Tu Y Q, Wu X Y, Wang J Y, Du K X, Yu Y X
Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhonghua Yan Ke Za Zhi. 2019 Sep 11;55(9):670-676. doi: 10.3760/cma.j.issn.0412-4081.2019.09.009.
To analyze clinical effects of modified Yokoyama's surgery combined with medial rectus muscle recession for treatment of high myopic strabismus fixus. Retrospective analysis of records of 9 patients (14 eyes) with high myopic strabismus fixus treated from February 2013 to December 2016 in the Department of Ophthalmology, Xiangya Hospital, Central South University. All patients underwent modified Yokoyama's surgery. The temporal 1/2 of the superior rectus (SR) and the superior 1/2 of the lateral rectus (LR) were united 12 to 14 mm, combined with medial rectus muscle recession. The angle of deviation of primary position, the mobility of the affected eye, and the change of CT imaging were observed and analyzed before and 6 months after surgery. Statistical analysis was performed by Mann-Whitney test. The patients were 5 females and 4 males with an average age of (60±10) years. The duration of high myopia was (33.33±6.61) years. The refractive power was (-23.32±5.95) D, and the axial length was (33.04±2.63) mm. The recession mount of medial rectus was (7.2±2.1) mm (4.0-10.0 mm) intraoperatively. At 6 months, the median esotropia improved from 130 (80-140) prism diopter (PD) to 0 (0-10) PD, and the hypotropia from 20 (15-25) PD to 0 (0-5) PD. The median abduction limitation decreased from -3 (-4--1) to -1 (-2-0), and the median limitation of elevation decreased from -2 (-4--1) to 0 (-1-0). The angle of esotropia and hypotropia significantly improved (-2.67, -2.70; 0.008, 0.007), and the restriction of abduction and elevation decreased (-3.35, -3.24; both 0.001). Only 3 patients' CT images were enrolled in a comparative study. Preoperative orbital CT scans showed inferior LR displacement and medial SR displacement with the posterior portion of the eyeball to the superotemporal quadrant of the orbit. After surgery, the mean reduction ratio of dislocation degree of the 3 patients was 28.97%, the dislocation of LR and SR was reduced, and the posterior global part was correctly positioned within the orbit. The modified Yokoyama's surgery combined with medial rectus muscle recession can effectively correct high myopic strabismus fixus, recover the eyeball anatomical position, and evidently improve eye mobility. The clinical effects are satisfactory. .
分析改良横山手术联合内直肌后徙术治疗高度近视固定性斜视的临床效果。回顾性分析2013年2月至2016年12月在中南大学湘雅医院眼科治疗的9例（14只眼）高度近视固定性斜视患者的病历资料。所有患者均接受改良横山手术。将上直肌颞侧1/2与外直肌上1/2在12至14mm处联合，并联合内直肌后徙术。观察并分析手术前和手术后6个月的原在位斜视度、患眼活动度及CT影像学变化。采用Mann-Whitney检验进行统计学分析。患者中女性5例，男性4例，平均年龄（60±10）岁。高度近视病程为（33.33±6.61）年。屈光度数为（-23.32±5.95）D，眼轴长度为（33.04±2.63）mm。术中内直肌后徙量为（7.2±2.1）mm（4.0 - 10.0mm）。术后6个月，内斜视度数中位数从130（80 - 140）三棱镜度（PD）改善至0（0 - 10）PD，下斜视度数从20（15 - 25）PD改善至0（0 - 5）PD。外展受限中位数从-3（-4 - -1）降至-1（-2 - 0），上转受限中位数从-2（-4 - -1）降至0（-1 - 0）。内斜视和下斜视角度明显改善（-2.67，-2.70；P = 0.008，0.007），外展和上转受限减轻（-3.35，-3.24；P均 = 0.001）。仅3例患者的CT图像纳入对比研究。术前眼眶CT扫描显示外直肌下移和上直肌内移，眼球后部移至眼眶颞上象限。术后，3例患者脱位程度平均降低率为28.97%，外直肌和上直肌脱位减轻，眼球后部正确复位至眼眶内。改良横山手术联合内直肌后徙术可有效矫正高度近视固定性斜视，恢复眼球解剖位置，明显改善眼球活动度。临床效果满意。
