First, the best time for strabismus surgery
The best time for strabismus surgery, congenital esotropia found after birth or within 6 months, should be performed before the development of binocular monocular function in 1 ~ 2 years old; If esotropia appears after 6 months, you must not operate immediately. You must have a mydriatic optometry first. If you have hyperopia, you should wear corrective glasses for 3 ~ 6 months. If esotropia is completely corrected, there is no need for surgery. Wearing glasses for more than 6 months will relieve esotropia. If residual strabismus still exists, surgery should be performed as soon as possible. If the strabismus does not change after wearing glasses, it is necessary to operate earlier. Monocular esotropia can be treated by covering therapy first, and then by surgery, which is more conducive to restoring binocular monocular function. If the coverage is ineffective for more than half a year, it can also be treated surgically.
Professor Wang Lihua, an expert in strabismus surgery in Jinan, reminded that the best time for strabismus combined with amblyopia in children strabismus surgery is to treat amblyopia first and then strabismus. Only by improving eyesight can the surgical effect be consolidated. However, for large strabismus, strabismus should be corrected first, otherwise strabismus eyes can't be fixed well and amblyopia eyes can't be treated well. For esotropia and exotropia complicated with intraocular diseases, surgery should be performed after 12 years old to prevent the recurrence of exotropia or exotropia without binocular vision control after operation.
Second, the diagnosis method of strabismus
(1) Vision:
① Check monocular vision. Patients with nystagmus should check their binocular vision at the same time, because binocular vision at the same time is better than monocular vision, and some of them can reach normal level.
② Naked vision and corrected vision with glasses.
③ Check the long distance of 5m and the short distance of 33cm. According to the near and far vision, we can preliminarily diagnose what kind of ametropia it is. For example, far vision is abnormal, near vision is normal, it may be myopia, near vision is poor, it may be hyperopia or astigmatism or amblyopia.
④ The visual acuity of infants under 3 years old can be examined by ring visual acuity chart or selective visual acuity chart.
(2) binocular visual function examination:
① Syncope is widely used to check the third level of binocular visual function in China.
② Stereo
Quantitative determination of visual function, using stereogram of synoptophore or Yan's random point stereogram to determine stereoacuity.
(3) Refraction examination: optometry of ciliary muscle with atropine paralysis, one is to know whether there is amblyopia, and the other is to know the relationship between strabismus and refraction.
(4) Determination of eye position and strabismus angle: Determine what kind of strabismus it is. Surgical design must check the size of oblique angle of view. Eye movement examination: to judge the function of extraocular muscles.
For more questions about strabismus surgery in Jinan, you can add Professor Wang's assistant WeChat to consult lzhxyk.
Third, the treatment of strabismus
The treatment of strabismus varies according to the type of strabismus, which can generally be divided into surgical treatment and non-surgical treatment.
1. Surgical treatment is to adjust the strength of the external eye muscle and the position of the attachment point through surgery, so that the eye position tends to be normal. Congenital esotropia and up-and-down strabismus mostly need surgical treatment, and unadjusted strabismus with large inclination usually needs surgical correction.
2. Non-surgical treatment: Not all strabismus requires surgical treatment. If it is accommodative esotropia, it can be corrected by wearing appropriate hyperopia glasses or binoculars. If you have moderate or high ametropia, you often need glasses to correct it. In addition, axial alignment training can help the recovery of monocular vision and increase the ability of image fusion. For example, training with a visual axis correction training machine, or wearing prism lenses. If there is amblyopia, amblyopia training is also essential.
Brief introduction of Professor Wang Lihua, an expert in strabismus surgery in Jinan.