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目的垂直斜视手术治疗的临床观察方法垂直斜视病例43例,其中麻痹性斜视33例,垂直性分离性偏斜(DVD)8例,甲状腺相关性眼病2例。检查双眼和单眼运动、角膜映光法、三棱镜遮盖试验及同视机检查垂直和水平斜视角,垂直斜视角3△～60△,水平斜视角10△～70△,作牵拉试验和Bielschowsky头位倾斜试验。手术一期完成31例,二期手术12例。手术选择在高位眼,麻痹眼及非注视眼。上斜肌麻痹26例行单侧或双侧下斜肌减弱术,5例行下斜肌和垂直直肌手术。1例上直肌麻痹行对侧眼下斜肌后退术,另1例行同侧眼下直肌后退术。8例DVD均采用一眼或双眼上直肌等量或不等量后退,后退量为6～9mm,合并下斜肌亢进的同时作下斜肌减弱术,其中1例行下斜肌转位术。2例甲状腺相关性眼病,行下直肌后退术。结果40例病人第一眼位正位,复视消失。2例DVD患者术后明显改善,1例甲状腺相关性眼病患者术后垂直斜视8△。结论垂直斜视的手术起点是垂直斜度大于10△,在斜度最大视野内起作用的肌肉上手术,垂直斜视矫正应保证正前方及前下方注视野,手术宜选择在高位眼,麻痹眼及非注视眼上进行。
Objective To observe the clinical observation of vertical strabismus surgery in 43 cases of vertical strabismus, including 33 cases of paralytic strabismus, vertical deviation (DVD) in 8 cases, 2 cases of thyroid associated ophthalmopathy. Check the eyes and monocular movement, corneal reflection method, prism cover test and the same inspection machine vertical and horizontal oblique viewing angle, vertical oblique viewing angle 3 △ ~ 60 △, horizontal oblique viewing angle 10 △ ~ 70 △, for pulling test and Bielschowsky head Bit tilt test. The first operation was completed in 31 cases and the second operation in 12 cases. Surgical options in the high eyes, paralyzed eyes and non-gaze eyes. Upper oblique paralysis 26 cases of unilateral or bilateral lower oblique muscle weakening, 5 cases of inferior oblique and vertical rectus muscle surgery. One case of rectus muscle paralysis line contralateral oblique muscle retreat surgery, the other one line of ipsilateral right rectus retreat. 8 cases of DVD are using one eye or both eyes of the rectus equal or unequal amount of back, back amount of 6 ~ 9mm, combined with inferior oblique hyperthyroidism at the same time for inferior oblique muscle surgery, of which 1 case of inferior oblique muscle transposition . 2 cases of thyroid associated ophthalmopathy, rectus underwent retrograde surgery. Results 40 patients first eye position, diplopia disappeared. Two cases of DVD patients were significantly improved after surgery, one case of thyroid associated ophthalmopathy in patients with vertical strabismus 8 △. Conclusion Vertical strabismus surgery is the starting point of the vertical gradient is greater than 10 △, the maximum angle of view in the role of the muscle surgery, vertical strabismus correction should ensure that front and front under the field of vision, surgery should be selected in the high position eyes, paralyzed eyes and Non-gaze eyes.