目的 针对近年来应用360º视网膜切开术治疗复杂性视网膜脱离出现黄斑转位的患者，分析发生视网膜旋转、黄斑转位的原因，并探讨旋转性斜视和复视的诊断及治疗。方法 2例因视网膜脱离合并严重前增殖性玻璃体视网膜病变的视网膜脱离眼，松弛性360º视网膜切开术后视网膜复位，但同时发生黄斑转位。观察患者手术前后的视力、双眼视功能、主客观偏斜和眼位情况、视网膜旋转度数及黄斑移位程度。结果 病例1随诊21个月，硅油取出15个月，视力从眼前光感提高到0.01；病例2随诊3个月，硅油存留，视力从眼前光感提高到0.03。2例患者均有垂直和水平斜视，黄斑旋转40º-50º，黄斑移位约1.5DD（Disc Diameter, 视盘直径），均有主观视物偏斜症状。结论 在复杂性视网膜脱离术中360º视网膜切开能充分松解缩短的视网膜，恢复其活动度，便于清除广泛的视网膜下增生膜，提高了视网膜的解剖复位率。但术中可能发生视网膜旋转、黄斑转位，造成旋转性斜视和复视。
Objective： Analysis the causes for cyclotorsional strabismus and diplopia after 360ºretinotomy in treatment of complicated retinal detachment. Discuss the diagnosis and therapy for cyclotorsional strabismus and diplopia.Methods Two patients were treated with 360º retinotomy during vitrectomy for complicated retinal detachment with proliferative vitreoretinopathy when complete reattachment or retina was not obtained despite careful mambrane peeling. Visual acuity, binocular vision, degree of cyclotorsion, distance of foveal shift were investigated. Results Retinal attachments were obtained in the two patients. Case 1 was followed-up of 21 months, vision improved from LF to 0.01, and had undergone silicone removed. Case 2 was followed-up of 3 months, vision improved from LF to 0.03.Both patients developed horizontal and vertical strabismus with torsion of up to 40-50º,macular shift about 1.5 disc diameter(DD), and two patients complain of image tilt. Conclusion 360º retinotomy is beneficial to reattachment the retina for eyes with advanced proliferative vitreoretinopathy, and also could make the retinal rotation、macular translocation. Both patients had significant ocular torsion and strabismus.