Schrader W F, Hamburger G, Lieb B, Hansen L L, Kommerell G
Universitätsaugenklinik Freiburg.
Klin Monbl Augenheilkd. 1995 Oct;207(4):224-31. doi: 10.1055/s-2008-1035373.
The incidence of motility disturbances induced by episkleral buckle operations for retinal detachment has been reported to range between 7 and 77%. We anticipated a relation between the buckle size and the incidence and extent of motility disturbances.
We examined 45 patients 2 to 4 years after successful retinal detachment surgery with a radial buckle. The buckle diameter was 3-11 mm. Patients were examined for diplopia and heterophoria in the primary position and in 20 degrees secondary and tertiary gaze deviations. Stereopsis was determined using the TNO plates. Refractive error and visual acuity were also measured.
Heterophoria measurements in the various directions of gaze revealed a hypermotility in 22/45 cases. A hypomotility was encountered only in one of the 45 cases. In 40 of the 45 cases the field of binocular single vision had a radius of at least 20 degrees. 39 of the 45 patients had stereopsis (after macular detachment 17/22, without macular detachment 22/23). 7/32 patients with a buckle of > or = 5 mm reported on diplopia, but none of the 13 patients with a buckle of < or = 4 mm. Heterotropia in the primary position was found in one of the 45 cases. He had three buckles, a 10.5 mm buckle under the superior rectus muscle of one eye and a 4 and 7.5 mm buckle under the inferior oblique and rectus muscles of the other eye. The resulting vertical deviation was successfully treated with prisms. Motility disturbances in the upper field of gaze were found in 2 of 45 cases with buckles of 5 and 7.5 mm. Diplopia was not permanent in these cases.
Hypermotility towards the position of the buckle may be explained by a deviation of the adjacent rectus muscles, after sharp preparation and shrinkage of the intermuscular septum.
Since motility disturbances were encountered only with buckles of > or = 5 mm, small buckles (< or = 4 mm) should be applied whenever possible.
据报道，巩膜扣带术治疗视网膜脱离引起的眼球运动障碍发生率在7%至77%之间。我们预期扣带大小与眼球运动障碍的发生率及程度之间存在关联。
我们对45例成功接受放射状巩膜扣带术治疗视网膜脱离2至4年的患者进行了检查。扣带直径为3 - 11毫米。对患者在第一眼位以及20度二级和三级注视偏斜时的复视和隐斜视情况进行检查。使用TNO图测定立体视。还测量了屈光不正和视力。
在不同注视方向的隐斜视测量显示，45例中有22例存在眼球运动亢进。45例中仅1例存在眼球运动减弱。45例中有40例双眼单视范围半径至少为20度。45例患者中有39例有立体视（黄斑脱离后22例中的17例，无黄斑脱离22例中的23例）。32例扣带直径≥5毫米的患者中有7例报告有复视，但13例扣带直径≤4毫米的患者中无一例报告有复视。45例中有1例在第一眼位存在斜视。他有三个扣带，一只眼上直肌下方有一个10.5毫米的扣带，另一只眼下斜肌和下直肌下方分别有一个4毫米和7.5毫米的扣带。由此导致的垂直偏斜通过棱镜成功矫正。45例中有2例扣带直径分别为5毫米和7.5毫米的患者在上注视野存在眼球运动障碍。这些病例中的复视并非永久性的。
向扣带所在位置的眼球运动亢进可能是由于肌间膜锐性分离和收缩后相邻直肌的偏移所致。
由于仅在扣带直径≥5毫米时出现眼球运动障碍，故应尽可能使用小扣带（≤4毫米）。
