Mojon Daniel S
Department of Strabismology & Neuro-Ophthalmology, and University of Bern, Kantonsspital St. Gallen, St. Gallen, 9007, Switzerland.
Graefes Arch Clin Exp Ophthalmol. 2009 Feb;247(2):261-5. doi: 10.1007/s00417-008-0972-7. Epub 2008 Oct 29.
To present a novel, minimally invasive strabismus surgery (MISS) technique for inferior obliquus recessions.
Graded MISS inferior obliquus recessions were performed in 20 eyes of 15 patients by applying two small conjunctival cuts, one at the insertion of inferior obliquus and another where the scleral anchoring of the muscle occurred.
The amount of recession was 12.2 +/- 2.3 mm (range 6 to 14 mm). The vertical deviation, which was measured in 25 degrees of adduction, decreased from preoperatively 12.8 degrees +/- 5.6 degrees to 2.7 degrees +/- 2.2 degrees (p < 0.0001) at 6 months. LogMAR visual acuity was preoperatively -0.10 +/- 0.17 and at 6 months -0.14 +/- 0.22 (p > 0.1). In one eye (2.5%) the two cuts had to be joined because of excessive bleeding. Binocular vision improved in eight patients, remained unchanged in six patients, and decreased from 30 to 60 arcsec in one patient (p > 0.1). Conjunctival and lid swelling were hardly visible on the first postoperative day in primary gaze position in 10/20 (50%) of eyes. Five of the eyes (25%) had mild and five (25%) moderate visibility of surgery. One patient out of 15 (7%) needed repeat surgery because of insufficient reduction of the sursoadduction within the first 6 months. The dose-effect relationship 6 months postoperatively for an accommodative near target at 25 degrees adduction was 0.83 degrees +/- 0.43 degrees per mm of recession.
This study demonstrates that small-incision, minimal dissection inferior obliquus graded recessions are feasible and effective to improve ocular alignment in patients with strabismus sursoadductorius.
介绍一种用于下斜肌后徙术的新型微创斜视手术（MISS）技术。
对15例患者的20只眼进行分级MISS下斜肌后徙术，通过在结膜上做两个小切口，一个位于下斜肌附着处，另一个位于肌肉巩膜固定处。
后徙量为12.2±2.3mm（范围6至14mm）。在内收25度时测量的垂直斜视度，术前为12.8度±5.6度，6个月时降至2.7度±2.2度（p<0.0001）。术前LogMAR视力为-0.10±0.17，6个月时为-0.14±0.22（p>0.1）。一只眼（2.5%）因出血过多，两个切口不得不缝合。8例患者双眼视觉改善，6例患者不变，1例患者从30弧秒降至60弧秒（p>0.1）。在术后第1天，10/20（50%）的眼在第一眼位时结膜和眼睑肿胀几乎不可见。5只眼（25%）手术痕迹轻度可见，5只眼（25%）中度可见。15例患者中有1例（7%）因在最初6个月内上转内收不足需要再次手术。术后6个月，在内收25度时调节近用目标的剂量-效应关系为每毫米后徙0.83度±0.43度。
本研究表明，小切口、最小化分离的分级下斜肌后徙术对于改善上转内收性斜视患者的眼位是可行且有效的。
