CAJ | 학술논문

目的探讨后巩膜加固联合外斜视矫正术治疗病理性近视合并共同性外斜视的安全性和有效性。方法回顾性系列病例研究。分析在郑州市眼科医院住院行手术治疗的32例病理性近视合并共同性外斜视患者的病历资料。其中联合手术组18例，即采用异体巩膜行后巩膜加固的同时联合外斜视矫正术（外直肌后徙或联合内直肌截除）；分期手术组14例，即分期行后巩膜加固术和外斜视矫正术，比较两种手术方式的疗效。随访12～30个月，平均18.5个月。数据采用x2检验和fisher确切概率法进行分析。结果术后3个月，联合手术组矫正视力提高或无变化者占82％，在分期手术组也占82％；双眼视功能较术前改善和恢复者在两组分别有4例和1例；对美容效果满意（眼位在±50内或三棱镜度±10△内）者在两组分别占83％和86％；屈光度稳定（增加≤0.50 D/年）者在两组分别占75％和73％；眼轴稳定（增长≤0.3 mm/年）者在两组分别占75％和77％；上述指标两组差异均无统计学意义。两组患者均未发生视网膜脱离、眼前节缺血等严重并发症。不同程度的结膜筋膜水肿和复视较常见。结论联合手术是治疗病理性近视合并共同性外斜视的一种安全有效的方法，具有单次手术，疗效好，费用低等优点。同时术中解剖层次清晰，视野暴露好，避免了分期手术的黏连所致的操作困难。
목적 탐토후공막가고연합외사시교정술치료병이성근시합병공동성외사시적안전성화유효성。방법 회고성계렬병례연구。분석재정주시안과의원주원행수술치료적32례병이성근시합병공동성외사시환자적병력자료。기중연합수술조18례，즉채용이체공막행후공막가고적동시연합외사시교정술（외직기후사혹연합내직기절제）；분기수술조14례，즉분기행후공막가고술화외사시교정술，비교량충수술방식적료효。수방12～30개월，평균18.5개월。수거채용x2검험화fisher학절개솔법진행분석。결과 술후3개월，연합수술조교정시력제고혹무변화자점82％，재분기수술조야점82％；쌍안시공능교술전개선화회복자재량조분별유4례화1례；대미용효과만의（안위재±50내혹삼릉경도±10△내）자재량조분별점83％화86％；굴광도은정（증가≤0.50 D/년）자재량조분별점75％화73％；안축은정（증장≤0.3 mm/년）자재량조분별점75％화77％；상술지표량조차이균무통계학의의。량조환자균미발생시망막탈리、안전절결혈등엄중병발증。불동정도적결막근막수종화복시교상견。결론 연합수술시치료병이성근시합병공동성외사시적일충안전유효적방법，구유단차수술，료효호，비용저등우점。동시술중해부층차청석，시야폭로호，피면료분기수술적점련소치적조작곤난。
Objective To investigate the safety and effectivity of posterior scleral reinforcement surgery combined with strabismus surgery in treating pathological myopia with concomitant exotropia. Methods Thirty-two cases of pathological myopia and concomitant exotropia were analyzed retrospectively. Eighteen cases in a combined-surgery group underwent posterior scleral reinforcement for a variant sclera combined with strabismus surgery (lateral rectus recession alone or combined with medial rectus excision); 14 cases in a two-stage operation group underwent posterior scleral reinforcement and strabismus surgery at different time. The therapeutic effects of the procedures were observed and compared. All cases were followed for 12 to 30 months. Data were analyzed with chi-square test or fisher exact probabilities. Results Eighty-two percent eyes attained stable best corrected visual acuity at 3 months postoperatively (improved or unchanged) in the combined-surgery group, and the same in the two-stage operation group. The difference was not statistically significant.Improvement and recovery of binocular vision: 4 cases in the combined-surgery group and 1 case in the two-stage operation group. The difference was not statistically significant. Eye position: 83％ attained satisfactory cosmetic result (primary eye position was within ±5° or prism angle was within ±10△) in the combined-surgery group, and 86％ in the two-stage operation group. The difference was not statistically significant. Stable refractive error (change≤0.5 D per year): 75％ in the combined-surgery group, and 73％ in the two-stage operation group. The difference was not statistically significant.Ocular axis stability (change≤0.3 mm per year): 75％ in the combined-surgery group, and 77％ in the two-stage operation group. The difference was not statistically significant. Complications: there were no complications such as retinal detachment, anterior segment ischemia, etc. However, different degrees of conjunctival aponeurosis edema and diplopia were common. Conclusion Combined surgery is a safe and effective method for treating pathological myopia combined with concomitant exotropia. It has the advantage of a single surgical intervention, better curative results, lower cost, etc. Meanwhile,a clearer anatomical layer and better exposure of visual fields during the operation can avoid the difficulty caused by conglutination in two-stage operation.