III型急性获得性共同性内斜视临床特征及手术量分析

Analysis of Clinical Characteristics and Surgical Dose of Type III Acute Acquired Comitant Esotropia

摘要: 目的：观察分析III型急性获得性共同性内斜视患者的内直肌解剖及手术量分析。方法：收集2022年01月至2024年12月行手术治疗的急性获得性共同性内斜视(AACE) III型患者69例，男39例，女30例。共同性内斜视(ET)对照组71例，男40例，女31例。术后随访6个月。除眼部疾患史或既往其他类型斜视病史；无全身疾病或头部外伤史；神经系统检查未发现神经系统疾病，大脑和眼眶计算机断层扫描(CT)/磁共振成像(MRI)均未见异常。纳入参考指标包括：年龄、视力、屈光状态、内直肌肌止端距角膜缘距离(mm)、术前斜视度(PD)，手术方式为单侧内直肌后退或双侧内直肌后退。结果：ACCE组中度近视34例(49.28%)，高度近视21例(30.43%)，轻度近视11例(15.94%)；ET组轻度远视或正视51例(71.83%)，轻度近视16例(22.53%)。ACCE组内直肌肌止端附着点距角膜缘4.3 mm ± 0.23 mm，ET组内直肌肌止端附着点距角膜缘4.5 mm ± 0.21 mm。ACCE组术前平均斜视度31.04 PD ± 10.46 PD，总手术量8.96 mm ± 2.70 mm，每后退1 mm可矫正3.46 PD。ET组术前平均斜视度34.00 PD ± 13.60 PD，总手术量8.44 mm ± 2.67 mm，每后退1 mm可矫正4 PD。斜视度每增加1 PD，ACCE组较ET组手术量增加16%。结论：ACCE组内直肌肌止端较ET组更靠近角膜缘；相对ET，矫正ACCE需要更大(增加16%)的手术量。

Abstract: Objective: To observe and analyze the clinical course and surgical dose with Type III acute acquired comitant esotropia (ACCE). Methods: The clinical features and surgical dose of 69 patients (man 39 cases, femal 30 cases) with diplopia due to acute acquired comitant esotropia were retrospectively reviewed from January 2022 to December 2024 were collected. Exclusion criteria were a history of prematurity, cerebral palsy, head trauma, or febrile illness before the onset of acquired comitant esotropia, incomitant strabismus, accommodative spasm, and divergence paralysis. The control group consisted of 71 patients (man40cases, femal31cases) with comitant esotropia (ET). No abnormalities were found in the brain and orbital computed tomography (CT) or magnetic resonance imaging (MRI). The measurement of the distance between the limbus and the medial rectusmuscle’s insertion, age onset, refraction, Deviation (PD) were ana-lysed. All patients underwent unilateral or bilateral medial rectus recession. Results: There were 69 cases of acute comitant esotropia and 71 cases of comitant esotropia in this study. In the ACCE group, there were 34 cases (49.28%) of moderate myopia, 21 cases (30.43%) of high myopia, and 11 cases (15.94%) of mild myopia. In the ET group, there were 51 cases (71.83%) of mild hyperopia and 16 cases (22.53%) of mild myopia. The distance from the medial rectus muscle insertion to the limbus was 4.3 mm ± 0.23 mm in the ACCE group and 4.5 mm± 0.21 mm in the ET group. The preoperative deviation was 31.04 PD ± 10.46 PD on distance in the ACCE group, with a total surgical dose of 8.96mm ± 2.70 mm. A recession of 1 mm could correct 3.46 PD. The preoperative deviation was 34.00 PD ± 13.60 PD on distance in the ET group, with a total surgical dose of 8.44 mm ± 2.67 mm. A recession of 1 mm could correct 4 PD. The ACCE group increase 16% in surgical dose compared to the ET group. Conclusion: The medial rectus muscle insertion in the ACCE group is closer to the limbus than that in the ET group. More surgical dose (add 16%) is re-quired in the ACCE group than ET group.