急性获得性共同性内斜视的临床分析及手术探讨

Clinical analysis and surgical exploration of acute acquired concomitant esotropia

目的探讨急性获得性共同性内斜视的临床特征、病因及手术治疗的方式与效果。方法回顾性病例研究。收集2019年5月至2023年3月在合肥普瑞眼科医院由同一主刀医生手术治疗的59例急性获得性共同性内斜视患者,对其眼部全面检查、新斯的明试验、排除外伤史、弱视治疗遮盖史,CT或MRI检查排除头颅及眼眶疾病系统分析后,综合看远和看近的斜视度数及主导眼,设计全矫手术方案,观察其手术治疗前后复视情况、眼位、眼球运动,同视机及Titmus图检查双眼同时视和立体视功能。结果59例患者经手术治疗:看远及看近无显斜,复视像均消失,眼球运动均正常,三棱镜+马氏杆检查:隐斜度数≤±10 PD(术后第1天:56例,术后1个月:53例,术后6个月:53例),+10 PD~+15 PD(术后第1天:3例,术后1个月:6例,术后6个月:6例);术前无同时视的患者均恢复同时视功能,所有患者立体视均比治疗前明显改善,随访6个月无1例斜视复发、未再出现复视。结论急性获得性共同性内斜视多发生在近视患者,且与近距离过度用眼有关,病程超过6个月的患者尽早实行手术治疗,术前充分评估斜视度、手术设计量要足,术毕效果达到近眼位外隐斜、远眼位内隐斜较好,术后患者复视消失,并恢复双眼视功能,达到满意疗效。

Objective To investigate the clinical features,etiology,and surgical treatment of acute acquired concomitant esotropia.Methods A retrospective study was conducted to collect 59 patients with acute acquired concomitant esotropia who underwent surgical treatment by the same chief surgeon at Hefei Bright Eye Hospital from May 2019 to March 2023.After a systematic analysis of the ophthalmic examination,neostigmine test,exclusion of history of trauma,amblyopia treatment cover up,and exclusion of cranial and orbital diseases in computed tomography(CT)or magnetic resonance imaging(MRI),according to the degree of strabismus in both far and near views and the dominant eye,the total correction was designed and the diplopia,eye position and eye movement were observed before and after the operation,the binocular simultaneous vision and stereoscopic vision were examined with synoptophore and Titmus.Results 59 cases were treated by operation:no strabismus in both distant and near vision,no diplopia and normal eye movement,prism+Markov Rod Examination:the degree of slant≤±10 PD(at the first day after the operation:56 cases,at the first month after the operation:53 cases,at the sixth months after the operation:53 cases),+10 PD~+15 PD(3 cases at the first day after the operation,6 cases at the first month after the operation,6 cases at the sixth months after the operation),during 6 months follow-up,no strabismus recurred and no diplopia occurred.Conclusions Acute acquired concomitant esotropia mostly occurs in myopic patients,and it is related to excessive use of eyes at short distance.Patients whose course of disease is more than 6 months should be operated on as soon as possible.The preoperative evaluation of strabismus and the design of the operation should be sufficient,and the effect of the end of the operation should be close to the eyes with external and far eyes with internal strabismus.After the operation,the diplopia disappeared and the binocular visual function was restored to a satisfactory effect.