CAJ | 학술논문

目的探讨伴下斜肌亢进的分离性垂直偏斜（DVD）的手术方式及效果分析。方法回顾性分析28例合并下斜肌亢进DVD手术方式，原在位垂直斜度较小选择单纯下斜肌转位术；大度数垂直斜视行下斜肌后徙联合同侧上直肌后徙术。三棱镜加遮盖法检查垂直斜度，反复检查3次，取平均值；下斜肌亢进分＋1～＋4；术后随访1个月至3年。结果术前下斜肌亢进28例（41只眼），其中双眼13例；亢进＋1，4只眼；＋2，20只眼；＋3，16只眼；＋4，1只眼。下斜肌亢进均得到矫正。单纯下斜肌转位22例（30只眼），单眼14例，双眼8例。近期满意率85．71％。远期满意率71．42％。下斜肌后徙＋同侧上直肌后徙术6例（15只眼），双眼5例，单眼1例；双眼5例中4例满意，1例好转，其中2例术后出现轻度上转受限；单眼1例，效果满意，但术眼出现轻度上转受限，睑裂变小。结论伴有下斜肌亢进DVD垂直斜度较小时下斜肌转位术效果良好；垂直斜度较大需行下斜肌减弱＋同侧上直肌后徙术，上转肌同时减弱术，双眼手术比单眼安全。
목적탐토반하사기항진적분리성수직편사（DVD）적수술방식급효과분석。방법회고성분석28례합병하사기항진DVD수술방식，원재위수직사도교소선택단순하사기전위술；대도수수직사시행하사기후사연합동측상직기후사술。삼릉경가차개법검사수직사도，반복검사3차，취평균치；하사기항진분＋1～＋4；술후수방1개월지3년。결과술전하사기항진28례（41지안），기중쌍안13례；항진＋1，4지안；＋2，20지안；＋3，16지안；＋4，1지안。하사기항진균득도교정。단순하사기전위22례（30지안），단안14례，쌍안8례。근기만의솔85．71％。원기만의솔71．42％。하사기후사＋동측상직기후사술6례（15지안），쌍안5례，단안1례；쌍안5례중4례만의，1례호전，기중2례술후출현경도상전수한；단안1례，효과만의，단술안출현경도상전수한，검렬변소。결론반유하사기항진DVD수직사도교소시하사기전위술효과량호；수직사도교대수행하사기감약＋동측상직기후사술，상전기동시감약술，쌍안수술비단안안전。
Objective To investigate the effect of the different surgical manner of dissociated vertical deviation (DVD)coexisting IO overaction. Methods A retrospective review of medical records was performed that 28patients disso-ciated vertical deviation (DVD)coexisting IO overaction. If the vertical deviation in the primary position small was underg-one inferior oblique muscle anterior transposition(IOAT);If the vertical deviationmoderate to large was undergone IOAT associated with the same eye superior rectus(SR)weakening. The prism under cover test was used to measure vertical devi-ation in 3times. Overaction of the inferior oblique(IO)muscle was graded 1 + to 4 + . The surgical results were evaluated at 1month and 3years after surgery. Results Before the operation,28patients(41eyes)with IO overaction 4 eyes had +1,20 eyes had + 2,16 eyes had + 3and 1 eye had + 4. after the operation,41eyes IO overaction were diminished, 22patients(30eyes)were operated by IOAT,unilateral IOAT was 14eyes,bilateral IOAT was 8eyes,The excellent rate of after 1month was 85. 71% and after 3years was 71. 42% . 6 patients were undergone IOAT combined with the same eye SR recession,5 patients were bilateral operation and 4patients had an excellent 21patients good result;1 patient was unilateral operation,1 eye had an excellent,the operation eye had noticed moderate limitation of elevation. Conclusion IOAT was an effective treatment for treatment of small dissociated vertical deviation coexisting inferior oblique muscle overaction ;IO-AT associated with the same eye SR weakening when the DVD were moderate to large;bilateral SR recession combined with bilateral IO weakening was safe than unilateral SR recession combined with IO weakening in the management of patients with large angle or recurrent DVD.