双眼外直肌倾斜后徙术治疗儿童集合不足型外斜视

doi:10.3760/cma.j.cn115909-20210510-00190

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摘要目的：评价双眼外直肌倾斜后徙术（S-BLRc）治疗儿童集合不足型间歇性外斜视（CI-IXT）的有效性和安全性。方法：回顾性病例对照研究。收集2019年8月至2020年7月于天津市眼科医院收治的集合不足型外斜视儿童患者58例，年龄4～10岁。根据S-BLRc外直肌上、下缘止点后徙量的差异分为 3组：A组（1 mm，22例）、B组（1.5 mm，18例）和C组（2 mm，18例）。比较各组术前和术后6个月时的看近、看远斜视度，近远斜视度差（NDD），眼底客观旋转角，上转和下转25°时斜视度差，调节性集合与调节比值（AC/A），立体视及手术成功率，屈光状态。手术成功的标准：看近、看远的斜视度，外斜视<-8△，内斜视<+5△；NDD<5△。术前和术后数据采用配对t检验进行比较。组间数据采用单因素方差分析进行比较。立体视觉和手术成功率采用Fisher精确检验法分析。结果：术后6个月，看近、远的斜视度分别由-37.1△±4.2△、-25.8△±3.7△下降至-1.4△±4.6△、-0.1△±4.1△，手术前后的差异具有统计学意义（t=45.72，P<0.001；t=32.54，P<0.001）。各组术后NDD（A组1.8△±1.9△，B组 0.8△±2.1△，C组0.9△±2.5△ ）均较术前（A组10.0△±0△，B组11.2△±1.5△，C组13.3△±2.2△ ）显著降低，手术前后差异具有统计学意义（t=20.3，P<0.001；t=17.2，P<0.001；t=13.6，P<0.001）；NDD平均改善量分别为8.2△±1.9△、10.3△±2.5△、12.4△±3.9△，3组间差异有统计学意义（F=10.80，P<0.001）。纳入的患者术前AC/A均值为（1.55±0.73）△/D，术后AC/A均值为（1.53±0.74）△/D，术前术后比较差异没有统计学意义。所有患者术后立体视觉均有不同程度的改善。术后无旋转性复视、A-V型斜视。手术前后各组间的球镜度、散光轴位比较差异无统计学意义，而右眼和左眼散光度在术后6个月随访时与术前比较差异有统计学意义（t=5.06，P<0.001；t=5.32，P<0.001）。术后6～9个月随访时的手术成功率为89.7%，3组的成功率比较差异无统计学意义。结论：S-BLRc是治疗儿童CI-IXT的一种安全有效的手术矫正方法，有效矫正看近、看远外斜视，降低NDD，有利于双眼视觉改善。NDD的改善量与外直肌上、下缘的倾斜量有关。

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关键词 ： , 间歇性外斜视, 集合不足, 外直肌斜形后退手术, 远近斜视度差

Abstract： Objective: To investigate the efficacy and safety of slanted bilateral lateral rectus recession (S-BLRc) for the treatment of convergence insufficiency-type intermittent exotropia (CI-IXT) in children. Methods: This was a retrospective case-control study. Fifty-eight patients with CI-IXT, aged 4 to 10 years old, underwent S-BLRc procedures. All the patients were grouped based on the different slanted amounts between the upper and lower poles of the lateral rectus: Group A (1 mm, n=22), group B (1.5 mm, n=18), and group C (2 mm, n=18). The preoperative and postoperative data included deviations both at near and at distance, the near-distance difference (NDD), objective torsion, horizontal deviation at up and down gaze, binocular vision, surgical success rate and refractive errors among the three groups and were analyzed and compared. The successful surgical outcome was defined as deviation ranging from exotropia <-8△ to esotropia <5△ both at near and distance as well as the NDD<5△. The preoperative and postoperative data were compared using a paired t-test. The data among the three groups were compared using one-way ANOVA. The improvement in stereopsis and surgical success rates among the three groups were analyzed using a Fisher's exact test. Results: The average deviations significantly decreased from -37.1△±4.2△ (exotropia) to -1.4△±4.6△ at near and from -25.8△±3.7△ to -0.1△±4.1△ at distance (t=45.72, P<0.001; t=32.54, P<0.001). The NDD was significantly reduced from 10.0△±0△ to 1.8△±1.9△ in Group A, from 11.2△±1.5△ to 0.8△±2.1△ in Group B and from 13.3△±2.2△ to 0.9△±2.5△ in Group C (t=20.30, P<0.001; t=17.24, P<0.001; t=13.64, P<0.001). There were significant differences in the mean corrections of NDD among the three groups (8.2△±1.9△, 10.3△±2.5△, 12.4△±3.9△, respectively) (F=10.80, P<0.001). There was no significant difference in the AC/A ratios before and after the operation. All patients obtained various improvements in stereopsis after surgery. There was no significant difference in the spherical refractive error and the axis of astigmatism between the groups before and after the operation. At 6 months after surgery, the differences in astigmatism between before and after operation were still remarkable (t=5.06 in the right eye, 5.32 in the left eye; both P<0.001). None had torsional diplopia or A-V pattern. The surgical success rate was 89.7% in our study and there was no significant difference in success rates among the three groups. Conclusions: S-BLRc is an effective and safe procedure for the treatment of CI-IXT in children. S-BLRc can successfully collapse exotropia at distance and at near and NDD and the benefit is a gain in binocular vision. The correction of NDD is associated with the degree of the slant.

Key words： inermittent exotropia convergence insufficiency slanted bilateral rectus recession near distance difference

收稿日期: 2021-05-10

PACS:

基金资助: 天津市卫生健康委员会科技项目（ZC20187）；天津市眼科医院科技基金资助面上项目（YKZD2001）

通讯作者: 李月平（ORCID：0000-0002-2430-4565），Email：leeyueping@aliyun.com

引用本文:

林惠玉1 李月平2 要青清3 曲艳青4. 双眼外直肌倾斜后徙术治疗儿童集合不足型外斜视[J]. 中华眼视光学与视觉科学杂志, 2021, 23(9): 675-681. Huiyu Lin1,Yueping Li2,Qingqing Yao3,Yanqing Qu4. Slanted Recession on the Bilateral Lateral Rectus for the Treatment of Intermittent Exotropia with Convergence Insufficiency. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(9): 675-681. DOI: 10.3760/cma.j.cn115909-20210510-00190

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20210510-00190 或 https://www.cjoovs.com/CN/Y2021/V23/I9/675

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