摘要目的 探讨Ⅴ型斜视伴斜肌功能异常的手术疗效.方法 回顾性分析45例伴斜肌功能异常Ⅴ型斜视患者的临床资料,检查手术前后原在位斜视角、上转25°与下转25°注视斜视角差别、眼球运动、斜肌功能及双眼视功能.手术原则减弱亢进的下斜肌或联合加强上斜肌、减弱协同肌或配偶肌,水平斜视按原在位矫正.随访时间2个月至2年,平均(6.7±3.23)月.结果 45例伴斜肌异常Ⅴ型斜视,术后眼位总正位率91.11％,Ⅴ征均消失,术后下斜肌功能均有明显改善;下斜肌非对称减弱组16例垂直斜视角术后得到明显改善,与术前相比,差异具有统计学意义(P＜0.01).术后25.58％新获得了近立体视,总体达74.42％.术前近立体视损害,Ⅴ型内斜组明显高于Ⅴ型外斜组;术后近立体视恢复,Ⅴ型外斜组明显早于Ⅴ型内斜组,差异均具有统计学意义(P＜0.05).结论 Ⅴ型斜视伴斜肌功能异常者,双侧下斜肌亢进程度相近行双下斜肌对称减弱术效果好;双侧下斜肌亢进程度不相等,宜选择下斜肌非对称减弱上下斜肌手术,术后可能仍存在残留垂直斜视;Ⅴ型内斜较Ⅴ型外斜更易损害视功能,术后视功能恢复Ⅴ型外斜视组明显早于Ⅴ型内斜视组.

abstractsObjective To investigate the surgical efficacy of Ⅴ pattern strabismus with oblique muscle dysfunction.Methods The medical records of 45 Ⅴ pattern strabismus patients with oblique muscle dysfunction were retrospectively analyzed.The strabismus degree of the eye's primary position was checked.The strabismus degree difference of the eyes turned up 25° and turned down 25° was compared.The eye movements,oblique muscle and binocular visual function were checked.The principle of surgery was that weakening the inferior oblique muscle,or combinning strengthened superior oblique muscle and/or weakened synergist muscle,and/or weakened antagonist muscle.The horizontal strabismus was corrected according to the primary eye position.The patients were followedup for two months to two years after the surgery.Results The total postoperative alignment eyes position rate was 91.11％ (41/45)and the Ⅴ symptoms were disappeared in all cases.The inferior obliques overaction were obviously weakened after the surgery.The near stereo vision received 74.42％ and improved on 11 patients in 43 cases.The preoperative near stereo vision of Ⅴ pattern esotropia group was morn obviously damaged than that of Ⅴ pattern exotropia group(P ＜0.05).The postoperative recovery of the near stereo vision of the Ⅴ pattern exotropia was more obviously earlier than that of the Ⅴ pattern esotropia,the differences between the two groups were statistically significant(P ＜0.05).Conclusions The Ⅴ pattern strabismus patientswith oblique muscle dysfunction are suitable taken the bilateral symmetric inferior oblique weakening surger yand the effect is satisfied when they have bilateral inferior obliques equal overaction.But the cases may still exist the residual vertical strabismus degree and the inferior oblique overaction after surgery.Ⅴ pattern esotropia is more easily damaged the binocular visual function than that of Ⅴ pattern exotropia.