摘要
目的 :探讨间歇性外斜视发生机制 ,及转归相关因素、相关程度。方法 :分析比较 2 2 6例患者术前、术后角膜曲率 ,屈光状态 ,视网膜对应情况 ,及远、近立体视觉和眼外肌超微结构及VEP等。结果 :(1 )术后 1 2岁以下与 1 3岁以上视功能恢复差异有显著性 ;(2 ) 2 2 6例手术前有不同程度的近立体视觉 1 47例 ,术后改善 41例 ,术后近立体视觉重建有明显改善 (P <0 .0 5 ) ;(3 )术前术后同视机I、II级功能重建差异有显著性 (P<0 0 5 ) ;(4 )观察术后不同时期的角膜屈折力 ,斜视手术。尤其是儿童 ,在同一只眼行水平直肌后徙加缩短 ,术后 7周内角膜水平经线屈折力有变化 ,7周后这种变化恢复原状 ,而儿童在一只眼行水平直肌后徙和成人水平肌加强和减弱手术 ,对角膜屈折力无影响 ;(5 )术前术后视网膜对应情况差异有显著性(P <0 .0 5 ) ;(6)在光镜和电镜下观察眼外肌 ,可见内直肌有不同程度的退化变性 ,部分外直肌有纤维化的病理改变 ;(7)VEP检查 :术前VEP测试时能控制正位组与不能控制正位组均值差异有显著性 (P <0 .0 5 ) ;不能控制正位组术前术后VEP均值比较差异有显著性 (P<0 .0 5 ) ;(8)影响功能治愈的相关因素 :术后双眼视功能恢复取决于病程及发病年龄 ,发病年龄越小 ,病程越长 ,对双眼视觉损害越大 ,术后恢?
Objective:To explore the mechanism of intermittent exotropia,outcome of clinical factors and the extent of their correlations.Methods:226 cases of intermittent exotropia were involved in the study. The date of corneal curvature, retinal correspondence,near and distant stereoacuity, property of fixation, ultra structure of extraocular muscle and VEP before and after operation were analyzed.Result:(1)The difference of the functional recovery of biocular single vision between children who were younger than 13 years old and older than 14 years old were significant;(2) Of the 226 cases, 145 had different extent of near-distance stereoacuity before operation.After operation there were 41 cases improved. The near-distance stereoacuity had significant improved (P<0.05);(3)The rebuilding of the function of I and II biocular single vision examined by major amblyoscope before and after operation had significant difference (P<0.05) ;(4) Analyzing the corneal curvature during different period of follow-up after operation ,we found that recession and resection of horizontal rectus muscle in one eye could change the horizontal refractive power of cornea within 7 weeks especially in children .But these changes would recover 7 weeks after surgery.The surgery that recession of the horizontal rectus muscle in children and recession combined with resection of horizontal rectus muscle in adults had no effect on corneal curvature;(5)The retinal correspondence of pre-operation and post-operation had significant difference (P<0.05) ;(6) The ultrastructure changes that medial rectus muscle degenerated in different extent and lateral rectus muscle fibrous degenearated partially were observed by electron microscope;(7)VEP:The average amplitude of the preoperative VEP between patients that can keep orthophoria and that can't keep orthophoria had significant difference (P<0.05) . The average amplitude of preoperative and postoperative VEP in patients that can't keep orthophoria had significant difference (P<0.05);(8)Factors that affected the functional recovery .The post operative recovery of biocular single vision was due to the course and the age of occurence of intermittent exotropia . The younger the occurence age and the longer the course the more severe that the function of biocular single vision would be damaged and the more difficult to recovery. Conclusion:(1)The younger the patients and the shorter time of onset the intermittent exotropia, the more difficult to form abnormal retinal correspondence and the more easier to change retinal correspondence from abnormal to normal state after surgery;(2)The operation is effective for intermittent exotropia.In patients whose fusion is damaged firstly , the damaging of fusion examined by major anblyoscope is the indication of operation;(3)The under-developed fusion is the possible mechanism of intermittent exotropia.
出处
《山东大学基础医学院学报》
2003年第1期55-60,共6页
Journal of Preclinical Medicine College of Shandong Medical University
