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巴基斯坦海德拉巴地區連續性斜視17例手術治療臨床觀察.doc

'巴基斯坦海德拉巴地區連續性斜視17例手術治療臨床觀察.doc'
?巴基斯坦海德拉巴地區連續性斜視17例手術治療臨床觀察 作者:Sameen^AfzdJunejo 單位:巴基斯坦海徳拉巴,Liaquat大學醫學院眼科醫院【摘要】目的:觀察接受斜視手術的連續性斜視患者的臨床過程和治療效果。方法:連續 性斜視患者(<45歲)分為兩組:英中第1紐為內斜視患者;第2組為外斜視患者。我們 使用棱鏡屈光度(PD)來測最患者的偏斜角,對第一次手術后的患者在隨訪期間(6mo內) 進行保守療法。同時選擇隨訪6mo后偏斜角仍超過15PD的斜視患者進行再次于術。本實 驗所有參與對彖均進行了強制性檢查。所有二次手術患者均在全身麻醉下進行,并于術后 3,15d: 3,6mo進行追蹤隨訪。結果:在整個研究期間有28.8%的患者發展成為連續性斜視。 所有斜視患者主視眼(固視眼)的二次手術均在一次手術后6?9nw內進行。經過二次手術 干預后,在隨訪期間兩紐患者均獲得了很好的治療效果,同時并未出現過矯的趨勢。結論: 在二次手術過程中我們需謹慎肌肉矯止以避免口后過矯?!娟P鍵詞】連續性斜視;主視眼;手術矯止;海徳拉巴INTRODUCTIONStrabismus can be defined as the ocular misalignment resulting in to deviation of visual axis from bi foveal fixation. 1( is one of the frequent health problems, sometimes associated with neurologiccd disorders such as cerebral palsy and craniofacial developmental anomalies. Generally the global prevalence of strabismus ranges from 3% to 5 %[1,2]? In a world wide survey, among different races, the strabismus was detected in 2% to 4% of white population and 0.6 % in Asians[3]? Donnelly et al[4] reported the prevalence of strabismus as 3.98%? In a study from Australia in 2006 the squint was diagnosed in 48 patients (2.8% of total popula tion)[5]. In one local study the squint was detected in 1.4% subjects among Afghan refugees in Pakistan[6J. In another study from Peshawar Pakistan in 2004 the over all prevalence of strabismus was 2%[7]. The consecutive strabismus usually develops during long term follow up after primary surgical correction of squint. The incidence of consecutive squint after first strabismus surgery has been reported to be 6% 20%[&9]? The surgical treatment for consecutive strabismus is required when the patients present with deviations greater than 15PD, do not respond to conservative treatment, developing amblyo pia and experience limitations in eye movementsl 10J. In the present study the postoperative changes in deviation were observed in the patients undergoing surgical correction for consecutive strabismus.PATIENTS AND METHODSPatients This was a retrospective clinical analysis conducted on the patients of both sexes with consecutive strabismus, who underwent monocular surgery for horizontal squint six to eleven months before at unit III Liaquat University eye hospital, Hyderabad of Liaquat University of Medical and Health Sciences/Jamshoro, Pakistan, from June 2003 to December 2008. The subjects suffering consecutive strabismus with deviation of more than 15 prism diopter(PD) and completing the postoperative follow up of six months were included?Methods After primary surgical intervention, on non dominant eye, the scheduled postoperative follow up was done in out patient department by two permanently posted senior ophthalmologists and four medical officers? The infomied consent of patients and attendants was obtained and complete orthoptic examination was carried out including best corrected visual acuity using Snellen s chart and E chart for illiterate children, slit lamp biomicroscopy, applanation tonometry, and indirect ophthalmoscopy a。省略部分。d 88%[ 14]. According to Park et alfl5] the surgical outcome of consecutive squint was 100% successful. In this study, 80.0% (eight subjects) achieved successful surgical outcome at the last follow up.Sometimes there is an increased tendency of developing a consecutive deviation particularly after lateral rectus muscle advancement in consecutive esotropia of larger deviations? Therefore the operating surgeon has to be very careful before planning the amount of muscle adjustment and surgical technique[16]. The increasing rate of consecutive strabismus strongly favors augmented muscle correction at the time of primary surgical intervention particularly in larger deviations of more than 65PD.【參考文獻】1 Arora A, Williums B, Arora AK. Decreasing strabismus surgery. Br J Ophthamol 2005;89:409 412 2 Abrahamsson M, Magnusson G Sjostrand J. Inheritance ofstrabismus and the gain of using heredity to determine population at risk of developing strabismus. Eye 2002; 16:519 521 3 Hu DN. Prevalence and mode of inheritance of major geneticeye diseases in China. J Med Genet 1987;24:584 588 4 Donnelly UM, Stewart NM,Hollinger M? Prevalence and outcomes of childhood visual disorders? Ophlhalmic Epidemiol 2005; 12:243 250 5 Dana Robaei, Kathryn A.Rose, Annette Kitley. Factors AssociatedWith Childhood Strabismus: Findings from a Population Based Study. Ophthalmology 2006;(113):l 146 1153 6 H.R Awan and T. Ahsan. Prevalence of Visual Impairment andEye Diseases In Afghan Refugees in Pakistan. Eastern Mediterranean Health Journal 1998;4(3):560 566 7 Nisar Ahmed, A.H Aaniir, Iqbal Hussain, Shoukat Ghulani.Annual Prevalence of Various Diseases in Hospitalized Patients in a Tertiary Level Teaching Hospital at Peshawar. Pak J Med Res 2004;43(4): 166 171 8 Hardesty HH, Bonyton JR,Keenan JP. Treatment of intermittent exotropia. Arch Ophthalmol 1978;96:268 274 9Cho YA, Kang SM, Roh GH. Asymmetric bilateral lateral recti recession in intermittent exotropia. J Korean Ophthalmol Soc 1999;40:544 549 10 von Noorden GK. Binocular Vision andOcular Motility. 6th ed. St. Louis: Mosby; 2002:371 372 11 Hardesty HH. Treatment ofovercorrected intermittent exotropia. Am J Ophthalmol 196&66:80 86 12 Burke MJ.Intermittent exotropia? In: Nelson LB, Wagner RS, editors? Intcmalional Ophthalmology Clinics, v. 25. Boston: Brown and Company; 1985. chap. 4 13 Son AN, Park SC, Lee WR. Clinicalstudy of consecutive esotropia. J Korean Ophthalmol Soc 1990;31:1328 1334 14 KimSJ, Lee SH, Woo KH. The surgical correction of consecutive esotropia. J Korean Ophthalmol Soc 1994;35:332 336 15 Park HS, Kim JB, Seo MS, Paik YG A study on the consecutiveesotropia after intermittent exotropia surgery. J Korean Ophthalmol Soc 1994;35:1327 133416 Se Hwan Jung, Sang Hoon Rah. The Clinical Course of Consecutive Esotropia after Surgical Correction. Korean J Ophthalmol 2007;21(4):228 231申明:本論文版權歸原刊發雜志社所有,我們轉載的目的是用于學術交流與討論,僅供參考不構成任何學術建議。vp>
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斜視 連續性 17 地區 手術 治療 拉巴 海德 臨床 巴基斯坦
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