Ruttum M S
Department of Ophthalmology, Children's Hospital of Wisconsin, Milwaukee, USA.
J AAPOS. 1997 Jun;1(2):88-91. doi: 10.1016/s1091-8531(97)90004-5.
Although initial overcorrection is believed to be important after bilateral lateral rectus muscle recessions for intermittent exotropia, not all patients with desirable amounts of initial overcorrection have good final outcomes. The purpose of this study is to evaluate the relationship between initial postoperative and subsequent postoperative motor outcomes in a group of patients operated on for intermittent exotropia.
All patients on whom I performed bilateral lateral rectus muscle recessions as the initial surgical procedure for intermittent exotropia and who had at least 6 months of postoperative follow-up were included in this study.
Of the 60 patients in this study, 38 (63%) had good outcomes (< or = 10 PD exophoria or < or = 5 PD esophoria), 15 (25%) had undercorrection (> 10 PD exodeviation), and seven (12%) had overcorrection (> 5 PD esodeviation). The chance of a good outcome was highest with initial postoperative alignment between orthotropia and 9 PD of esotropia, but 22% of patients with alignment in this range after the operation ended up overcorrected or undercorrected. Most patients had an exotropic drift after the operation, but seven patients had a drift in an esotropic direction.
Although an initial alignment within the range of orthotropia to 9 PD of esotropia during the first few days after the operation is desirable for patients with intermittent exotropia, alignment within this range does not guarantee a good final outcome, nor does alignment outside this range guarantee a bad outcome. Little predictability exists with respect to the amount and occasionally even the direction of postoperative drift. This unpredictability may in part reflect the artifactual nature of the initial postoperative measurement.
尽管对于间歇性外斜视，双侧外直肌后徙术后的初始过矫被认为很重要，但并非所有初始过矫量合适的患者都能获得良好的最终效果。本研究的目的是评估一组接受间歇性外斜视手术患者的术后初始和后续运动结果之间的关系。
本研究纳入了所有我为其实施双侧外直肌后徙作为间歇性外斜视初始手术且术后随访至少6个月的患者。
本研究的60例患者中，38例（63%）效果良好（外隐斜≤10棱镜度或内隐斜≤5棱镜度），15例（25%）矫正不足（外斜视度＞10棱镜度），7例（12%）过矫（内斜视度＞5棱镜度）。术后初始眼位在正位和9棱镜度内斜视之间时，获得良好效果的可能性最高，但在此范围内眼位矫正的患者中有22%最终出现过矫或矫正不足。大多数患者术后有外斜视漂移，但有7例患者有内斜视方向的漂移。
尽管对于间歇性外斜视患者，术后最初几天内初始眼位在正位至9棱镜度内斜视范围内是理想的，但在此范围内的眼位矫正并不能保证良好的最终效果，在此范围之外的眼位矫正也不能保证效果不佳。术后漂移的量甚至方向在很大程度上都难以预测。这种不可预测性可能部分反映了术后初始测量的人为因素。
