Wang Ping, Lou Liping, Song Lin
Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
J Huazhong Univ Sci Technolog Med Sci. 2011 Oct;31(5):678. doi: 10.1007/s11596-011-0581-2. Epub 2011 Oct 25.
The design and efficacy of surgery for horizontal idiopathic nystagmus (HIN) with abnormal head posture and strabismus were investigated. Different surgical procedures were selected according to the angle of head turn in 44 cases of HIN with abnormal head posture and strabismus. For patients with a head turn of 15° or less, the Anderson procedure was used; the yoke muscles were recessed upon slow-phase. For patients with a head turn between 15° and 25°, the surgery was designed as a Kestenbaum 5-4-4-5 procedure. For patients with a head turn of 25° or more, the surgery was designed as a Parks 5-8-6-7 procedure. The surgery to correct the abnormal head posture was performed on the fixating eye while that to correct the deviation was then performed on the non-fixating eye at the same time. The amount of surgery of the horizontal rectus muscles on the non-fixating eye was sum of the angle of head turn and the degree of deviation, which was calculated as follows: recession/resection amount of medial and lateral rectis / 2×5 =angle of head turn ± degree of deviation. The results showed as follows: (1) Visual acuity: the visual acuity in the primary ocular position increased two lines or more in 35 patients, accounting for 79.55%. Nine patients had no or only one-line improvement, accounting for 20.45% of the entire study population; (2) The degree of deviation in the primary ocular position: 37 cases had a normal primary ocular position or the degree of deviation ≤ 8(δ) after surgery, accounting for 84.09%. Six patients had a residual degree of deviation of 8(δ)-15(δ), accounting for 13.64%. One patient had a residual degree of deviation >20(δ), accounting for 2.27% of the patients examined; (3) Abnormal head posture: 34 patients had a normal head posture or a head turn of less than 5°, accounting for 72.27%. Eight patients had a residual head turn of 5°-15°, accounting for 18.18%. Two patients had a head turn of 15°-25°, accounting for 4.55%. It was concluded that different surgical procedures based on the angle of head turn and the relationship between deviation and null zone can eliminate anomalous head posture, correct deviation, and improve vision acuity in the primary ocular position.
对伴有异常头位和斜视的水平型特发性眼球震颤（HIN）手术的设计及疗效进行了研究。根据44例伴有异常头位和斜视的HIN患者的头转向角度选择不同的手术方式。对于头转向角度为15°及以下的患者，采用安德森手术；在慢相时对配偶肌进行后徙。对于头转向角度在15°至25°之间的患者，手术设计为凯斯滕鲍姆5-4-4-5手术。对于头转向角度为25°及以上的患者，手术设计为帕克斯5-8-6-7手术。在注视眼上进行纠正异常头位的手术，同时在非注视眼上进行纠正斜视的手术。非注视眼上水平直肌的手术量为头转向角度与斜视度之和，计算方法如下：内直肌和外直肌后徙/缩短量/2×5 =头转向角度±斜视度。结果如下：（1）视力：35例患者原眼位视力提高两行或更多，占79.55%。9例患者视力无提高或仅提高一行，占整个研究人群的20.45%；（2）原眼位斜视度：37例患者术后原眼位正常或斜视度≤8（δ），占84.09%。6例患者残留斜视度为8（δ）-15（δ），占13.64%。1例患者残留斜视度>20（δ），占受检患者的2.27%；（3）异常头位：34例患者头位正常或头转向角度小于5°，占72.27%。8例患者残留头转向角度为5°-15°，占18.18%。2例患者头转向角度为15°-25°，占4.55%。得出结论：基于头转向角度以及斜视度与中和带之间的关系采用不同的手术方式，可消除异常头位，纠正斜视，并提高原眼位视力。
