Brodsky M C, Fray K J
University of Arkansas for Medical Sciences, Little Rock, USA.
J AAPOS. 1998 Dec;2(6):330-2. doi: 10.1016/s1091-8531(98)90028-3.
A subgroup of patients with intermittent exotropia have a high AC/A ratio, which places them at risk for esotropia at near after surgical treatment of their distance deviation.
A retrospective review of six patients with intermittent exotropia and a high AC/A ratio who were simultaneously treated with lateral rectus recessions to fully correct their exotropia at distance and placement of posterior fixation sutures on both medial rectus muscles in hopes of preventing an esotropia at near after surgery.
Despite the persistence of a high postoperative AC/A ratio as assessed by the gradient method, five of six patients achieved stable postoperative alignment at distance and near without bifocals. One patient required postoperative bifocal correction for intermittent esotropia at near.
In patients with intermittent exotropia and a high AC/A ratio, posterior fixation of the medial rectus muscles at the time of lateral rectus recessions enables the surgeon to fully correct the distance deviation and minimizes the risk of postoperative esotropia at near.
一部分间歇性外斜视患者的AC/A比率较高，这使他们在手术矫正远距离斜视后出现近距离内斜视的风险增加。
回顾性分析6例间歇性外斜视且AC/A比率较高的患者，这些患者同时接受了外直肌后徙术以完全矫正其远距离斜视，并在内直肌上放置后固定缝线，以期预防术后出现近距离内斜视。
尽管采用梯度法评估显示术后AC/A比率持续较高，但6例患者中有5例在远距离和近距离均实现了稳定的术后眼位，无需双焦点眼镜。1例患者术后需要双焦点眼镜矫正近距离间歇性内斜视。
对于间歇性外斜视且AC/A比率较高的患者，在外直肌后徙术时对内直肌进行后固定，可使手术医生完全矫正远距离斜视，并将术后出现近距离内斜视的风险降至最低。
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