| Acquired paralytic strabismus is a common disease.Clinical features are as follows: 1)suddenly diplopia. 2)may have trauma,nervous system and systemic diseases. 3) limitation of eye movements to various degrees.4)the second oblique angle is more than the first. 4)may have compensatory head position.It is not difficult to diagnosis paralytic muscle according to ocular symptoms and ophthalmic examination. Because the cause of extraocular muscle paralysis is very complicated, to find out the cause is the first problem before appropriate treatment. Surgery is the important method to correct strabismus and recover single binocular vision for acquired paralytic strabismus when there was no effect with conservative treatment for 6 months. In order to investigate the clinical features and surgical treatments of acquired paralytic strabismus, the clinical data of 42 patients between Mar.2002 to Feb.2007 were retrospectively summarized.Of 42 cases, 71.4%(30/42) is male and 28.6%(12/42) is female.The age is 11~65 years old(average31.5). Monocular ratio is 90.5% (38/42) and binocular ratio is 9.5%(4/42). Strabismus surgery were performed on 40 patients.1,Examination:(1) Inquired in detail about incidence,past history and complete examination of patients.(2)Following routine examinations were proceeded, such as:Visual acuity & corrected visual acuity; corneal reflection test; ocularmovements; synoptophore examination; Maddox rod and prism test; Bielschowsky tilt test; compensatory head posture;diplopia image;forced duction and fundus photograph. (3)Orbital or head CT scan.2,Treatment:The latest patients are treated by medicine.Surgery was performed on that cases whose conditions were not improved with conservative treatment for 6 months. Following principles were preferred for surgical technique choices:①with abducent palsy :Jensen rectus conjoint surgery or combined with internal rectus weakened procedure.②with oculomotor paralysis: strengthening paralytic muscles and/or weakening the directed antagonist.③with superior oblique palsies associated with under oblique hyperparathyroidism: weakening under oblique .④Cases with amputated or absent muscles by various causes were sutured after muscle exploration. Left small degree after strabismus surgery can be solved by wearing prism.3,The therapeutic effects were assessed according to following criteria:①cure: remnant squint angle≤10△,compensatory head posture and diplopia disappeared and single binocular vision was recovered.②good: diplopia looking down and horizontally disappeared,the head tilt was weaked and eye movement was obviously improved than used to, but squint angle >10△.③effective: squint angle>10△,symptoms and signs are better than before the surgery, but they are still disturbing normal life of patients.④failure: pre-and post-operative eye position has not changed. The postoperative follow-up:1,clinical feature:①The common etiologic factor which caused acquired paralytic strabismus is trauma, often with orbital fracture.②In the extraocular muscle paralysis, the frequency of a nerve injury is:abducent nerve>oculomotor nerve>trochlear nerve>composite nerve.2,Surgical effect:①Of 20 cases with abducent palsy,19cases were performed the operation with Jensen rectus conjoint surgery or combined with internalrectus weakened procedure and achieved satisfactory effect. The 14 cases were cured, 3 cases were improved and 2 cases were mended.②For cases with oculomotor paralysis, 6 of 12 patients who underwent operation were completely cured after operation, 4 cases were found with relatively good results and outcome of rest 2 cases was effective.③In 3 cases with superior oblique palsies, head tilts of 2 cases were improved and that of the rest one disappeared. The symptom of diplopia in the primary eye position disappeared.④Of 4 cases with amputated or absent muscles by various causes , 3 cases healed and 1 failed. 3,Follow– up: Effect of surgical treatments for abducent palsy is good, but the regression of eye pasition in certain degree occurred in some cases. As for oculomotor palsy, detailed preoperative examination and intraoperative ocular position observation is very important because of many uncertainties which can not be quantified. For cases with completely or partially amputated muscles by a virety of reasons , to find out ruptured muscle and fix it with primary muscle stump,and the surgical treatment effect is better than Jensen rectus conjoint surgery.According to the above clinical data and surgical results we summarized the following conclusions:(1) The common etiologic factor which caused acquired paralytic strabismus is trauma, often with orbital fracture. (2)In the extraocular muscle paralysis, the frequency of a nerve injury is:abducent nerve>oculomotor nerve>trochlear nerve>composite nerve .(3)The treatment for paralytic strabismus with botulinum toxin A is not the basic way for the treatment of this disease for its brief curative effect . (4) Bcause of the obvious squint angle and the serious degree of muscle weakness,we treated cases with abducent palsy esotropia with Jensen conjoint surgery or combined with internal recturs weakened procedure and obtained satisfactory results. As foroculomotor palsy, detailed preoperative examination and intraoperative ocular position observation is very important because of many uncertainties which can not be quantified. For cases with completely or partially amputated muscles by a virety of reasons , to find out ruptured muscle and fix it with primary muscle stump,and the surgical treatment effect is better than Jensen renctus conjoint surgery.(5) The follow-up survey showed that the regression of eye position occurred in some cases with abducent or oculomotor palsy, so appropriate over-correction was important to achieve the right eye position. |
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