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内直肌后徙术治疗分开不足型内斜视的疗效观察

The Surgical Effects of Medial Rectus Recession on Divergence Insufficiency Esotropia

    摘要
  • 摘要:
      目的   研究内直肌后徙术对分开不足型内斜视的治疗效果。
      方法   回顾性研究2017年12月−2020年6月于上海交通大学医学院附属新华医院行内直肌后徙术的9例分开不足型内斜视患者资料，随访至少1年，观察患者术后视近、视远斜视角及视功能。
      结果   9例患者平均年龄28. 8岁（10～49岁），其中18岁以下青少年患者有3例。9例患者术前视近斜视角为（+19.8±13.2） PD，视远斜视角为（+32.6±15.3） PD，术后1年视近斜视角为（−0.2±3.5） PD，视远斜视角为（+5.8±5.6） PD，均较术前显著改善（P=0.012，P=0.007）。 术前视近视远斜视角度差为（12.8±2.4） PD，术后1年为（6.0±2.2） PD，有明显改善（P=0.008），回退不明显（F=0.075，P=0.900）。患者术后近立体视改善不明显（P=0.306），视远双眼单视功能改善，差异有统计学意义（Worth4点灯P=0.017；Bagolini线状镜P=0.035）。根据患者年龄分为青少年组（≤18周岁，n=3）及成年组（>18周岁，n=6），青少年组术前的球面屈光度平均值（右眼−1.75 D，左眼−1.92 D）较成年组（右眼−6.17 D，左眼−6.04 D）低（P=0.012）。术前调节性集合与调节的比值（AC/A）的平均值青少年组为4.33；成年组平均值为2.33，低于正常值，且较青少年组降低（P=0.12）。青少年组与成年组手术前后视近视远斜视角及其差值差异均无统计学意义。
      结论   内直肌后徙术能够改善分开不足型内斜视的视近视远斜视角度差及视远双眼单视功能，视近斜视角及视远斜视角易回退，因此应加大手术量。

     

    Abstract:
      Objective   To study the surgical effects of medial rectus recession (MRR) on divergence insufficiency esotropia (DIE).
      Methods   Nine DIE patients who were admitted to and had MRR at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University between December 2017 and June 2020 were included in this retrospective study. All patients were followed up for 1 year at least. The postoperative esodeviation, near-distant disparity (NDD) and visual function were observed and compared.
      Results   The mean age of the 9 patients was 28.8 years old (10-49 yr.), including 3 adolescent patients (≤18 yr.). The mean preoperative esodeviation was (19.8±13.2) PD for near and (32.6±15.3) PD at distance, while, the mean postoperative esodeviation 1 year after MMR was (−0.2±3.5) PD for near and (6.0±2.2) PD at distance, showing significant improvement over the mean preoperative esodeviation (P=0.012, P=0.007). NDD dropped from (12.8±2.4) PD before the surgery to (6.0±2.2) PD 1 year after the surgery, showing significant improvement (P=0.008), and remained stable 1 year after the surgery (F=0.075, P=0.900). There was no significant improvement of near stereopsis (P=0.306). Binocular function at distance was significantly improved after surgery (Worth 4 dots test : P=0.017; Bagolini striated glasses: P=0.035). The patients were divided into two groups, the adolescent group (age≤18 yr., n=3) and the adult group (age>18 yr.,n=6). Prior to the operation, the mean spherical diopter of the adolescent group (OD −1.75 D, OS −1.92 D) was lower than that of the adult group (OD −6.17 D, OS −6.04 D) (P=0.012). The average value of preoperative AC/A of the adolescent group was 4.33. It was 2.33 in the adult group, which was lower than the normal value, and significantly lower than that of the adolescent group (P=0.12). There was no significant difference in esodeviation or NDD between the adolescent group and the adult group before and after operation.
      Conclusions   Medial rectus muscle recession can effectively improve the NDD and the binocular function at distance of patients with divergence insufficiency esotropia. Postoperative esodeviations both for near and at distance tend to regress after the surgery. Therefore, it is recommended that the amount of MRR be increased in the treatment of DIE.

     

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