单眼水平直肌后徙联合缩短术与内直肌斜向缩短术治疗集合不足型外斜视的疗效对比

摘要

目的:比较单眼水平直肌后徙联合缩短手术与内直肌斜向缩短术对集合不足型外斜视的治疗效果.方法:前瞻性研究.对2016年9月到2017年2月在郑州大学第一附属医院就诊的36例集合不足型外斜视患者行手术治疗,随访时间≥6个月.根据手术方式不同分为3组:单眼水平直肌后徙联合缩短手术组(A组,16例)、单眼内直肌斜向缩短术组(B组,9例)和双眼内直肌斜向缩短术组(C组,11例).A组中外直肌按照看远斜视度数后徙,内直肌按照看近斜视度数缩短.B组和C组中内直肌肌止端上端按照看远斜视度数缩短,肌止端下端按照看近斜视度数缩短.术后正位的评价标准为看远斜视度在±10△以内.采用Fisher精确概率检验、重复测量方差分析进行数据分析.结果:随访期末,A组正位占比为14/16例,显著高于B组(2/9例)和C组(4/11例),差异具有统计学意义(均P＜0.05).A组看近和看远斜视度均小于其他2组,差异具有统计学意义(均P＜0.05).3组间手术后看近和看远斜视度的差异无统计学意义.结论:单眼水平直肌后徙联合缩短手术中外直肌按照看远斜视度数后徙,内直肌按照看近斜视度数缩短设计术式,可以有效治疗集合不足型外斜视,优于内直肌斜向缩短手术.%Objective:To compare the surgical efficiency of unilateral recession-resection and slanted medial rectus (MR) resection for convergence insufficient exotropia.Methods:In this prospective study,36 patients with exotropia of convergence insufficiency treated in the ophthalmic center of the First Affiliated Hospital of Zhengzhou University from September 2016 to February 2017.Patients were divided into three groups according to different surgical procedures including unilateral recession-resection (Group A,16 cases),unilateral slanted MR resection (Group B,9 cases),and bilateral slanted MR resection (Group C,11 cases).In Group A,the amount of MR resection was based on the near deviation,and the amount of lateral rectus (LR) recession was based on the distant deviation.In Groups B and C,the upper edge of the MR was resected according to the distant exodeviation,and the lower edge of the MR was resected according to the near exodeviation.Successful outcome was defined as a postoperative residual deviation at a distance of ±10 △.The proportion of postoperative success,the postoperative deviations at near and distant field,and the difference between near and distant field among the three groups were compared.Results:At the final follow-up examination,the proportion of success in Group A (14/16 cases) was significantly higher than in Group B (2/9 cases) and Group C (4/11 cases) (P ＜ 0.05).The mean deviation at near and distant in Group A was significantly lower than in Groups B and C (P ＜ 0.05).There were no significant differences in the near and distant deviation among the three groups.Conclusions:Unilateral recession-resection in which the MR resection is made according to the near deviation and the LR recession according to the distant deviation can successfully treat exotropia of convergence insufficiency better than the slanted MR resection.