Ludwig I H, Chow A Y
Department of Ophthalmology, LSU Eye Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.
J AAPOS. 2000 Dec;4(6):326-33. doi: 10.1067/mpa.2000.107899.
We sought to investigate abnormal scar lengthening after strabismus surgery.
Patients with overcorrection after strabismus surgery or undercorrection after extraocular muscle resection underwent exploration of previously operated muscles. Abnormal findings were documented by inspection and photography, and repair was undertaken at first with absorbable sutures and later with nonabsorbable sutures.
Lengthened scars, consisting of amorphous connective tissue, were repaired on 198 muscles in 134 procedures by excision of the scar and reattachment of the muscle to sclera; absorbable sutures were used in 64 procedures, and nonabsorbable sutures were used in 70 procedures. Thirty-one procedures were followed by partial recurrence of the original overcorrection; 7 of these had documented restretching. The use of nonabsorbable sutures decreased the recurrence of strabismus from 42% to 6%. Factors that distinguished patients with stretched scars from patients with classic slipped muscles included minimal or no limitation of versions, less separation of the tendons from sclera, and thicker appearance of the scar segments.
A lengthened or stretched remodeled scar between an operated muscle tendon and sclera may contribute to variability of outcome after strabismus repair, even years later. Definitive repair requires firm reattachment of tendon to sclera with nonabsorbable suture support.
我们试图研究斜视手术后异常瘢痕延长的情况。
对斜视手术后过矫或眼外肌切除术后欠矫的患者，对先前手术的肌肉进行探查。通过检查和摄影记录异常发现，并首先使用可吸收缝线进行修复，随后使用不可吸收缝线进行修复。
在134例手术中的198条肌肉上修复了由无定形结缔组织组成的延长瘢痕，方法是切除瘢痕并将肌肉重新附着于巩膜；64例手术使用了可吸收缝线，70例手术使用了不可吸收缝线。31例手术后原过矫部分复发；其中7例有记录的再次拉伸。使用不可吸收缝线使斜视复发率从42%降至6%。区分瘢痕拉伸患者与典型肌肉滑脱患者的因素包括眼球运动极少受限或无受限、肌腱与巩膜分离较少以及瘢痕段外观较厚。
手术肌肉肌腱与巩膜之间延长或拉伸的重塑瘢痕可能导致斜视修复术后结果的变异性，即使在数年之后。确切的修复需要用不可吸收缝线支撑将肌腱牢固地重新附着于巩膜。
