婴儿眼球震颤综合征行中间带移位术的临床效果观察

摘要

目的 探讨婴儿眼球震颤综合征(INS)行中间带移位术后相关眼部参数变化特点,为临床术后效果评估及合理安排随访时间提供参考.方法 回顾性系列病例研究.收集2014年6月至2016年12月在上海交通大学医学院附属新华医院眼科诊断为INS并施行中间带移位术的17例患儿的临床及随访资料,手术方式分别为Parks 5-6-7-8、Anderson、Kestenbaum 5-5-6-4、中间带合并斜视矫正及垂直肌中间带移位术.采用单因素重复测量方差分析对患儿术前与术后3、6、12个月双眼最佳矫正视力(BCBVA)、中间带位置、扩大的眼球震颤视功能(NAFX)和中心凹时间进行比较,采用独立样本t检验及秩和检验对术后中间带回退患儿与未回退患儿的BCBVA、NAFX和中心凹时间进行比较.结果 17例患儿中女性6例,男性11例,手术年龄5～11岁,术后随访时间为(14.8±6.0)个月.INS患儿术前头正位、代偿头位BCBVA分别为0.382±0.147、0.300±0.056,中心凹时间为(0.594±0.011)s,中间带位置为23.570°±0.118°;术后3个月头正位、代偿头位BCBVA分别为0.318±0.044、0.260±0.045,中心凹时间为(0.950±0.146)s,中间带位置为5.360°±1.107°;术后6个月头正位、代偿头位BCBVA分别为0.264±0.039、0.230±0.037,中心凹时间为(1.496±0.233)s,中间带位置为6.070°±1.303°;术后12个月头正位、代偿头位BCBVA分别为0.309±0.039、0.250±0.045,中心凹时间为(1.455±0.201)s,中间带位置为9.290°±8.520°;术前与术后上述指标比较差异均有统计学意义(均P＜0.05).6例患者在术后6个月之后出现中间带位置回退.术后中间带回退患儿术前第一眼位、中间带NAFX分别为0.308±0.063、0.393±0.210,术后3个月第一眼位、中间带NAFX分别为0.430±0.090、0.471±0.140,术前头正位、代偿头位BCBVA分别为0.450±0.043、0.417±0.031,术前、术后3个月中心凹时间分别为0.122(0.080～1.014)s、0.438 (0.170～1.450)s,均低于术后中间带无回退患儿[0.523 ±0.142、0.601 ±0.110、0.610±0.160、0.680±0.120、0.200±0.063、0.250±0.076、0.725 (0.230～1.440)s、0.975 (0.380～2.000)s],差异有统计学意义(均P＜0.05).结论 中间带移位术是一种改善INS患者代偿头位、提高视力及中心凹时间的有效方法.术后6个月后会出现部分中间带位置回退,与患者自身的NAFX、BCBVA及中心凹时间有关,随访时间应至少延长至术后6个月.%Objective To characterize the postoperative change of eyes related parameters of patients with infantile nystagmus syndrome(INS),so as to provide a reference for the clinical evaluation of postoperative effect and the rational arrangement of patients' follow-up time after operation.Methods A retrospective study.Clinical and follow-up data of 17 patients diagnosed with INS at Department of Ophthalmology in Xinhua Hospital,School of Medicine,Shanghai Jiaotong University from June 2014 to December 2016 were collected.All patients with abnormal head posture (AHP) underwent null zone shift surgery.The operative methods were Parks 5-6-7-8,Anderson,Kestenbum 5-5-6-4,null zone shift combined with strabismus correction and vertical null zone transposition.Ophthalmological examination and eye movement were recorded,including best corrected binocular visual acuity (BCBVA),position of the null zone,expanded nystagmus acuity function (NAFX) and foveation time.Single factor repeated analysis of variance,independent sample t test and rank sum test were used for statistical analysis.Results Among the 17 children,6 were females and 11 were males.The age at surgery of the patients was 5-11 years.The follow-up time was (14.8±6.0) months.Preoperative BCBVA was 0.382±0.147 (corrected posture),0.300±0.056 (AHP);foveation time was (0.594±0.011)s;position of null zone was 23.570°±0.118°.The BCBVA at three months after operation was 0.318±0.044 (corrected posture),0.260±0.045 (AHP);foveation time was (0.950±0.146)s;position of null zone was 5.360°± 1.107°.The BCBVA at six months after operation was 0.264±0.039 (corrected posture),0.230±0.037 (AHP);foveation time was (1.496±0.233) s;position of nullzone was 6.070°± 1.303°.The BCBVA at twelve months after operation was 0.309±0.039 (corrected posture),0.250±0.045 (AHP);foveation time was (1.455±0.201) s;position of null zone was 9.290°±8.520°.There was statistical difference between the data of pre-operation and post-operation(all P＜0.05).Change of null zone position was identified in six patients after six months.The preoperative NAFX of patients with presence of change of null zone positon was 0.308±0.063 (the primary position),0.393±0.210 (null zone);BCBVA was 0.450 ±0.043 (corrected posture),0.417 ± 0.031 (AHP);foveation time was 0.122 (0.080-1.014)s.The postoperative N AFX of those patients was 0.430± 0.090(the primary position),0.471 ± 0.140 (null zone);foveation time was 0.438(0.170-1.450) s.The data above were lower than that of patients with no regression of null zone[0.523±0.142,0.601±0.110,0.200±0.063,0.250±0.076,0.725(0.230-1.440)s,0.610±0.160,0.680±0.120,0.975(0.380-2.000)s].The difference was statistically significant(all P＜0.05).Conclusions Null zone shifting surgery is an effective approach for treating INS.Reduction in the null zone position can be observed in some patients at 6 months after operation,which was related to NAFX,BCBVA and foveation time.It is recommended to extend the follow-up time to at least 6 months after the operation.