Vroman D T, Hutchinson A K, Saunders R A, Wilson M E
N. Edgar Miles Center for Pediatric Ophthalmology, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-2236, USA.
J AAPOS. 2000 Oct;4(5):267-70. doi: 10.1067/mpa.2000.106960.
Standard surgical treatment of congenital esotropia (CET) in patients with preoperative angles of deviation measuring </=50 PD is well defined. However, there is controversy over the management of larger angles of esotropia. Some surgeons prefer to operate on 3 or 4 horizontal rectus muscles, while others prefer to perform large recessions of the medial rectus muscles alone. The purpose of this study was to compare the rate of reoperation after bilateral medial rectus muscle recession of smaller angle (< or =50 PD) CET with the rate of reoperation after surgery for larger angle (>50 PD) CET.
Medical records of 102 patients who underwent bilateral medial rectus muscle recessions between January 1991 and December 1997 were reviewed. Patients were excluded if neurologic abnormalities or developmental delays were documented before the operation, if major structural abnormalities of the eye were present, or if less than 1-month follow-up after surgery was documented. The remaining 56 patients were assigned to either the larger angle (>50 PD) or smaller angle (< or =50 PD) group, based on the magnitude of their preoperative esotropia. Rates of reoperation for residual CET, for consecutive exotropia or dissociated horizontal deviation, or for dissociated vertical deviation with or without oblique muscle dysfunction were determined for each group.
Forty of 56 patients (71%) were assigned to the smaller angle group and 16 of 56 patients (29%) to the larger angle group. In the larger angle group, 4 patients (25%) underwent surgery for residual esotropia. In the smaller angle group, 8 patients (19%) underwent surgery for residual esotropia, 8 (19%) underwent surgery for consecutive exotropia or dissociated horizontal deviation, and 8 (19%) underwent surgery for dissociated vertical deviation or oblique muscle dysfunction.
The success rate for ocular realignment in patients with CET by using bilateral medial rectus muscle recession did not appear to diminish when applied to deviations greater than 50 PD as compared with smaller angle deviations. Surgery on 3 or 4 horizontal rectus muscles may be unnecessary in the treatment of patients with very large angles of CET.
对于术前斜视度测量≤50三棱镜度（PD）的先天性内斜视（CET）患者，标准的手术治疗方法已明确。然而，对于更大斜视度的治疗存在争议。一些外科医生倾向于对3条或4条水平直肌进行手术，而另一些医生则倾向于仅对内直肌进行大幅度后徙术。本研究的目的是比较小角度（≤50 PD）CET患者双侧内直肌后徙术后的再次手术率与大角度（>50 PD）CET患者手术后的再次手术率。
回顾了1991年1月至1997年12月期间接受双侧内直肌后徙术的102例患者的病历。如果术前记录有神经异常或发育迟缓、存在眼部主要结构异常或术后随访时间少于1个月，则将患者排除。根据术前内斜视的程度，将其余56例患者分为大角度（>50 PD）组或小角度（≤50 PD）组。确定每组中因残余CET、连续性外斜视或分离性水平偏斜、或伴有或不伴有斜肌功能障碍的分离性垂直偏斜而进行再次手术的比率。
56例患者中有40例（71%）被分配到小角度组，56例患者中有16例（29%）被分配到大角度组。在大角度组中，4例患者（25%）因残余内斜视接受手术。在小角度组中，8例患者（19%）因残余内斜视接受手术，8例（19%）因连续性外斜视或分离性水平偏斜接受手术，8例（19%）因分离性垂直偏斜或斜肌功能障碍接受手术。
与小角度斜视相比，对于大于50 PD的斜视，采用双侧内直肌后徙术进行眼位矫正的成功率似乎并未降低。对于非常大角度的CET患者，可能无需对3条或4条水平直肌进行手术。
