CAJ | 학술논문

目的了解间歇性外斜视患者行水平直肌手术后的散光改变.方法临床病例对照研究.选取2013年7～9月在江苏省人民医院眼科就诊的71例间歇性外斜视患者进行病例系列研究.按照手术方法分为两组,Ⅰ组:单纯外直肌后徙术组,共26例;Ⅱ组:外直肌后徙联合内直肌肌截除术组,共45例.所有患者在术前1周内、术后1周、1、3个月进行非散瞳屈光检查.通过Fourier矢量分析计算CYL0(散光在水平方向/垂直方向的矢量分解值)和CYL45值(散光在斜轴方向的矢量分解值),比较术前、术后散光度数和轴向的改变.结果 Ⅰ组和Ⅱ组CYL0术后1周、1、3个月较术前差异均有统计学意义(P＜0.05).CYL45无显著变化.两组间CYL0、CYL45变化值的差异无统计学意义(P＞0.05).重复测量轮廓图示术后1周至1月两组CYL0均呈上升趋势,术后1～3个月呈下降趋势,CYL45上下波动,但波动范围较小.Ⅰ组术后1周、1、3个月时CYL0变化(D)与外直肌后徙量(mm)之间均无线性相关关系.结论间歇性外斜视患者行水平直肌手术后发生顺规散光改变,术后3个月时手术诱发散光仍存在.内直肌截除术对散光的影响可能较外直肌后徙术小,但尚需要大样本的研究以证实.
목적 료해간헐성외사시환자행수평직기수술후적산광개변.방법 림상병례대조연구.선취2013년7～9월재강소성인민의원안과취진적71례간헐성외사시환자진행병례계렬연구.안조수술방법분위량조,Ⅰ조:단순외직기후사술조,공26례;Ⅱ조:외직기후사연합내직기기절제술조,공45례.소유환자재술전1주내、술후1주、1、3개월진행비산동굴광검사.통과Fourier시량분석계산CYL0(산광재수평방향/수직방향적시량분해치)화CYL45치(산광재사축방향적시량분해치),비교술전、술후산광도수화축향적개변.결과 Ⅰ조화Ⅱ조CYL0술후1주、1、3개월교술전차이균유통계학의의(P＜0.05).CYL45무현저변화.량조간CYL0、CYL45변화치적차이무통계학의의(P＞0.05).중복측량륜곽도시술후1주지1월량조CYL0균정상승추세,술후1～3개월정하강추세,CYL45상하파동,단파동범위교소.Ⅰ조술후1주、1、3개월시CYL0변화(D)여외직기후사량(mm)지간균무선성상관관계.결론 간헐성외사시환자행수평직기수술후발생순규산광개변,술후3개월시수술유발산광잉존재.내직기절제술대산광적영향가능교외직기후사술소,단상수요대양본적연구이증실.
Objective To evaluate astigmatic changes after horizontal rectus muscle surgery in intermittent exotropic patitents.Methods Seventy-one exotropic patients with intermittent exotropia were enrolled in this case-series study.The subjects were divided into two groups: group 1 with lateral rectus recession (26 patients) and group 2 with unilateral lateral rectus recession and medial rectus resection (45 patients).Non-cycloplegic refractions were measured within 1 week before surgery, at 1 week, 1 month, and 3 months after surgery.CYL0 (horizontal or vertical vector of the cylinder) and CYL45 (oblique vector of the cylinder) using Fourier power vectors were calculated to determine and compare the changes of refractive astigmatism and axis in both groups.Results In group 1, CYL0 showed significant changes at 1 week, 1 month and 3 months after surgery.In group 2, CYL0 also changed significantly between 1 week and 3 months postoperatively.CYL45 did not change significantly as time passed in both groups.There was no statistically significant difference in the mean change of CYL0 and CYL45 after the 3-month follow-up.There was no significant correlation between the amount of lateral rectus recession and the amount of CYL0 in group 1 at 1 week, 1 month and 3 months after surgery.Conclusions Intermittent exotropic patients after horizontal rectus muscle surgery tend to develop statistically significant changes in astigmatism in the with-the-rule direction.At 3 months after surgery, the astigmatic changes seem to be still remarkable.Comparison between the two groups imply that the astigmatic effect caused by medial rectus resection is likely smaller compared to that caused by lateral rectus recession and study on large sample is necessary to prove it.