Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China.
Medicina (Kaunas). 2022 Jul 29;58(8):1018. doi: 10.3390/medicina58081018.
Background and objectives: To analyze demographic and clinical features of pattern strabismus patients and assess the relationship among these clinical variables and risk factors. Materials and Methods: Medical records of pattern strabismus patients who had undergone strabismus surgery at our center between 2014 and 2019 were retrospectively reviewed. Data collected included gender, age at onset, age at surgery, refraction, Cobb angle, pre- and post-operative deviations in the primary position, up- and downgaze, angle of ocular torsion, type/amount of pattern, grade of oblique muscle function and presence/grade of binocular function. To verify the clinical significance of the Cobb angle, 666 patients who had undergone surgery within one week after ocular trauma between 2015 and 2021 were enrolled as controls. Results: Of the 8738 patients with horizontal strabismus, 905 (507 males and 398 females) had pattern strabismus, accounting for 10.36%. Among these 905 patients, 313 showed an A-pattern and 592 showed a V-pattern. The predominant subtype was V-exotropia, followed by A-exotropia, V-esotropia and A-esotropia. Over half of these patients (54.6%) manifested an A- or V-pattern in childhood. The overall mean ± SD Cobb angle was 5.03 ± 4.06° and the prevalence of thoracic scoliosis was 12.4%, both of which were higher than that observed in normal controls (4.26 ± 3.36° and 7.8%). Within A-pattern patients, 80.2% had SOOA and 81.5% an intorsion, while in V-pattern patients, 81.5% had IOOA and 73.4% an extorsion. Patients with binocular function showed decreases in all of these percent values. Only 126 (13.9%) had binocular function, while 11.8% of A-pattern and 15.1% of V-pattern patients still maintained binocular function. Pre-operative horizontal deviation was negatively correlated with binocular function (r = −0.223, p < 0.0001), while the grade of oblique muscle overaction was positively correlated with the amount of pattern (r = 0.768, p < 0.0001) and ocular torsion (r = 0.794, p < 0.0001). There were no significant correlations between the Cobb angle and any of the other clinical variables. There were 724 patients (80.0%) who had received an oblique muscle procedure and 181 (20.0%) who received horizontal rectus muscle surgery. The most commonly used procedure consisted of horizontal rectus surgery plus inferior oblique myectomy (n = 293, 32.4%), followed by isolated horizontal rectus surgery (n = 122, 13.4%). Reductions of pattern were 14.67 ± 6.93 PD in response to horizontal rectus surgery and 18.26 ± 7.49 PD following oblique muscle surgery. Post-operative deviations were less in V- versus A-pattern strabismus. Post-operative binocular function was obtained in 276 of these patients (30.5%), which represented a 16.6% increase over that of pre-operative levels. The number of patients with binocular function in V-pattern strabismus was greater than that of A-pattern strabismus (p = 0.048). Conclusions: Of patients receiving horizontal strabismus surgery, 10.36% showed pattern strabismus. In these patients, 54.6% manifested an A- or V-pattern in childhood, and V-exotropia was the most frequent subtype. Pattern strabismus patients showed a high risk for developing scoliosis. Cyclovertical muscle surgery was performed in 724 of these patients (80.0%), and horizontal rectus surgery was effective in correcting relatively small levels of patterns. Binocular function represented an important factor as being involved with affecting the occurrence and development of pattern strabismus.
分析斜视患者的临床特征和斜视模式，评估这些临床变量与风险因素之间的关系。材料与方法：回顾性分析 2014 年至 2019 年期间在我院接受斜视手术的斜视患者的病历资料。收集的资料包括性别、起病年龄、手术年龄、屈光不正、Cobb 角、主位正位和上下斜视时的偏斜度、眼扭转角、斜视模式的类型/量、斜肌功能分级和双眼功能的存在/分级。为了验证 Cobb 角的临床意义，我们纳入了 2015 年至 2021 年期间 666 例眼外伤术后一周内接受手术的患者作为对照。结果：在 8738 例水平斜视患者中，905 例（507 例男性和 398 例女性）为斜视模式，占 10.36%。在这 905 例患者中，313 例为 A 型模式，592 例为 V 型模式。主要亚型为 V 型外斜视，其次为 A 型外斜视、V 型内斜视和 A 型内斜视。超过一半的患者（54.6%）在儿童期表现出 A 型或 V 型斜视。总的平均 Cobb 角为 5.03 ± 4.06°，脊柱侧凸的患病率为 12.4%，均高于正常对照组的 4.26 ± 3.36°和 7.8%。在 A 型模式患者中，80.2%存在下斜肌亢进，81.5%存在内旋，而在 V 型模式患者中，81.5%存在上斜肌亢进，73.4%存在外旋。双眼功能患者的所有百分比值均下降。仅有 126 例（13.9%）具有双眼功能，而 11.8%的 A 型斜视和 15.1%的 V 型斜视患者仍保持双眼功能。术前水平斜视与双眼功能呈负相关（r = -0.223，p < 0.0001），而斜肌亢进程度与斜视模式的量（r = 0.768，p < 0.0001）和眼扭转角（r = 0.794，p < 0.0001）呈正相关。Cobb 角与其他任何临床变量之间均无显著相关性。724 例（80.0%）患者接受了斜肌手术，181 例（20.0%）患者接受了水平直肌手术。最常用的手术方法包括水平直肌手术加下斜肌切除术（n = 293，32.4%），其次是单纯水平直肌手术（n = 122，13.4%）。水平直肌手术后斜视模式减少了 14.67 ± 6.93 PD，斜肌手术后斜视模式减少了 18.26 ± 7.49 PD。V 型斜视比 A 型斜视术后偏斜度更小。术后双眼功能获得的患者有 276 例（30.5%），较术前增加 16.6%。V 型斜视患者中具有双眼功能的患者多于 A 型斜视患者（p = 0.048）。结论：在接受水平斜视手术的患者中，10.36%表现为斜视模式。在这些患者中，54.6%在儿童期表现出 A 型或 V 型斜视，最常见的亚型为 V 型外斜视。斜视模式患者发生脊柱侧凸的风险较高。724 例患者（80.0%）行斜视肌手术，水平直肌手术有效矫正较小程度的斜视模式。双眼功能是影响斜视模式发生和发展的重要因素。
