Chang Yoon-Hee, Ma Kyoung Tak, Lee Jong Bok, Han Sueng-Han
Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea.
Yonsei Med J. 2004 Aug 31;45(4):609-14. doi: 10.3349/ymj.2004.45.4.609.
Although many weakening procedures for the inferior oblique muscle have been advocated, there is some controversy as to the most beneficial procedure for weakening overacting inferior oblique muscles. This study was undertaken to determine if unilateral anterior transposition of the inferior oblique muscle alone could be a safe and effective procedure for treating unilateral superior oblique palsy from the perspective of hypertropia, inferior oblique overaction, and abnormal head posture. The records of 33 patients, who underwent anterior transposition of the inferior oblique muscle for unilateral superior oblique palsy at our institution between Jan 1995 and Dec 2002, were retrospectively reviewed. The average preoperative inferior oblique overaction was 2.3 +/- 0.64, and the hypertropia in the primary position was 12.3 +/- 7.69 prism diopter (PD). Twenty-six patients showed head tilt to the opposite direction preoperatively. After the anterior transposition of the inferior oblique, inferior oblique overaction was diminished in 32 patients (97%). Twenty-six out of 33 patients (79%) had no hypertropia in the primary position at last postoperative assessment. Of the 26 patients with head tilt before surgery, 21 patients (81%) achieved full correction after surgery. Satisfactory results were obtained in most of the patients in our study with the exception of three patients who required additional surgery. No patient demonstrated postoperative hypotropia in the primary position. None of the patients noticed elevation deficiency or lower lid elevation. The anterior transposition of the inferior oblique was found to be safe and effective for treating superior oblique palsy with secondary overaction of the inferior oblique muscle.
尽管已经提出了许多用于减弱下斜肌的手术方法，但对于减弱亢进的下斜肌的最有益手术方法仍存在一些争议。本研究旨在从垂直斜视、下斜肌亢进和异常头位的角度确定单纯下斜肌单侧前徙术是否可能是治疗单侧上斜肌麻痹的一种安全有效的方法。回顾性分析了1995年1月至2002年12月在本机构接受下斜肌单侧前徙术治疗单侧上斜肌麻痹的33例患者的记录。术前下斜肌平均亢进程度为2.3±0.64，原在位垂直斜视度为12.3±7.69棱镜度（PD）。26例患者术前表现为向对侧的头位倾斜。下斜肌前徙术后，32例患者（97%）的下斜肌亢进减轻。在最后一次术后评估中，33例患者中有26例（79%）原在位无垂直斜视。在术前有头位倾斜的26例患者中，21例（81%）术后获得完全矫正。除3例需要额外手术的患者外，本研究中的大多数患者都取得了满意的结果。没有患者在原在位出现术后下斜视。没有患者出现上睑上举不足或下睑上举。发现下斜肌前徙术治疗上斜肌麻痹继发下斜肌亢进是安全有效的。
