CAJ | 학술논문

目的评价改良的Yokoyama术治疗高度近视眼限制性斜视的手术疗效.方法临床病例研究.分析5例(7只眼)高度近视眼性斜视患者的临床、影像学及手术资料.眼轴长应用A超检查.斜视角度应用Krimsky加三棱镜方法检查.根据眼球运动情况行受限程度分级.手术前后均行眼眶MRI和CT检查,并分析眼外肌和眼球位置的改变.手术方式为改良的Yokoyama术,并联合内直肌后徙术.结果 5例(7只眼)患者的平均眼轴长为32.62 mm( SD l.84).术前平均内斜视角度为82.86 PD( SD 37.62),平均垂直斜视角度为20 PD(SD 7.91).7只手术眼均存在明显的眼球外转和上转运动受限.术前眼眶MRI和CT检查显示,上直肌鼻侧偏位,外直肌下偏位,眼球从肌锥的颞上方疝出,眼球的后部与外侧骨壁的空间变窄.术后第1天术眼眼位均正位,眼球外转和上转均能过中线,随时间推移眼球运动又进一步改善.术后MRI显示,外直肌和上直肌联结后,脱位的眼球被还纳至肌锥内,上直肌与外直肌止点位置偏移恢复正常.平均随访时间5个月,患者的术后情况保持稳定.结论通过改良的Yokoyama术可有效矫正高度近视眼限制性内下斜视,还纳脱出的眼球至肌锥内,并改善眼外肌走行及眼球运动功能.
목적 평개개량적Yokoyama술치료고도근시안한제성사시적수술료효.방법 림상병례연구.분석5례(7지안)고도근시안성사시환자적림상、영상학급수술자료.안축장응용A초검사.사시각도응용Krimsky가삼릉경방법검사.근거안구운동정황행수한정도분급.수술전후균행안광MRI화CT검사,병분석안외기화안구위치적개변.수술방식위개량적Yokoyama술,병연합내직기후사술.결과 5례(7지안)환자적평균안축장위32.62 mm( SD l.84).술전평균내사시각도위82.86 PD( SD 37.62),평균수직사시각도위20 PD(SD 7.91).7지수술안균존재명현적안구외전화상전운동수한.술전안광MRI화CT검사현시,상직기비측편위,외직기하편위,안구종기추적섭상방산출,안구적후부여외측골벽적공간변착.술후제1천술안안위균정위,안구외전화상전균능과중선,수시간추이안구운동우진일보개선.술후MRI현시,외직기화상직기련결후,탈위적안구피환납지기추내,상직기여외직기지점위치편이회복정상.평균수방시간5개월,환자적술후정황보지은정.결론 통과개량적Yokoyama술가유효교정고도근시안한제성내하사시,환납탈출적안구지기추내,병개선안외기주행급안구운동공능.
Objective To evaluate the surgical results of modified Yokoyama's procedure for treating myopic strabismus fixus.Methods Retrospective analysis of records of 5 patients (7 eyes) with high myopic strabismus.Pre- and postoperative orthoptic measurements were recorded and analyzed.Anatomic relationships between the muscle cone and globe were analyzed using MRI or CT scan.The surgical procedure is a modification of Yokoyama's technique and medial rectus muscle was also recessed.Results The average axis length of 7 eyes was 32.62 mm( SD1.84).The mean preoperative horizontal deviation was 82.86 PD (SD 37.62)esotropia and mean vertical deviation was 20 PD( SD 7.91 )hypotropia.All patients had marked limitation of elevation and abduction.Displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by CT or MRI scan of the orbits and by observation during surgery.After surgery,the supertemporal dislocation of globe was improved.Both the horizontal and vertical deviations decreased significantly,and the abduction and sursumduction motility were also improved gradually.The average follow-up was 5 months,all patients achieved satisfactory results and remained stable.Conclusions In high myopic patients,if the deviant paths of the LR and SR muscles were demonstrated by MRI or CT scan,the surgical procedure to restore the dislocated globe back into the muscle cone by uniting muscle bellies of the superior rectus and lateral rectus muscles is effective and recommended.