Trigler Lucas, Siatkowski R Michael
Dean A. McGee Eye Institute, Department of Ophthalmology, University of Oklahoma College of Medicine, Oklahoma City, USA.
J AAPOS. 2002 Feb;6(1):15-20. doi: 10.1067/mpa.2002.120644.
Risk factors for requiring multiple surgeries in infantile esotropia remain unclear. We identified clinical and demographic factors associated with horizontal reoperation in this disease.
A retrospective chart review of patients who underwent surgery from 1994-1997 was performed. Subjects were divided into 2 groups: those requiring only one operation and those requiring 2 or more operations to achieve orthotropia +/-10 PD.
In 149 patients, the overall horizontal reoperation rate was 34%. There were no statistically significant differences between the 2 groups with respect to mean age at first surgery, mean preoperative deviation, gender, prematurity, Medicaid coverage, parental age, family history of strabismus, or refractive error. The presence of nystagmus, oblique muscle dysfunction, dissociated vertical deviation (DVD), or a variable angle of esotropia was not associated with increased horizontal reoperation rate. There was a greater frequency of horizontal reoperation in patients with amblyopia, although not significant. Premature infants and infants with neurologic dysfunction had a lower incidence of horizontal reoperation, but also not significant. Deviations of less than 30 PD were associated with fewer horizontal reoperations (16% vs 31%, P =.047). Significantly more patients underwent horizontal reoperation when initial surgery was performed at less than or equal to 15 months of age (67% vs. 47%, P =.022).
Several factors thought to predispose to poor sensorimotor outcome (dissociated vertical deviation, oblique muscle dysfunction, and nystagmus) were not associated with an increased incidence of horizontal reoperation. Horizontal reoperation was less frequent in patients with angles less than 30 PD. Although some studies suggest that early surgical intervention in patients with infantile esotropia affords better sensory outcome, it may be associated with a higher horizontal reoperation rate.
婴儿型内斜视需要多次手术的危险因素仍不明确。我们确定了与该疾病水平再次手术相关的临床和人口统计学因素。
对1994年至1997年接受手术的患者进行回顾性病历审查。受试者分为两组：仅需一次手术的患者和需要两次或更多次手术以达到正位视（±10棱镜度）的患者。
149例患者中，总体水平再次手术率为34%。两组在首次手术时的平均年龄、术前平均斜视度、性别、早产、医疗补助覆盖情况、父母年龄、斜视家族史或屈光不正方面无统计学显著差异。眼球震颤、斜肌功能障碍、分离性垂直偏斜（DVD）或内斜视角度变化与水平再次手术率增加无关。弱视患者水平再次手术的频率更高，尽管差异不显著。早产儿和有神经功能障碍的婴儿水平再次手术的发生率较低，但也不显著。斜视度小于30棱镜度的患者水平再次手术较少（16%对31%，P = 0.047）。当首次手术在15个月及以内进行时，接受水平再次手术的患者明显更多（67%对47%，P = 0.022）。
一些被认为易导致感觉运动预后不良的因素（分离性垂直偏斜、斜肌功能障碍和眼球震颤）与水平再次手术发生率增加无关。斜视度小于30棱镜度的患者水平再次手术频率较低。尽管一些研究表明婴儿型内斜视患者早期手术干预能带来更好的感觉预后，但可能与更高的水平再次手术率相关。
