Rajavi Zhale, Mohammad Rabei Hossein, Ramezani Alireza, Heidari Alireza, Daneshvar Faride
Imam Hossein Medical Center, Shaheed Beheshti University of Medical Sciences, No 31, Rafat Ave. Shariati St., Tehran 1934653961, Iran.
Int Ophthalmol. 2008 Apr;28(2):83-8. doi: 10.1007/s10792-007-9116-z. Epub 2007 Jul 19.
To determine refractive and corneal topographic changes after horizontal rectus muscles recession.
In a noncomparative interventional case series, 49 eyes of 27 patients were evaluated in two groups: (1) exotropic patients (24 eyes) who underwent lateral rectus muscle(s) recession, and (2) esotropic patients (25 eyes) who underwent medial rectus muscle(s) recession. Full ophthalmic examination including cycloplegic automated refraction was carried out before, 1 and 3 months after surgery. Corneal topography was performed preoperatively and repeated at 3 months postoperatively.
In eyes underwent medial rectus recession, there were statistically significant myopic shifts in spherical equivalent at month 1 (from +2.09+/-1.82 to +1.88+/-1.83 diopters, P=0.03) and in astigmatic power at both month 1 (from -0.85+/-0.67 to -1.15+/-0.65 diopter, P=0.04) and month 3 (from -0.85+/-0.67 to -1.16+/-0.65 diopter, P=0.01). Myopic shifts were also noted following lateral rectus recession; however, there were not statistically meaningful. Significant astigmatic axis shift, which was toward with the rule astigmatism, was detected only after lateral rectus recession at both month 1 (P=0.02) and month 3 (P=0.02). Corneal power measured by topography was also demonstrated a statistically significant reduction (less than 0.3 diopter) after recession of either medial (P<0.001) or lateral (P<0.001) rectus muscle.
In spite of being statistically significant in some parts, the amounts of refractive and corneal topographic changes were not clinically remarkable. Therefore, it does not seem necessary to perform cycloplegic refraction early after horizontal rectus muscle recession; however, a precise refraction in all cases of strabismus should not be deferred later than 3 months.
确定水平直肌后徙术后的屈光和角膜地形图变化。
在一个非对照性干预病例系列中，对27例患者的49只眼进行了两组评估：（1）外斜视患者（24只眼）接受外直肌后徙术，（2）内斜视患者（25只眼）接受内直肌后徙术。在手术前、术后1个月和3个月进行了包括睫状肌麻痹自动验光在内的全面眼科检查。术前进行角膜地形图检查，并在术后3个月重复检查。
在内直肌后徙的眼中，术后1个月等效球镜有统计学意义的近视性移位（从+2.09±1.82屈光度至+1.88±1.83屈光度，P=0.03），术后1个月和3个月散光度数均有变化（从-0.85±0.67屈光度至-1.15±0.65屈光度，P=0.04；从-0.85±0.67屈光度至-1.16±0.65屈光度，P=0.01）。外直肌后徙后也观察到近视性移位，但无统计学意义。仅在外直肌后徙术后1个月（P=0.02）和3个月（P=0.02）检测到明显的散光轴移位，向顺规散光方向。无论是内直肌（P<0.001）还是外直肌（P<0.001）后徙后，角膜地形图测量的角膜屈光力也显示出统计学意义的降低（小于0.3屈光度）。
尽管在某些方面有统计学意义，但屈光和角膜地形图变化的程度在临床上并不显著。因此，水平直肌后徙术后早期似乎没有必要进行睫状肌麻痹验光；然而，所有斜视病例的精确验光不应迟于3个月。
