摘要：
目的 探讨急性获得性共同性内斜视(AACE)Ⅱ型和Ⅲ型的临床特征及手术疗效.方法 回顾性系列病例研究.收集2011年1月至2016年6月在山东大学附属省立医院接受手术治疗且随访时间在3个月以上的AACE-Ⅱ型和AACE-Ⅲ型连续性病例29例,其中男性17例,女12例;年龄(22.1±15.1)岁.所有患者均接受眼科常规检查和斜视专科检查,并排除了因其他原因发生的内斜视以及与颅内及全身疾病相关的AACE.根据看远及看近的斜视度数和主导眼的情况选择不同术式治疗,手术成功的标准为:看远及看近无显性斜视,隐斜视度数≤±8三棱镜度(PD),复视像消失.计数资料组间比较采用卡方检验与Fisher确切卡方检验,计量资料组间比较采用Wlincox秩和检验.结果 AACE-Ⅱ型患者矫正视力(LogMAR)为0(0.22,0),AACE-Ⅲ型患者矫正视力为0(0.10,0).AACE-Ⅱ型患者看远斜视度为35(10,55)PD,看近斜视度为35(20,60)PD;AACE-Ⅲ型患者看远斜视度为30(12,50)PD,看近斜视度为30(6,50)PD.29例患者术前红色滤光片试验均为水平同侧复视,左右侧向注视时复视像距离相等.行单眼内直肌后徙术14例,双眼内直肌后徙术10例,单眼内直肌后徙联合外直肌截除术4例,单眼外直肌截除术1例.术后平均随访(12.0±12.6)个月,29例患者中24例(83％)经一次手术成功;5例(17％)欠矫/复发者中4例经第二次手术(平均于第1次手术后3.5个月)成功,1例采用压贴三棱镜治疗.最后随访时,在手术成功的28例中,20例(71％)恢复了双眼中心融合,8例(29％)恢复了双眼周边融合;17例(61％)恢复了正常的立体视觉(立体视锐度≤60″),其余患者也恢复了一定程度的立体视觉(立体视锐度80″～400″).AACE-Ⅱ型与AACE-Ⅲ型两组患者术后双眼中心融合与周边融合构成比的差异无统计学意义(x2=0.235,P＞0.05),中心立体视、黄斑立体视、周边立体视构成比的差异无统计学意义(x2=0.762,P＞0.05).结论 AACE-Ⅱ型和Ⅲ型患者具有发病年龄范围较大、急性发病伴有同侧复视、矫正视力及眼球运动正常、为中等程度的内斜视但斜视度数范围较大、具有潜在双眼单视功能的临床特点;根据患者看远及看近的斜视度数和主导眼的情况选择不同术式,在运动和知觉方面可获得良好的疗效.%Objective To investigate the clinical features and surgical outcomes of patients with acute acquired concomitant esotropia (AACE) type Ⅱ (AACE-Ⅱ) and type Ⅲ (AACE-Ⅲ).Methods Retrospective case series analysis.Medical records of consecutive patients who underwent strabismus surgery for AACE-Ⅱ and AACE-Ⅲ in Shandong Provincial Hospital affiliated to Shandong University between January 2011 and June 2016 with a minimum follow-up time of 3 months were collected.Each patient underwent a complete ophthalmological and orthoptic examination to exclude esotropia resulting from other reasons,and a systemic assessment to exclude AACE related to intracranial and systemic diseases.Surgical procedures were determined according to the esodeviations measured at distance and near and the different dominant eye of patients.A successful surgical alignment was defined as the distant and near deviation in the primary gaze within 8 prism diopters (PD) of orthophoria and no diplopia.Results Twenty-nine patients were enrolled in this study,including 17 males and 12 females.The mean age of the patients was 22.14t 15.13 years (range,5-63 years).The median corrected visual acuity (LogMAR) of patients with AACE-Ⅱ was 0 (range,0.22 to 0),and that of patients with AACE-Ⅲ was 0 (range,0.10 to 0).The median esodeviation of patients with AACE-Ⅱ at distance was 35 PD (range,10 to 55 PD),and that at near was 35 PD (range,20 to 60 PD).The median esodeviation of patients with AACE-]Ⅲ at distance was 30 PD (range,12 to 50 PD),and that at near was 30 PD (range,6 to 50 PD).When tested with the red filter test preoperatively,all the patients had an uncrossed horizontal diplopia with the same distance in left and right lateral fixations.With a mean follow-up time of 12.0± 12.6 months,of all the 29 patients,24 patients (83％) achieved successful surgical alignment after one surgery,and 5 patients (17％) were undercorrected or had recurrence,in whom 4 were successfully aligned after repeated surgery (performed at a mean of 3.5 months after the first surgery) and 1 was treated with the Fresnel press-on prism.At the last follow-up,of all the 28 patients successfully aligned,20 (71％) regained bifoveal fusion,8 (29％) regained peripheral fusion,17 (61％) regained normal stereopsis (stereoacuity ≤60"),and 11 regained a certain degree of stereopsis (stereoacuity 80"-400").The constituent ratio of biocular central fusion and peripheral fusion in patients with AACE-Ⅱ had no significant difference from patients with AACE-Ⅲ (x2=0.235,P＞0.05),and the constituent ratio of central stereopsis,macular stereopsis,and peripheral stereopsis in patients with AACE-Ⅱ had no significant difference from patients with AACE-Ⅲ (x2=0.762,P＞0.05).Conclusions All patients exhibited the typical features of AACE,which included an acute onset of diplopia and comitant esotropia,a wide range of onset age of the patients,normal corrected visual acuity and ocular movements,a mean moderate level of esodeviation with a wide range,and a good binocular potential.According to the esodeviations measured at distance and near and the different dominant eye of patients,good oculomotor alignment and perceptual outcomes may be obtained in patients with AACE-Ⅱ and AACE-Ⅲ.
