摘要目的 探讨单纯Knapp手术在双上转肌麻痹(double elevator palsy,DEP)治疗中的手术效果.方法 对2007年1月至2015年6月,回顾性分析在天津市眼科医院应用Knapp斜视矫正手术治疗的15例DEP患者,观察术前与术后眼位、斜视度数、患眼上转和下转功能及双眼视功能的变化.结果 Knapp手术治疗前、治疗后原在位平均垂直斜视度分别为(34.67±8.55) PD、(6.53±6.50) PD,差异有统计学意义(P＜0.05),平均垂直斜视矫正量(28.13±3.58) PD.术前、术后眼球上转运动分级分别为(-3.73±0.70)和(-1.8±0.77)差异有统计学意义(P＜0.05),上转运动改善(1.93±0.59).术后眼球下转运动轻度受限(-0.80±0.41).术前5例代偿头位下有双眼视功能患者,术后代偿头位消失或＜5.,于功能眼位(原在位和阅读视野)获得双眼视觉.单纯Knapp手术对DEP一次手术治愈率73.3％,术前原在位垂直斜视度≥40 PD患者欠矫明显,需要二次手术.结论 单纯Knapp手术适用于下无下直肌限制因素的DEP,显著改善麻痹眼上转运动和矫正原在位垂直斜视,有助于双眼视功能的恢复.

abstractsObjective To investigate the efficacy of Knapp procedure in the treatment of double elevator palsy.Methods Fifteen patients with congenital double elevator palsy underwent Knapp procedures and retrospective analysis of the preoperative and postoperative vertical deviation in the primary position,ocular motility,and binocular vision.Results The average vertical deviation in the primary position was 34.67±8.55 prism diopters (PD) before surgery and 6.53±6.50 PD after surgery (P ＜0.05).The average corrected vertical deviation was 28.13±3.58 PD.The average preoperative upgaze was-3.73±0.70 and postoperative upgaze was-1.8±0.77 (P ＜0.05).The mean improved upgaze was 1.9340.59.Mild limitation in downgaze (mean-0.80±0.41) presented after operation.Five patients having binocular vision with abnormal head posture (AHP) before surgery obtained binocular single vision in the primary position and reading position after operation.After surgery AHPs disappeared or reduced to less than 5°.The surgical outcomes were satisfied in 73.3％ patients.But the patients with ≥40 PD preoperative vertical deviation were under corrected and needed the secondary operations.Conclusions Knapp procedure is an efficient procedure for treatment of double elevator palsy without restriction of ipsilateral inferior rectus.It can obviously correct the vertical deviation in the primary position and improve upgaze,which is good to obtain the binocular single vision in the primary and reading position.