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ENGLISH ABSTRACT
AS-OCT对共同性外斜视矫正术后眼外肌止端探查的可行性
段瑞
杨积文
刘佳
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20191103-00478
Feasibility of AS-OCT measuring rectus muscle insertion after concomitant exotropic corrective surgery
Duan Rui
Yang Jiwen
Liu Jia
Authors Info & Affiliations
Duan Rui
Aier School of Ophthalmology, Central South University, Changsha 410015, China
Yang Jiwen
Shenyang Aier Eye Hospital, Shengyang 110000, China
Liu Jia
Shenyang Aier Eye Hospital, Shengyang 110000, China
·
DOI： 10.3760/cma.j.cn115989-20191103-00478
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摘要

目的评估眼前节光相干断层扫描(AS-OCT)探查共同性外斜视矫正术后水平眼外肌止端位置的可行性。

方法采用横断面研究方法，纳入2018年3月至2019年2月在沈阳爱尔眼视光医院就诊的共同性外斜视患者25例25眼，所有患者均接受斜视矫正手术。分别于术前、手术开始、术终、术后2周及术后1、3和6个月测量角膜缘至水平眼外肌止端的距离，手术开始及术终时用卡尺进行测量，术前及术后用AS-OCT进行测量，应用AS-OCT评价斜视矫正术后不同时间点眼外肌止端的位置变化。采用33 cm三棱镜联合交替遮盖法检查术前及术后不同时间点术眼斜视度。

结果共测量共同性外斜视患者25眼的44条水平眼外肌，包括外直肌25条和内直肌19条。术后2周和术后1个月AS-OCT对肌止端的检出率低。术终卡尺测量以及术后3个月和6个月AS-OCT测量的角膜缘至外直肌止端的距离分别为(12.30±1.40)、(11.72±1.45)和(11.84±1.27)mm，总体比较差异有统计学意义( F＝4.085， P＝0.023)；术终测量角膜缘至外直肌止端的距离大于术后3个月，差异有统计学意义( P＝0.018)。术终卡尺测量及术后3个月和6个月测量的角膜缘至内直肌止端的距离分别为(5.12±0.42)、(5.56±0.61)和(5.28±0.57)mm，总体比较差异无统计学意义( F＝3.912， P＝0.055)。术后各时间点患者斜视度均明显小于术前，差异均有统计学意义(均 P<0.05)。

结论AS-OCT可以成功显示共同性外斜视矫正术后水平眼外肌止端位置的纵向变化。

共同性外斜视;生物测量;光相干断层扫描，眼前节;眼外肌;肌止端
ABSTRACT

ObjectiveTo investigate the feasibility of rectus muscle insertion measurement with anterior segment optical coherence tomography (AS-OCT) after corrective surgery of concomitant exotropia.

MethodsA cross-sectional study was performed.Twenty-five eyes of 25 patients with concomitant exotropia were included in Shenyang Aier Eye Hospital from March 2018 to February 2019, and all patients received concomitant exotropic corrective surgery.The distance of limbus to rectus muscle insertion was measured before operation, at the beginning and at the end of operation with a caliper and at postoperative 2 weeks, 1 month, 3 months and 6 months with AS-OCT, respectively.Degree of strabismus was examined by the alternate prism cover test at 33 cm.The research followed the Declaration of Helsinki and the protocol was approved by a Medical Ethics Committee of Shenyang Aier Eye Hospital (No.2017KJB005). Written informed consent was obtained from the patients/custodians prior to any medical examination and treatment.

ResultsA total of 44 rectus muscles of 25 eyes with concomitant exotropia were measured, including 25 lateral rectus muscles and 19 medial rectus muscles.The detection rate of the muscle insertion by AS-OCT was low at 2 weeks and 1 month after surgery.The mean distance of limbus to lateral rectus muscle insertions was (12.30±1.40), (11.72±1.45) and (11.84±1.27)mm at the end of operation and postoperative 3 and 6 months, respectively, showing a significant difference among them (F=4.085, P=0.023), and the distance measured at the end of operation was significantly larger than that at postoperative 3 months (P=0.018). The mean distance of limbus tomedial rectus muscle insertion was (5.12±0.42), (5.56±0.61) and (5.28±0.57)mm at the end of operation, postoperative 3 and 6 months, respectively, and there was no significant difference among the three time points (F=3.912, P=0.055). The degree of strabismus of the patients at various time points after surgery were significantly reduced in comparison with that before surgery (all at P<0.05).

ConclusionsAS-OCT can track the position of extraocular muscle insertions after concomitant exotropic corrective surgery.

Concomitant exotropia;Biometry;Optical coherence tomography, anterior segment;Extraocular muscle;Muscle insertion
Yang Jiwen, Email: mocdef.3ab61.piv5791newijgnay
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引用本文

段瑞,杨积文,刘佳. AS-OCT对共同性外斜视矫正术后眼外肌止端探查的可行性[J]. 中华实验眼科杂志,2021,39(03)：228-232.

DOI:10.3760/cma.j.cn115989-20191103-00478

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共同性外斜视是临床上常见的一种斜视类型，不仅影响患者外观，而且影响其双眼视觉的形成和发育，手术治疗是矫正共同性外斜视的常用疗法。共同性外斜视矫正术后角膜缘至水平眼外肌止端的距离对眼位的恢复至关重要，斜视矫正术后出现过矫或欠矫者则需再次手术，了解角膜缘至眼外肌止端的距离十分重要。既往有多项研究采用超声生物显微镜(ultrasound biomicroscope，UBM)对角膜缘到眼外肌止端的距离进行测量 [ 1 , 2 , 3 , 4 , 5 ]，但其检查过程中超声探头需置于眼球表面，易引起患者不适，也给术后的观察随访带来困难。眼前节光相干断层扫描(anterior segment optical coherence tomography，AS-OCT)应用光学成像模式提供眼前节组织结构的横断面高分辨率图像，对操作者的检查技术无特殊要求，具有无创、非接触等优点，受到广泛关注 [ 6 , 7 ]。研究表明，AS-OCT可测量角膜缘至水平眼外肌止端距离，其测量结果与术中的卡尺测量法测量结果一致性较好 [ 8 ]，从而实现对斜视术后眼外肌止端的评估，但目前鲜有人体水平眼外肌后退和缩短术后肌止端的纵向变化情况研究。本研究探讨AS-OCT对共同性外斜视矫正术后水平眼外肌止端动态变化检查的可行性，为AS-OCT指导需要再次手术眼的手术设计提供参考。
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杨积文，Email： mocdef.3ab61.piv5791newijgnay
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