摘要目的 研究单眼外直肌后退联合内直肌缩短术对眼球外转功能的影响. 方法 回顾分析87例2014年6月至2015年8月诊断为共同性外斜视并初次行斜视矫正术并且术后随访时间不少于6个月的患者资料.非手术眼的测量值作为对照组(61眼).将113眼术眼分为4个组:(1)外直肌后退(LR)组(27眼):单条外直肌后徙7 ～8 mm;(2)小量外直肌后徙/内直肌缩短组,简称小量R-R组(24眼):外直肌后徙5 ～～6 mm,内直肌缩短4～5 mm;(3)中量R-R组(29眼):外直肌后徙7～8 mm,内直肌缩短5～6 mm;(4)大量R-R组(33眼)组:外直肌后徙8～10 mm,内直肌缩短7～8 mm.三棱镜交替遮盖测量手术前后的斜视度,数码照片记录手术后的眼球外转位置,计算手术后的眼球运动幅度,弓形视野计测量手术前后的外转单眼注视野.结果 87例患者术后6个月,71例为正位,手术成功率为81.61％,手术失败为16例,失败率为18.39％,其中过矫5例,占5.56％,欠矫11例,占12.64％.数码照相显示,对照组、LR组、小量R-R组、中量R-R组和大量R-R组病例术前平均外转幅度分别为(11.86±1.11)、(12.04±0.68)、(11.58±1.06)、(11.86±0.93)和(12.22±0.60)mm,术后平均外转幅度分别为(11.81±1.03)、(11.81±0.70)、(10.78±1.05)、(10.54±1.07)和(9.90±0.82)mm,术前各组外转幅度差异无统计学意义(F=1.85,P=0.12),术后各组外转幅度差异有统计学意义(F=28.04,P=0.00),组间比较对照组和LR组术后差异无统计学意义(P=0.99),其余各手术组术后外转幅度均减少,差异均有统计学意义(均P=0.00).弓形视野计测得对照组、LR组、小量R-R组、中量R-R组和大量R-R组术前平均单眼外转注视野分别为(50.82±3.30)°、(51.48±2.39)°、(50.13±3.51)°、(51.06±2.90)°和(52.09±2.61)°,术后各组单眼外转注视野分别为(50.52±3.51)°、(50.11±2.36)°、(46.38±3.67)°、(44.00±3.00)°和(41.84±2.46)°,术前各组单眼外转注视野差异无统计学意义(F=1.75,P=0.14),术后各组单眼外转注视野差异有统计学意义(F=55.75,P=0.00),组间比较对照组和LR组术后差异无统计学意义(P=0.57),其余各手术组术后单眼外转注视野都减少. 结论 单眼外直肌后徙联合内直肌缩短术对眼球外转功能会有一定影响,因此,应避免因单眼手术量过大引起术后产生侧方注视的非共同性,从而影响双眼单视功能.

abstractsObjective This study was to identify the surgical procedures associated with changes of lateral eye movement to help inform surgical planning for patients with concomitant exotropia.Methods The medical records of 87 concomitant exotropia surgical procedures that were performed at Henan Eye Hospital from June 2014 to August 2015 were retrospectively reviewed.The deviation angle was measured by prism and alternate cover test.Photographs and arc campimeter was used to obtain changes of abduction and lateral monocular fixation field respectively.Data were compared preoperatively and postoperatively among five groups based on the surgical procedures.The surgical procedures were 0 mm for control group (61 eyes),8 mm unilateral rectus recession for lateral rectus recession (LR) group (27 eyes),5-6 mm recession/4-5 mm resection for small amount recess-resect (R-R) group (24 eyes),7-8 mm recession/5-6 mm resection for medium amount R-R group (29 eyes) and 8-10 mm recession/7-8 mm resection for large amount R-R group (33 eyes).The minimum follow-up period was 6 months.Informed consent was signed from each patient or the guardian.Results The success,overcorrection and undercorrection rate was 81.61％,5.56％ and 12.64％,respectively.Mean preoperative abduction of each group was (11.86± 1.11)mm in the control group,(12.04±0.68)mm in the LR group,(11.58 ± 1.06)mm in the small amount R-R group,(11.86±0.93)mm in the medium amount R-R group and (12.22±0.60)mm in the large amount R-R group.The postoperative mean abduction of each group was (11.81±1.03),(11.81 ±0.70),(10.78±1.05),(10.54±1.07) and (9.90±0.82)mm,respectively.Mean abduction among the five groups was not significantly different preoperatively (F =1.85,P =0.12),while it was significantly different postoperatively (F =28.04,P =0.00).The abduction between control group and small amount R-R group was not significantly different postoperatively (P =0.99),but the abduction of control group was significantly greater than that of all the R-R groups (all at P=0.00).Mean lateral monocular fixation field of each group preoperatively was (50.82 ± 3.30) ° in control group,(51.48 ±2.39)° in LR group,(50.13±3.51)° in small amount R-R group,(51.06±2.90)° in medium amount R-R group and (52.09±2.61)° in large amount R-R group.The postoperative mean lateral monocular fixation field of each group was (50.52 ± 3.51)°,(50.11 ± 2.36)°,(46.38 ± 3.67)°,(44.00 ± 3.00)°,(41.84 ±2.46)°,respectively.Preoperative lateral monocular fixation field among the five groups was not significantly different (F =1.75,P =0.14),while postoperative difference was significant (F =55.75,P =0.00).Lateral monocular fixation field between control group and LR group was not significantly different postoperatively (P=0.57),but the mean lateral monocular fixation field of control group was significantly greater than that of all the R-R groups (all at P =0.00).Conclusions The successful alignment rate of unilateral recess/resect procedure is satisfying,but it can also create abduction deficit especially in large surgical amounts eye.Patients with binocular vision will be sensitive to diplopia in side gaze;in such cases,the consequences of recess/resect procedure should be considered particularly to avoid decrease of the binocular single vision field.