摘要目的 探讨手术治疗伴有集合抑制的先天性眼球震颤的效果.方法 回顾性系列病例研究.收集自2010年9月至2012年9月在首都医科大学附属北京儿童医院确诊为伴有集合抑制的先天性眼球震颤患儿的临床资料8例,年龄中位数为9.5(12,6)岁,随访时间中位数为9(24,6)个月,对所有患儿均进行光学诱导集合并采取双眼内直肌后徙加双眼外直肌断腱后原位缝合的手术方法,分析诱导集合前后及手术前后双眼最佳矫正视力,融合范围的变化,使用眼震仪测量手术前后眼球震颤的频率、振幅及强度的变化.使用SPSS13.0统计学软件对诱导集合前后及手术前后视力、眼震频率、振幅及强度进行配对t检验.结果 使用同视机测定手术前后融合范围,术前平均融合范围为-3.75°±1.83°～+19.38°±3.16°,术后平均融合范围为-3.88°±1.55°～+19.00°±3.02°,差异无统计学意义(t=0.24,P=0.82),对使用集合前后及手术前后最佳矫正双眼视力进行配对比较,使用集合前平均视力为0.21±0.15,使用集合后平均视力为0.28±0.18,使用集合后视力较术前有所提高,差异有统计学意义(t=-4.43,P=0.00).术后平均视力为0.32±0.20,术后视力较术前使用集合前的视力有所提高,差异有统计学意义(t=-5.29,P=0.00),与术前使用集合后的视力相比,差异无统计学意义(t=-2.12,P=0.07),术前使用集合功能后及术后眼震频率(t=3.28,3.02,P＜0.05)及眼震强度较(t=3.27,3.48,P＜0.05)术前使用集合前下降,差异有统计学意义.眼震振幅的变化无统计学意义(t=1.31,1.57,0.31,P＞0.05).结论 双眼内直肌后徙加双眼外直肌断腱再缝合手术可以有效改善伴有集合抑制的先天性眼球震颤患儿的眼震强度及视力,手术对融合范围没有明显影响.集合抑制现象对于眼球震颤频率的影响要大于对其振幅的影响.

abstractsObjective To evaluate the efficacy of surgery in the treatment of congenital nystagmus with convergence damping.Methods Retrospective and comparative case series.Eight patients diagnosed as congenital nystagmus with convergence damping at Beijing Children's Hospital between September 2010 and September 2012 were enrolled in this study.The ages were 9.5 (12,6)years old, and follow-up was 9 (24, 6) months.All patients received prism induced convergence and the same surgery of bimedial rectus recession and bilateral rectus tenotomy.The best corrected visual acuity, the range of fusion and the nystagmus waveforms were analyzed before and after surgery.Results The range of fusion was-3.75±1.83° to + 19.38±3.16°before surgery and-3.88± 1.55°to + 19.00±3.02° after surgery;there was no significant difference (t=0.24, P=0.82).The binocular visual acuity increased from 0.21±0.15 without convergence to 0.28 ± 0.18 using convergence;there was significant difference (t=-4.43, P=0.00).The visual acuity was 0.32±0.20 after surgery, significantly different from that before surgery without convergence (t=-5.29, P=0.00), but not significantly different from that before surgery using convergence (t=-2.12, P=0.07).Patients had significant improvements in the frequency (t=3.28, 3.02, P＜0.05)and intensity of the nystagmus waveforms when using convergence and postoperatively (t=3.27,3.48;P＜0.05), but there was no significant improvement in the amplitude of the waveforms (t=1.31,1.57,0.31, P＞0.05).Conclusions Surgery for congenital nystagmus with convergence damping can provide expectations for ocular motor and visual results.The range of fusion should be wide enough, and the effect of convergence on the frequency is greater than that on the amplitude.