摘要目的 探讨上斜肌减弱(断腱或后徙)术矫正伴上斜肌功能亢进A征的效果及眼球旋转状态的改变.方法 收集伴双侧上斜肌亢进的A型斜视82例,断腱术79例,后徙术3例,观察手术前后第一眼位、上下方斜视度及上斜肌亢进程度,于术前和术后1d行双眼眼底照相并测量黄斑-视盘夹角(FDA).结果 (1)断腱组:①术前A征斜度平均为(23.47±9.08)△;手术减少(25.27±11.79)△;随访期末残余斜度差为(-1.98±6.60)△,与术前比较差异有统计学意义.②术前平均FDA,右眼为(9.08±5.40)°、左眼为(12.10±4.77)°、双眼为(20.87±8.49)°;平均减少量,右眼(7.57±4.71)°、左眼(8.28±5.38)°、双眼(15.72±7.01)°;术后第1天FDA右眼(0.90±4.90)°、左眼(3.34±5.33)°、双眼(4.23±7.58)°;双眼FDA手术前、后比较,差异有统计学意义.(2)后徙组3例患者A征消失,手术矫正量为23△、35△、31△,双眼总FDA减少为24.00°、10.80°和11.00°.结论 双侧上斜肌减弱术可有效矫正A征和眼球内旋状态.断腱术A征矫正量与术前A征的度数呈正相关,术后内旋转度数减少量与术前客观旋转度数呈正相关.

abstractsObjective To investigate tenectomy(ST)and recession(SR),and their effects in treatment of A pattern,superior oblique overaction,and torsion.Methods Pre- and Post-operative primary eye position,upgaze and downgaze of deviation,superior oblique muscle function,fundus photograph were examined and analyzed in 82 patients of A-pattem deviation with bilateral superior oblique overaction(SOOA).Results ST ① Mean A-pattern was(23.47± 9.08)△ before and(-1.98± 6.60)△ after the operation.Mean correction was (25.27±11.79)△.② The mean pre-operative fovea-disc angle(FDA)of both eyes was(20.87± 8.49)° ,with the mean decreasing of(15.72± 7.01),and the mean FDA was(4.23± 7.58)° 1 day after operation.SR The mean correction of A pattern was 23△,35△and 31 △.The mean correction of total FDA was 24.00° ,10.80° and 11.00° .Conclusions Bilateral superior oblique weakening is effective in correcting A-pattern deviation and incyclodeviation.