Livir-Rallatos Gerasimos, Gunton Kammi B, Calhoun Joseph H
Department of Pediatric Ophthalmology, Wills Eye Hospital, Philadelphia, PA 19107, USA.
J AAPOS. 2002 Apr;6(2):77-80. doi: 10.1067/mpa.2002.122059.
This study examines the surgical results of correcting large angle exodeviations in adults who may lack bifixation. The expected results in adults are not to achieve improved fusion but, rather, to construct the alignment.
A retrospective chart review was conducted of all patients with comitant exodeviation greater than 35 Delta examined and treated by 1 pediatric ophthalmologist between January 1994 and May 1999. Any patients with large A or V patterns, nystagmus, history of botulinum toxin injections for strabismus, paralytic or mechanical cause for strabismus, or use of adjustable sutures were excluded. Charts were reviewed for postoperative alignment. Postoperative results were separated into 3 categories: exodeviation greater than 10 Delta, successful outcome (esotropia<10 Delta, orthotropia, or exodeviation <10 Delta), or esotropia greater than 10 Delta.
Sixty-three patients met the inclusion criteria. Their median age at the time of surgery was 18, with a standard deviation of 20. The majority of them had intermittent exotropia that had deteriorated into constant exotropia. Fifty-two patients had bilateral lateral rectus recessions, and 11 patients had recess/resect procedures. Sixty-two percent (39 of 63) had successful outcomes overall. Only 2 patients had overcorrection (esotropia>10 Delta). In patients with deviations greater than 50 Delta, 82% (9 of 11) were undercorrected (exodeviation >10 Delta).
Large-angle exodeviations can be successfully approached with bilateral lateral rectus recessions or recess/resect procedures in preoperative deviations up to and including 50 Delta with a success rate of 71%. In larger deviations, 2-muscle surgery was not as successful (18%, or 2 of 11).
本研究探讨矫正可能缺乏双眼固视的成人重度外斜视的手术效果。成人的预期效果并非实现融合改善，而是构建眼位正位。
对1994年1月至1999年5月间1名小儿眼科医生检查并治疗的所有伴有外斜视且斜视度大于35棱镜度的患者进行回顾性病历分析。排除任何有大A或V型斜视、眼球震颤、有肉毒杆菌毒素注射治疗斜视病史、麻痹性或机械性斜视病因或使用可调节缝线的患者。查阅病历以了解术后眼位正位情况。术后结果分为3类：外斜视度大于10棱镜度、成功结果（内斜视度<10棱镜度、正位或外斜视度<10棱镜度）或内斜视度大于10棱镜度。
63例患者符合纳入标准。手术时的中位年龄为18岁，标准差为20岁。他们大多数患有间歇性外斜视，已恶化为恒定性外斜视。52例患者行双侧外直肌后徙术，11例患者行后徙/缩短术。总体而言，62%（63例中的39例）获得成功结果。仅2例患者过度矫正（内斜视度>10棱镜度）。在斜视度大于50棱镜度的患者中，82%（11例中的9例）矫正不足（外斜视度>10棱镜度）。
对于术前斜视度达50棱镜度及以下的患者，采用双侧外直肌后徙术或后徙/缩短术可成功矫正大角度外斜视，成功率为71%。对于更大的斜视度，双肌肉手术效果不佳（11例中的2例，占18%）。
