间歇性外斜视手术71例临床分析

Influent factors on the long-term postoperative efficiency of intermittent exotropia

目的 :探讨间歇性外斜视的手术时机和疗效。方法 :对 71例手术治疗的间歇性外斜视患者 ,按年龄、术式、斜视类型、融合功能、非自主性辐辏功能强弱分组进行研究并观察疗效。结果 :71例随访平均 2 8(1～ 10 )a。眼位 :正位 5 7例 (80 % ) ,外斜 9例 (13 % ) ,内斜 5例 (7% ) ;眼位正位率与年龄、术式、斜视类型均无相关性 (P >0 0 5 ) ,而与术前融合功能的有无和非自主性辐辏功能强弱有关 (P <0 0 5 ) ;非自主性辐辏功能较差或术前无融合功能者眼位的回退率高 (P <0 0 5 ) ;同视机检查双眼视功能 :年龄越小 ,立体视功能恢复率越高 (P <0 0 1) ;A -V征全部消失。结论 :间歇性外斜视术前融合功能的有无和非自主性辐辏功能强弱对术后眼位有较大影响 ,早期手术有利于双眼视功能的恢复。

Objective:To discuss the factors that influences the long-term postoperative effects of the patients with intermittent exotropia. Methods:71 postoperative patients with intermittent exotropia were categorized according to the ages,types of operation,types of strabismus,presence of fusion and amplitude of involuntary convergence before operation.Curative effect of these groups was compared.Cases were followed up from 1 years to 10 years,average 2 8 years. Results:Their postoperative eye positions were orthophoria in 57 cases (80%),exotropia in 9 cases (13%) and esotropia in 5 cases (7%).The orthophoric rate did not correlate with ages,types of operation,types of strabismus (P>0 05),but with preoperative presence of fusion and amplitude of involuntary convergence (P<0 05).The under-correction rate of the patients who had not fusion function and had insufficiency in voluntary convergence before operation was higher (P<0 05).The over-correction rate was not related to these factors.The younger the patients′ mean age was,the higher the recovery rate of the stereoscopic vision was (P<0 01).A-V syndrome all disappeared. Conclusions:The preoperative presence of fusion and amplitude of involuntary convergence of the patients with intermittent exotropia have quite an effect on their postoperative eye positions.Operation earlier is in favor of the recovery of binocular vision.