTo evaluate the clinical efficacy of slanted bilateral lateral rectus recession(S-BLRc)in the treatment of covergence insufficiency type of intermittent exotropia(CI-IXT).MethodsThis was a retrospective case-control study.The clinical data of 128 eyes of 64 patients with CI-IXT in Anyang Eye Hospital from Jan.2020 to Jan.2023 were collected.They were divided into a S-BLRc group and a BLRc group based on different surgical methods,with 64 eyes of 32 cases in each group.The S-BLRc group underwent S-BLRc.The BLRc group underwent posterior migration of the external rectus muscle of both eyes.The follow-up duration was 6 months.The difference of deviation at distance,deviation at near,near distance deviation difference(NDD),surgical success rate,stereoscopic vision,refractive state,the difference of strabismus between 25°up rotation and 25°down rotation were compared between the two groups before and 6 months after surgery.ResultsIn the S-BLRc group,distal strabismus degree[(-2.84±3.32)prism degree(PD)],proximal strabismus degree[(-7.32±7.81)PD]and the degree of NDD[(5.07±5.91)PD]at 6 months after surgery were significantly higher than those before surgery[(-27.53±7.51)PD,(-38.84±8.85)PD and(11.37±3.82)PD(t=31.41,44.78,10.31;all P<0.01)]at 6 months after surgery.In the BLRc group,distal strabismus degree[(-2.62±3.43)PD],proximal strabismus degree[(-9.26±5.95)PD]and the degree of NDD[(6.81±7.33)PD]at 6 months after surgery were significantly higher than those before surgery[(-26.45±8.61)PD,(-37.75±7.80)PD and(11.12±3.94)PD(t=30.29,42.10,7.20;all P<0.01)].There were no significant differences in preoperative deviation at near,distance and NDD between the two groups(t=-1.43,-1.58,-0.89;P=0.157,0.112,0.376).At 6 months after surgery,there was no significant difference between the S-BLRc group and the BLRc group(t=0.30,P=0.763).The near-strabismus and NDD values of the S-BLRc group were lower than those of the BLRc group,and the differences were statistically significant(t=-2.86,2.60;P=0.006,0.011).At 6 months after surgery,the improvement of NDD was(6.25±6.20)PD in the S-BLRc group and(4.37±5.24)PD in the BLRc group,and the improvement in the S-BLRc group was significantly higher than that in the BLRc group,with statistical significance(t=-2.42,P=0.018).At 6 months after surgery,the positive position rate of the S-BLRc group was 84.38%(27/32),which was higher than the 53.13%(17/32)of the BLRc group.The stereoscopic vision of both groups improved after surgery,and there was no rotational strabismus or dioptric state,and the difference of strabismus between 25°up rotation and 25°down rotation did not change significantly.ConclusionS-BLRc can effectively reduce the distance deviation of patients with CI-IXT,and the surgical success rate and NDD improvement are better than those resulted from BLRc.