External or internal ophthalmoloplegia will result in a complete or a partial ocular dysmotility leading to a debilitating and variable manifest binocular diplopia for a majority of the patients. Complete third, forth...External or internal ophthalmoloplegia will result in a complete or a partial ocular dysmotility leading to a debilitating and variable manifest binocular diplopia for a majority of the patients. Complete third, forth and sixth nerve cranial nerve palsies are among the many number of etiologies appearing as paralytic strabismus. Successful clinical management, elimination of symptomatic diplopia in the primary field of gaze and increased binocular field of motor and sensory fusion as a result of the oculomotor nerve (III) palsy are challenging tasks for physicians facing this difficult clinical entity. Here we report a novel surgical technique in the clinical management of this disease through suture-fixation of medial rectus muscle onto Titanium plate (T-plate) already anchored into the nasal orbital wall.展开更多
BACKGROUND An unusual case of acute acquired concomitant esotropia(AACE)with congenital paralytic strabismus in the right eye is reported.CASE SUMMARY A 23-year-old woman presented with complaints of binocular diplopi...BACKGROUND An unusual case of acute acquired concomitant esotropia(AACE)with congenital paralytic strabismus in the right eye is reported.CASE SUMMARY A 23-year-old woman presented with complaints of binocular diplopia and esotropia of the right eye lasting 4 years and head tilt to the left since 1 year after birth.The Bielschowsky head tilt test showed right hypertropia on a right head tilt.She did not report any other intracranial pathology.A diagnosis of AACE and right congenital paralytic strabismus was made.Then,she underwent medial rectus muscle recession and lateral rectus muscle resection combined with inferior oblique muscle myectomy in the right eye.One day after surgery,the patient reported that she had no diplopia at either distance or near fixation and was found to be orthophoric in the primary position;furthermore,her head posture immediately and markedly improved.CONCLUSION In future clinical work,in cases of AACE combined with other types of strabismus,we can perform conventional single surgery for both at the same time,and the two types of strabismus can be solved simultaneously.展开更多
AIM: To investigate a new, safe and effective injection method for strabismus patients. Botulinum toxin type A (BTXA) was injected by pulling the extraocular muscles with a minimally-invasive technique into the ocular...AIM: To investigate a new, safe and effective injection method for strabismus patients. Botulinum toxin type A (BTXA) was injected by pulling the extraocular muscles with a minimally-invasive technique into the ocular surface, and it was ensured that the extraocular muscles was maintained in the suspended state. METHODS: A total of 32 patients with different types of strabismus were treated at our institution from February to October 2010. A small conjunctival incision (<= 2mm) was made under a microscope. The extraocular muscles were pulled out with a hook to ensure an elevated position compared with the wall of eyeball. The muscle fiber was clearly seen through the conjunctiva and BTXA was injected at a small angle under the microscope. The deviation angles before and after the injection were recorded. All patients were followed up at 5 and 30 days after the operation. Recovery was defined as abolition of diplopia in straight-ahead gaze and anteroinferior gaze and the symptoms of giddiness disappeared thoroughly. Eyeball position was Essentially normal. Improvement was defined as basic disappearance of diplopia in straight-ahead gaze and anteroinferior gaze; restriction of action of paralytic muscle improved. If most of the symptoms and signs still existed and disturbed normal work and life, the treatment was determined to be invalid. The injection dose for patients of 5 to 10 prism diopter (PD), 11 to 20PD, and >= 21PD was 1u, 3u and 4u to 5u, respectively. RESULTS: Of the 32 treated patients, 11 (34.4%) were cured, and 18 (56.3%) were improved at 5 days after the operation; 12 (40%) were cured, and 15 (46.9%) were improved at 30 days. Five patients (15.6%) who had unsatisfactory response after BTXA injection at 30 days received repeated injections or underwent strabismus surgery. Ptosis was present in 2.5% of the injected eyes. No retrobulbar hemorrhage or ocular perforation was found in any eye. CONCLUSION: It is safe and efficient to inject BTXA by pulling extraocular muscles with a minimally-invasive technique under the microscope to make the muscles separated from the wall of eyeball.展开更多
目的探讨在麻痹肌肌腹下行眶-球硅管连接术与肌腹下注射A型肉毒素治疗麻痹性斜视的疗效对比。方法收集36例(36眼)斜视患者,根据治疗方法不同分为两组,A组行肌腹下眶-球硅管连接术,B组行A型肉毒素眼外肌注射治疗,每组各18例(18眼)。记录...目的探讨在麻痹肌肌腹下行眶-球硅管连接术与肌腹下注射A型肉毒素治疗麻痹性斜视的疗效对比。方法收集36例(36眼)斜视患者,根据治疗方法不同分为两组,A组行肌腹下眶-球硅管连接术,B组行A型肉毒素眼外肌注射治疗,每组各18例(18眼)。记录术后1周与6 a时两组患者的临床效果、角膜散光、视功能及屈光度变化等情况。结果 A组患者术后均达到美容性眼位矫正;12例(66.7%)达到功能性眼位矫正;治疗1周后角膜前表面屈光度、散光值及散光轴向与治疗前相比明显增加,治疗6 a后角膜前表面屈光度、散光值及散光轴向基本恢复至术前水平;A组术后1周8例患者存在双眼视功能,随访6 a 14例存在双眼视功能。B组患者术后12例(66.7%)达到美容性眼位矫正;达到功能性眼位矫正者9例(50.0%);治疗1周后及随访6 a角膜前表面屈光度、散光值及散光轴向与治疗前相比差异均无统计学意义(均为P>0.05);B组术后1周6例患者存在双眼视功能,随访6 a 7例存在双眼视功能;两组治疗后1周近视度数相比差异无统计学意义(P>0.05),随访6 a,A组近视度数为(-3.52±2.82)D,B组为(-5.78±3.42)D,A组明显低于B组(P<0.05)。结论肌腹下眶-球硅管连接术与肌腹下注射A型肉毒素相比,在临床效果、角膜散光、视功能方面均有明显差异,眶-球硅管连接术是治疗麻痹性斜视的可行方法,值得推广。展开更多
文摘External or internal ophthalmoloplegia will result in a complete or a partial ocular dysmotility leading to a debilitating and variable manifest binocular diplopia for a majority of the patients. Complete third, forth and sixth nerve cranial nerve palsies are among the many number of etiologies appearing as paralytic strabismus. Successful clinical management, elimination of symptomatic diplopia in the primary field of gaze and increased binocular field of motor and sensory fusion as a result of the oculomotor nerve (III) palsy are challenging tasks for physicians facing this difficult clinical entity. Here we report a novel surgical technique in the clinical management of this disease through suture-fixation of medial rectus muscle onto Titanium plate (T-plate) already anchored into the nasal orbital wall.
