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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (03) : 173 -177. doi: 10.3877/cma.j.issn.2095-2007.2021.03.008

病例报告

手术治疗周期性斜视两例
付玥川1, 陶晨1,†()   
  1. 1. 200120　上海交通大学医学院附属仁济医院眼科
  • 收稿日期:2020-05-12 出版日期:2021-06-28
  • 通信作者: 陶晨
  • 基金资助:
    上海市科学技术委员会科研计划项目(16DZ1930105；17411950205)

Two cases of surgical treatment for periodic strabismus

Yuechuan Fu1, Chen Tao1()   

  • Received:2020-05-12 Published:2021-06-28
  • Corresponding author: Chen Tao
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付玥川, 陶晨. 手术治疗周期性斜视两例[J]. 中华眼科医学杂志(电子版), 2021, 11(03): 173-177.

Yuechuan Fu, Chen Tao. Two cases of surgical treatment for periodic strabismus[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(03): 173-177.

图1 患儿术前眼位记录图
图3 病例二患儿眼外肌手术前后的眼位照相　图3A示患儿眼外肌术前斜视日三棱镜联合角膜映光检查照相，可见左眼内斜40△；图3B示患儿眼外肌术前正位日，三棱镜联合角膜映光检查照相，可见左眼内斜10△；图3C~图3K示患儿眼外肌术后次日，患儿眼位明显改善；图3L示患儿术后随访3个月，患儿正眼位
表1 典型周期性斜视的病例汇总
第一作者 发表年份(年) 年龄(岁) 周期斜视类型 临床特点 相关疾病史 治疗方案 治疗效果
Ma等[24] 2014 9 右眼周期性内斜视 周期48 h，斜视日时，右眼内斜50△，伴复视；正位日时，眼位正 患儿既往左眼恒定性外斜视，行眼外肌手术治疗，具体不详；术后出现右眼内斜伴有复视，数周后转化为周期性内斜视 随访3个月，行左眼内直肌后徙(6 mm)联合外直肌折叠(10 mm) 术后随访3个月，眼位正，无偏斜
Garg等[25] 2007 57 右眼周期性外斜视 周期48 h，斜视日时，右眼外斜20△；正位日时，眼位正 患者既往右眼脉络膜黑色素瘤曾行放射治疗后出现右眼周期性内斜视，周期48 h，斜视日时，右眼内斜45△；正位日时，小角度内斜(小于5△) 行右眼内直肌后徙(6 mm)联合外直肌缩短(8 mm) 术后2个月出现周期性内斜视，于原正位日时右眼外斜20△；于原斜视日时，眼位正
Wang等[26] 2016 5 左眼周期性内斜视 周期48 h，AC/A为16.87；斜视日时，左眼内斜40△；正位日时，眼位正 患儿双眼间歇性外斜视行双眼外直肌后徙术后3个月出现周期性斜视 随访6个月，行双眼内直肌后徙术(5.5 mm) 术后第1天，2△小角度内斜视，术后随访12个月，未见明显眼位偏斜
Cole等[31] 1988 24 左眼周期性内斜视 周期48 h，斜视日时，左眼内斜50△，伴有复视；正位日时，眼位正 患者既往左眼外伤史，曾行左眼玻璃体切除联合眼内异物取出及左眼白内障摘除术 行左眼人工晶状体植入术 术后周期性改变，正位日时间逐渐延长，随访6个月，周期性消失，眼位正
Murthy等[32] 2009 35 左眼周期性外斜伴周期性下斜视 周期48 h，斜视日时，左眼外斜30△伴有下斜视20△；正位日时，眼位正 患者20年前曾行双眼青光眼滤过术，具体不详，左眼视力差，最佳矫正视力为眼前指数 行左眼外直肌后徙、内直肌缩短联合内外直肌上移术 术后随访2个月，眼位正且眼球运动正常
Pillai等[33] 1987 4 左眼周期性内斜视 患儿每日晨起左眼内斜34△，午后眼位正 患儿癫痫有发作病史 镇静药物治疗癫痫发作 随访1年后周期性斜视发作的规律消失
Souza-Dias等[36] 2018 48 右眼周期性内斜视 斜视日时，右眼内斜20△~25△，伴有复视；正位日时，眼位正 既往右眼视网膜脱离行巩膜扣带术，术后1周出现周期性斜视 行双眼内直肌后徙术(5 mm) 随访2年，患者眼位正，无偏斜
Hwang等[37] 2006 31 左眼周期性外斜视 周期48 h，斜视日时，左眼外斜25△~30△，伴有复视；正位日时，眼位正 双眼视网膜色素变性，视网膜骨细胞样色素沉着，动脉变细，黄斑退化病变，双眼视野向心性萎缩    
Paik等[38] 2016 40 左眼周期性下斜视 周期48 h，斜视日时，左眼下斜35△；正位日时，左眼下斜7△ 甲状腺功能亢进，眼眶电子计算机断层扫描显示左眼内直肌和下直肌不对称增粗 内科治疗甲亢 随访6个月，甲状腺功能正常，眼球突出缓解，周期性斜视发作的规律消失，左眼下斜视7△
Voide等[56] 2015 6 右眼周期性内斜视 周期48 h，斜视日时，右眼内斜40△；正位日时，右眼内斜6△   右眼配戴6△底朝外棱镜治疗 随访2年，患者眼位正，无偏斜
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