Park surgery

Congenital horizontal nystagmus (CHN) is an involuntary eye movement. Cogan divides CHN into 2 types. 1. Sensory defect nystagmus The macular imaging caused by afferent defects is unclear and hinders the control of the eyeball by the fixation mechanism. The clinical manifestation is bilateral bilateral pendulum type nystagmus, no fast, slow phase. The causes are congenital or traumatic cataracts, high myopia, congenital glaucoma, albinism and irido disease. 2. Motor defect nystagmus is a transmission defect, including the conjugated motion control center and the efferent pathway. It appears shortly afterwards, unchanged for life, and there is no abnormality in the eye. The nystagmus is mostly impulsive, with fast and slow phases. More accompanied by a clear compensatory head position. The purpose of CHN surgery is to reduce or eliminate nystagmus, improve the compensatory head position and improve vision. There are many surgical methods, such as Anderson's slow phase side pair of spouse muscle migration, and Goto's fast phase side pair of partner muscle shortening. Congenital nystagmus is associated with defects in the neural mechanisms of eye movement, and its diagnostic criteria include: 1 early onset, emerged from childhood; 2 oscillopsia, even if the nystagmus is quite serious, is the main criterion for diagnosis; 3 the involuntary continuous swing or beat of the eyeball has regularity; 4 eyeball rotation is barrier-free, no eye Abnormalities or other congenital anomalies; 5 daily activities have no effect, binocular vision and corrected visual acuity are generally above 0.1; 6 no imbalance and dizziness and other central nervous system disorders and vestibular dysfunction symptoms; 7 closed eyes or in the dark The nystagmus disappeared when the eye was seen; the nystagmus was confirmed by the 8 nystagmus. Treatment of diseases: congenital nystagmus Indication Park surgery is indicated for congenital horizontal nystagmus (CHN) with a significant compensatory head position. Contraindications Otogenic or central nystagmus. Preoperative preparation 1. ENG check: The frequency, amplitude, and angle of the resting eye position of the nystagmus are measured. 2. Use a prism to measure the degree of triangularity that reduces the nystagmus to the maximum or the abnormal head position. This prismatic degree should be used as the amount of surgery. 3. Use the torticolometry to measure the accuracy of the abnormal head position (ie, the degree of head tilt, face turn and mandible up or adduction of three axial positions). Surgical procedure The amount of rectus surgery in both eyes was 5-6 mm (ie 5 mm after migration of one leg of the eye and 6 mm of shortening of the other eye). The volume of the external rectus muscle was 7-8 mm (that is, the outer rectus muscle migrated 7 mm and the other eye shortened 8 mm). ). Take the right turn 25 ° ~ 30 ° as an example, the rest of the eye position on the left. In the right eye, the rectus muscle is 5mm after migration, and the left rectus muscle is shortened by 6mm; the left lateral rectus muscle is 7mm after migration, and the right lateral rectus muscle is shortened by 8mm, that is, 5, 6, 7, and 8. The sum of the two right rectus exercises was equal, 13 mm; 4 straight rectus surgery was performed at one time. At present, many advocates for asymmetric surgery, that is, the method of 5, 6, 7, 7mm or 6, 6, 7, 8mm. Due to the high recurrence rate after Park, Nelson et al. improved the amount of surgery for patients with compensated head position between 30° and 45° (40,4, 8.4, 9.8, 11.2 mm); head position >45° The amount of surgery increased by 60% (ie 8, 9.6, 11.2, 12.8 mm).

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