改良穹隆结膜小切口技术在儿童水平斜视中的应用
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摘要
目的应用Guyton斜视钩进行改良穹隆结膜小切口斜视手术,观察其在儿童水平斜视中的临床效果。方法回顾性分析2014年1月至2017年6月在我院行水平斜视患儿128例(170眼),年龄1.5~17.0(6.5±1.6)岁,男60例,女68例。应用Guyton斜视钩行改良穹隆结膜小切口手术,术后随访6~12个月,观察手术矫正效果、结膜切口干预情况、术后恢复情况及并发症情况等。结果 119例(93.0%)在第一眼位获得理想眼位,矫正后斜视角度<±10△。102眼(60.0%)未行切口缝合;68眼(40.0%)进行结膜切口干预,其中缝合1针者45眼(26.5%),缝合2针者20眼(11.8%),缝合3针者3眼(1.8%)。术后眼部刺激症状轻,结膜切口愈合佳,无明显手术瘢痕。结论在儿童水平斜视中,应用Guyton斜视钩的改良穹隆结膜小切口技术是安全有效的方法,术中、术后并发症少,疗效确切,美容效果满意。
Objective To evaluate the modified fornix-based technique with Guyton hook as an approach for the treatment of children with horizontal strabismus. Methods The clinical data of 128 patients( 170 eyes) who underw ent horizontal strabismus surgery betw een January2014 and June 2017 were retrospectively review ed,including 60 males and 68 females. The mean age was 1. 5-17. 0( 6. 5 ± 1. 6) years. All procedures under general anesthesia were performed using the modified fornix-based conjunctival incision with Guyton hook,and the follow-up period was 6 to 12 months. The clinical and cosmetic outcomes of strabismus surgery,the complications and interventions related to the incision were assessed. Results At 3 months after surgery,orthophoria with excellent cosmetics was achieved in 119 patients( 93%) with the deviation ≤± 10△. Together 102 eyes( 60%) had no intraoperative suture. Moreover,the incision was sutured with one stitch in 45 eye( 26. 5%),in 20( 11. 8%) with 2 stitches,and in 3( 1. 8%)with 3 stitches. D uring the follow up period,there was no severe intraoperative or postoperative complications. The sw elling and redness of conjunctiva recovered quickly. Patients' discomfort was alleviated in a few days after the surgery. No oblivious scarring was found along the incision lines. Conclusion The modified fornix-based approach with Guyton hook is an effective and safe method for minimal incision surgery in children with horizontal strabismus.
Objective To evaluate the modified fornix-based technique with Guyton hook as an approach for the treatment of children with horizontal strabismus. Methods The clinical data of 128 patients( 170 eyes) who underw ent horizontal strabismus surgery betw een January2014 and June 2017 were retrospectively review ed,including 60 males and 68 females. The mean age was 1. 5-17. 0( 6. 5 ± 1. 6) years. All procedures under general anesthesia were performed using the modified fornix-based conjunctival incision with Guyton hook,and the follow-up period was 6 to 12 months. The clinical and cosmetic outcomes of strabismus surgery,the complications and interventions related to the incision were assessed. Results At 3 months after surgery,orthophoria with excellent cosmetics was achieved in 119 patients( 93%) with the deviation ≤± 10△. Together 102 eyes( 60%) had no intraoperative suture. Moreover,the incision was sutured with one stitch in 45 eye( 26. 5%),in 20( 11. 8%) with 2 stitches,and in 3( 1. 8%)with 3 stitches. D uring the follow up period,there was no severe intraoperative or postoperative complications. The sw elling and redness of conjunctiva recovered quickly. Patients' discomfort was alleviated in a few days after the surgery. No oblivious scarring was found along the incision lines. Conclusion The modified fornix-based approach with Guyton hook is an effective and safe method for minimal incision surgery in children with horizontal strabismus.
引文
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[12]MIKHAIL M,VERRAN R,FARROKHYAR F,SABRI K.Choice of conjunctival incisions for horizontal rectus muscle surgery--a survey of American Association for Pediatric Ophthalmology and Strabismus members[J].JA A PO S,2013,17(2):184-187.
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[14]COATS D K.Cul-de-sac incision for strabismus surgery in older patients[J].Binocul V is Strabismus Q,2009,24(4):233-235.
[15]PEREZ-FLORES I.Minimal incision surgery in strabismus:Modified fornix-based approach[J].Arch Soc Esp O ftalmol,2016,91(7):327-332.
[16]SHARMA A K,THAPA M,SHRESTHA G B,SITAULA S,SHR EST HA G S.Outcome of horizontal strabismus surgery and parents’satisfaction[J].Nepal J Ophthalmol,2014,6(2):11704.
[2]GOTZARIDIS E V.Sutureless transconjunctival 20 gauge pars plana vitrectomy[J].Semin Ophthalmol,2007,22(3):179-183.
[3]GOZAWA M,TAKAMURA Y,MIYAKE S,IWASAKI K,AR IM U R A S,T AKIHAR A Y.Comparison of subconjunctival scarring after microincision vitrectomy surgery using 20-,23-,25-and 27-gauge systems in rabbits[J].Acta Ophthalmol,2017,95(7):e602-609.
[4]MOJON D S.Review:minimally invasive strabismus surgery[J].Eye(Lond),2015,29(2):225-233.
[5]VON NOORDEN G K.Modification of the limbal approach to surgery of the rectus muscles[J].Arch Ophthalmol,1969,82(3):349-350.
[6]SWAN K C,TALBOT T.Recession under Tenon’s capsule[J].AMA A rch Ophthalmol,1954,51(1):32-41.
[7]PARKS M M.Fornix incision for horizontal rectus muscle surgery[J].Am J Ophthalmol,1968,65(6):907-915.
[8]MOJON D S.Minimally invasive strabismus surgery for horizontal rectus muscle reoperations[J].Br J Ophthalmol,2008,92(12):1648-1652.
[9]TESSLER H H,URIST M J.Corneal dellen in the limbal approach to rectus muscle surgery[J].Br J Ophthalmol,1975,59(7):377-379.
[10]ASPROUDIS I,KOZEIS N,KATSANOS A,JAIN S,TRANOS P G,KO N ST AS G P.Areview of minimally invasive strabismus surgery(miss):Is this the way forw ard[J]?A dv T her,2017,34(4):826-833.
[11]GUYTON D L.Asmall-incision muscle hook for the Parks cul-desac approach for strabismus surgery[J].Binocul V is Strabismus Q,2005,20(3):147-150.
[12]MIKHAIL M,VERRAN R,FARROKHYAR F,SABRI K.Choice of conjunctival incisions for horizontal rectus muscle surgery--a survey of American Association for Pediatric Ophthalmology and Strabismus members[J].JA A PO S,2013,17(2):184-187.
[13]SAM I D A.Conjunctival incisions for strabismus surgery:A com pariso n o f techniques[J].Tech Ophthalmol,2007,5(3):125-129.
[14]COATS D K.Cul-de-sac incision for strabismus surgery in older patients[J].Binocul V is Strabismus Q,2009,24(4):233-235.
[15]PEREZ-FLORES I.Minimal incision surgery in strabismus:Modified fornix-based approach[J].Arch Soc Esp O ftalmol,2016,91(7):327-332.
[16]SHARMA A K,THAPA M,SHRESTHA G B,SITAULA S,SHR EST HA G S.Outcome of horizontal strabismus surgery and parents’satisfaction[J].Nepal J Ophthalmol,2014,6(2):11704.