基金Supported by Science and Technology Project of Education Department of Jilin Province during the“13th Five-Year Plan”,No.JJKH20180217KJNatural Science Foundation of Jilin Province,No.20200201530JC.
文摘BACKGROUND An unusual case of acute acquired concomitant esotropia(AACE)with congenital paralytic strabismus in the right eye is reported.CASE SUMMARY A 23-year-old woman presented with complaints of binocular diplopia and esotropia of the right eye lasting 4 years and head tilt to the left since 1 year after birth.The Bielschowsky head tilt test showed right hypertropia on a right head tilt.She did not report any other intracranial pathology.A diagnosis of AACE and right congenital paralytic strabismus was made.Then,she underwent medial rectus muscle recession and lateral rectus muscle resection combined with inferior oblique muscle myectomy in the right eye.One day after surgery,the patient reported that she had no diplopia at either distance or near fixation and was found to be orthophoric in the primary position;furthermore,her head posture immediately and markedly improved.CONCLUSION In future clinical work,in cases of AACE combined with other types of strabismus,we can perform conventional single surgery for both at the same time,and the two types of strabismus can be solved simultaneously.
文摘AIM: To investigate a new, safe and effective injection method for strabismus patients. Botulinum toxin type A (BTXA) was injected by pulling the extraocular muscles with a minimally-invasive technique into the ocular surface, and it was ensured that the extraocular muscles was maintained in the suspended state. METHODS: A total of 32 patients with different types of strabismus were treated at our institution from February to October 2010. A small conjunctival incision (<= 2mm) was made under a microscope. The extraocular muscles were pulled out with a hook to ensure an elevated position compared with the wall of eyeball. The muscle fiber was clearly seen through the conjunctiva and BTXA was injected at a small angle under the microscope. The deviation angles before and after the injection were recorded. All patients were followed up at 5 and 30 days after the operation. Recovery was defined as abolition of diplopia in straight-ahead gaze and anteroinferior gaze and the symptoms of giddiness disappeared thoroughly. Eyeball position was Essentially normal. Improvement was defined as basic disappearance of diplopia in straight-ahead gaze and anteroinferior gaze; restriction of action of paralytic muscle improved. If most of the symptoms and signs still existed and disturbed normal work and life, the treatment was determined to be invalid. The injection dose for patients of 5 to 10 prism diopter (PD), 11 to 20PD, and >= 21PD was 1u, 3u and 4u to 5u, respectively. RESULTS: Of the 32 treated patients, 11 (34.4%) were cured, and 18 (56.3%) were improved at 5 days after the operation; 12 (40%) were cured, and 15 (46.9%) were improved at 30 days. Five patients (15.6%) who had unsatisfactory response after BTXA injection at 30 days received repeated injections or underwent strabismus surgery. Ptosis was present in 2.5% of the injected eyes. No retrobulbar hemorrhage or ocular perforation was found in any eye. CONCLUSION: It is safe and efficient to inject BTXA by pulling extraocular muscles with a minimally-invasive technique under the microscope to make the muscles separated from the wall of eyeball.
文摘目的探讨在麻痹肌肌腹下行眶-球硅管连接术与肌腹下注射A型肉毒素治疗麻痹性斜视的疗效对比。方法收集36例(36眼)斜视患者,根据治疗方法不同分为两组,A组行肌腹下眶-球硅管连接术,B组行A型肉毒素眼外肌注射治疗,每组各18例(18眼)。记录术后1周与6 a时两组患者的临床效果、角膜散光、视功能及屈光度变化等情况。结果 A组患者术后均达到美容性眼位矫正;12例(66.7%)达到功能性眼位矫正;治疗1周后角膜前表面屈光度、散光值及散光轴向与治疗前相比明显增加,治疗6 a后角膜前表面屈光度、散光值及散光轴向基本恢复至术前水平;A组术后1周8例患者存在双眼视功能,随访6 a 14例存在双眼视功能。B组患者术后12例(66.7%)达到美容性眼位矫正;达到功能性眼位矫正者9例(50.0%);治疗1周后及随访6 a角膜前表面屈光度、散光值及散光轴向与治疗前相比差异均无统计学意义(均为P>0.05);B组术后1周6例患者存在双眼视功能,随访6 a 7例存在双眼视功能;两组治疗后1周近视度数相比差异无统计学意义(P>0.05),随访6 a,A组近视度数为(-3.52±2.82)D,B组为(-5.78±3.42)D,A组明显低于B组(P<0.05)。结论肌腹下眶-球硅管连接术与肌腹下注射A型肉毒素相比,在临床效果、角膜散光、视功能方面均有明显差异,眶-球硅管连接术是治疗麻痹性斜视的可行方法,值得推广。
