發(fā)布時間：2018-04-26 22:24

  本文選題：外斜視 + 斜視手術��； 參考：《山東大學》2011年碩士論文

【摘要】：研究背景和目的：間歇性外斜視是兒通最常見的外斜視類型。在間歇性外斜視發(fā)生的初期,患兒大部分時間可以控制外斜視,但是通常隨著年齡增長,間歇性外斜視患兒的斜視頻度增加、時間延長、斜視度增加,需要實施手術矯正眼位。間歇性外斜視的傳統(tǒng)手術方式主要包括雙眼外直肌對稱性后徙術或單眼外直肌后徙聯(lián)合內直肌截除術。一般認為,應用雙眼外直肌后徙術治療間歇性外斜視,術后早期眼位過矯有利于遠期眼位正位,但由于在兒童期其視知覺系統(tǒng)發(fā)育尚未成熟,如果術后持續(xù)過矯產生小度數(shù)的續(xù)發(fā)性內斜視,則可能會形成弱視、喪失正常的立體視覺。近年來已有應用單眼外直肌后徙術治療間歇性外斜視的文獻報告,但是對這一術式的臨床應用尚存在爭議,主要顧慮為該術式可能會造成術后眼球運動的非共同性。本文旨在探討單眼外直肌后徙術對中、小度數(shù)兒童間歇性外斜視的長期療效。 方法：回顧性病例系列研究。2009年4月至2010年3月期間,于我院行單眼外直肌后徙術治療、斜視度為15-35PD的間歇性外斜視兒童69例。所有病例術前均行視力、屈光狀態(tài)、眼球運動及眼科常規(guī)檢查。斜視度測量采用三棱鏡加交替遮蓋法,測定患兒戴鏡注視6m視標時第一眼位及左、右側向注視(25。)的斜視度和注視33cm視標時第一眼位的斜視度。采用手電筒式Worth四點燈檢查患兒中心融合(距離2m)和周邊融合(距離33cm)功能,采用Titmus立體視圖測定患兒立體視銳度。根據(jù)看遠斜視度定量行7～10mm單眼外直肌后徙術,所有手術均由同一醫(yī)生完成。隨訪時間≥6月。療效評價標準以眼位一8-0PD為正位；第一眼位與側向注視的斜視度相差≥10 PD為眼位非共同性陽性。 結果：(1)術后1-3天和≥6月隨訪正位率分別為81.2%和62.3%,欠矯率為11.6%和36.2%,過矯率為7.2%和1.5%。手術年齡、術前等效球鏡屈光度與術后遠期眼位正位無相關性(P=0.159；P=0.174)；術后遠期眼位正位與術前斜視度有相關性(P=0.006,r=-0.328)。(2)術前與術后遠期隨訪比較,具有正常中心融合和周邊融合者的差異有統(tǒng)計學意義(χ2=21.9,P=0.00;χ2=14.0,P=0.00)；具有正常立體視者的差異有統(tǒng)計學意義(χ2=15.0,P=0.00)。一部分患兒行單眼外直肌后徙術后雙眼單視功能較術前得到了明顯改善。(3)69例中,術后1-3天眼位非共同性陽性者6例,發(fā)生率為13.0%。術后遠期隨訪未發(fā)現(xiàn)眼位非共同性陽性者。 結論：(1)對斜視度為15-35PD的間歇性外斜視患兒行單眼外直肌后徙術,術后1-3天和≥6月隨訪的眼位正位率分別為81.2%和62.3%；(2)單眼外直肌后徙術改善了間歇性外斜視患兒的融合功能及立體視功能,促進了雙眼單視功能的恢復；(3)單眼外直肌后徙術后遠期,患兒無眼球運動的非共同性。因此,單眼外直肌后徙術是治療斜視度為15-35PD的兒童間歇性外斜視的安全、有效術式。
[Abstract]:Background and objective: intermittent exotropia is the most common type of exotropia. In the early stage of intermittent exotropia, most of the time, the children can control exotropia, but usually with the increase of age, the frequency of strabismus increases, the time prolongs, the strabismus increases, and surgery is needed to correct the eye position. The traditional surgical methods of intermittent exotropia include bilateral rectus symmetric recession or unilateral rectus recession combined with internal rectus amputation. It is generally believed that the treatment of intermittent exotropia with bilateral rectus rectus recession is beneficial to long-term orthotropia in the early postoperative period, but the visual perception system is not mature in childhood. If continuous overcorrection produces small degrees of recurrent esotropia, amblyopia may result and normal stereoscopic vision may be lost. In recent years, there have been reports on the treatment of intermittent exotropia with unilateral rectus surgery. However, the clinical application of this procedure is still controversial, and the main concern is that it may lead to the non-concomitant of postoperative eye movements. The purpose of this study was to investigate the long-term effect of single-eye rectus rectus recession on intermittent exotropia in children with middle and small degrees. Methods: from April 2009 to March 2010, 69 cases of intermittent exotropia with 15-35PD were treated with unilateral rectus muscle recession in our hospital. All patients underwent preoperative visual acuity, refraction, eye movement and routine ophthalmic examination. The strabismus was measured by prism and alternating shading. The first eye position, left and right fixation were 25. Strabismus and the squint of the first eye position when looking at the 33cm visual scale. The functions of central fusion (distance 2 m) and peripheral fusion (distance 33 cm) were examined by flashlight Worth four point lamp. The stereoscopic acuity of children was measured by Titmus stereoscopic view. The unilateral rectus muscle recession of 7~10mm was performed quantitatively according to the degree of far strabismus. All the operations were performed by the same doctor. The follow-up time was more than 6 months. The standard of evaluation of curative effect was eye position-8-0PD, and the difference of strabismus between the first eye position and lateral fixation was 鈮，

本文編號：1807958