外直肌和上直肌部分联结术治疗常规手术无效的高度近视眼限制性内下斜视

Reoperation of Highly Myopic Strabismus by Surgical Procedure Joining the Lateral Rectus and Superior Rectus Muscles

目的探讨应用外直肌和上直肌部分联结术治疗常规手术无效的高度近视眼限制性内下斜视的效果。方法收集2012年9月至2017年12月因常规退缩手术治疗无效到厦门大学附属厦门眼科中心再次行斜视矫正手术的高度近视眼限制性内下斜视患者5例(8只眼),男性2例(4只眼),女性3例(4只眼);年龄52.0～73.0岁,平均(61.2±2.4)岁。手术前后,全部患者均进行视力、验光、裂隙灯显微镜、眼底、眼球运动、斜视角、眼轴长度及眼眶冠状位和水平位计算机X射线断层扫描(CT)检查。采用外直肌和上直肌部分联结术进行治疗。结果全部患者5例(8只眼)患眼处于内下斜位,外转和上转功能受限; CT显示所有患眼存在上直肌向鼻侧移位、外直肌向下方移位、眼球后部向颞上方疝出肌圆锥。2例双眼(4只眼)行外直肌和上直肌部分联结术,1例双眼(2只眼)行外直肌和上直肌部分联结术联合内直肌后徙悬吊术,2例单眼(2只眼)行外直肌和上直肌部分联结术。患者随访超过6个月时,4例(6只眼)患者术后第一眼位正位,1例(2只眼)患者术后远期第一眼位为-15°,CT显示脱位的眼球被还纳回肌圆锥内,眼球的外转和上转功能逐渐恢复。所有患者未出现复视。无并发症发生。结论外直肌和上直肌部分联结术可有效矫正经常规退缩手术治疗无效的高度近视眼限制性内下斜视,还纳脱出的眼球至肌圆锥内,并改善眼球运动功能。

Objective To evaluate the effect of surgical procedure joining the lateral rectus andsuperior rectus muscles in the reoperation of highly myopic strabismus who failed to conventional surgery.Methods From September 2012 to December 2017,5 patients(8 eyes),2 males(4 eyes) and 3 females(4 eyes),aged 52.0-73.0 years,with an average of(61.2±2.4) with high myopia restricted esotropia whohad undergone strabismus correction again at Xiamen Ophthalmological Center affiliated to Xiamen Universitydue to ineffective conventional retraction surgery were collected. Year old. Before and after surgery,allpatients underwent visual acuity,refraction,slit lamp microscopy,fundus,eye movement,oblique angle,axial length,coronal and horizontal computed tomography(CT) examination. Partial ligation of lateral rectusand superior rectus was performed. Results 5 cases(8 eyes) were in the inferior oblique position withlimited external and upward rotation. CT showed that the superior rectus muscle shifted to the nasal side,thelateral rectus muscle moved downward,and the posterior part of the eyeball herniated to the superior temporalmuscle cone. 2 cases(4 eyes) underwent partial ligation of lateral rectus and superior rectus,1 case(2 eyes) underwent partial ligation of lateral rectus and superior rectus combined with recession suspension ofmedial rectus,and 2 cases(2 eyes) underwent partial ligation of lateral rectus and superior rectus. At thefollow-up of more than 6 months,4 cases(6 eyes) were in the first eye position after operation,and 1 case(2 eyes) had the first eye position of-15°in the long term. CT showed that the dislocated eye was returnedto the conus muscularis,and the function of the external and upward rotation of the eye gradually recovered.No diplopia occurred in all patients. No complications occurred. Conclusions Surgical procedure joining thelateral rectus and superior rectus muscles can effectively correct highly myopic strabismus which is ineffectiveafter conventional surgery. It can also restore the dislocated globe back into the muscle cone and improve thefunction of eye movement.