Hatz K B, Brodsky M C, Killer H E
Department of Ophthalmology, Kantonsspital Aarau and University Eyeclinic Basel, Basel, Switzerland.
Eur J Ophthalmol. 2006 Jan-Feb;16(1):10-6. doi: 10.1177/112067210601600103.
To evaluate the efficacy of isolated inferior oblique muscle weakening in the treatment of superior oblique palsy.
Forty-seven patients with superior oblique palsy underwent either single-muscle surgery (anteriorization or recession of the inferior oblique muscle) or two-muscle surgery (anteriorization of the inferior oblique muscle combined with recession of the contralateral inferior rectus muscle according to the amount of vertical deviation). In a retrospective noncomparative study the objective surgical effect was calculated as the difference between the deviation at the day before surgery and the deviations 6 weeks and at least 1 year after surgery. Pre- and postoperative sensorimotor status and subjective outcome were evaluated.
In patients who underwent isolated inferior oblique muscle surgery the mean preoperative vertical deviation decreased from 15+/-9 (distance)/16+/-10 (near) prism diopters (PD) (anteriorization) and 7+/-5 (distance)/9+/-8 (near) PD (recession) to 4+/-4 (distance)/4+/-6 (near) PD (anteriorization) and 2+/-2 (distance)/2+/-3 (near) PD (recession) at the 1-year follow-up. In patients who underwent two-muscle surgery the mean vertical deviation decreased from 20+/-11 (distance)/21+/-10 (near) PD preoperatively and 6+/-7 (distance)/6+/-6 (near) PD at 1-year follow-up. Subjective assessment showed excellent scores among the patients treated with single-muscle surgery and slightly lower but also favorable scores among the patients treated with combined techniques. A direct comparison of the different outcome scores was not possible because of the more difficult initial situation in patients who underwent combined surgery.
Isolated inferior oblique muscle weakening is an effective treatment option for superior oblique palsy up to 15 PD of vertical deviation in primary position. Two-muscle surgery should be reserved for patients with larger vertical deviations.
评估单纯下斜肌减弱术治疗上斜肌麻痹的疗效。
47例上斜肌麻痹患者接受了单肌手术（下斜肌前徙术或后徙术）或双肌手术（根据垂直偏斜量，下斜肌前徙术联合对侧下直肌后徙术）。在一项回顾性非对照研究中，客观手术效果通过术前一天的偏斜度与术后6周及至少1年后的偏斜度之差来计算。评估术前和术后的感觉运动状态及主观结果。
接受单纯下斜肌手术的患者，术前平均垂直偏斜度在远距离时为15±9（棱镜度）/近距离时为16±10（棱镜度）（前徙术），以及远距离时为7±5（棱镜度）/近距离时为9±8（棱镜度）（后徙术），在1年随访时分别降至4±4（棱镜度）/远距离时为4±6（棱镜度）（前徙术）及2±2（棱镜度）/远距离时为2±3（棱镜度）（后徙术）。接受双肌手术的患者，术前平均垂直偏斜度在远距离时为20±11（棱镜度）/近距离时为21±10（棱镜度），1年随访时为6±7（棱镜度）/远距离时为6±6（棱镜度）。主观评估显示，接受单肌手术的患者评分优秀，接受联合手术的患者评分略低但也良好。由于接受联合手术的患者初始情况更复杂，无法直接比较不同的结果评分。
单纯下斜肌减弱术是治疗原在位垂直偏斜达15棱镜度的上斜肌麻痹的有效治疗选择。双肌手术应保留给垂直偏斜较大的患者。
