Ophthalmology Department, UNICAMP, Campinas, SP, Brazil.
Clinics (Sao Paulo). 2009;64(4):303-8. doi: 10.1590/s1807-59322009000400006.
To evaluate the results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus.
Monocular surgery may preserve some muscles if a repeat operation is required, may help to avoid the exposure of the dominant eye to the inherent risks of a surgical procedure and may reduce surgical time.
We evaluated ninety-two consecutive patients who underwent monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus (angle of 40 prism diopters or greater). Patients were divided into group 1- esotropia and group 2 -exotropia. The postoperative follow-up was at 6 months, when the residual deviation was evaluated. In cases of residual deviations of over 15 PD (prism diopter), a second procedure was indicated.
In all patients with preoperative deviations up to 60 PD, residual deviations were under 15 PD. Some patients with preoperative deviations of 65 PD (two in group 1 and four in group 2) and all patients with deviations over 65 PD had residual deviations over 15 PD. The 13 patients who underwent a second procedure experienced successful outcomes. Our ROC curve analysis showed that the cutoff point for obtaining a successful surgical result was 62.5 PD. No patient presented with a major limitation in respect of ocular movement.
Monocular surgery under peribulbar anesthesia can be an alternative for horizontal large-angle strabismus given deviations of up to 60 PD. Monocular surgery did not result in successful outcomes for deviations of over 65 PD.
评估眼周麻醉下单眼手术治疗大角度水平斜视的效果。
如果需要再次手术，单眼手术可以保留部分肌肉，有助于避免主导眼暴露于手术固有风险，并可减少手术时间。
我们评估了 92 例连续接受眼周麻醉下单眼手术治疗大角度水平斜视（斜视角度 40 棱镜度或以上）的患者。患者分为内斜视组 1 和外斜视组 2。术后 6 个月评估残余偏斜度。如果残余偏斜度超过 15 PD（棱镜度），则需要进行第二次手术。
所有术前斜视角度在 60 PD 以内的患者，术后残余斜视角度均小于 15 PD。部分术前斜视角度为 65 PD 的患者（组 1 2 例，组 2 4 例）和所有术前斜视角度超过 65 PD 的患者，术后残余斜视角度大于 15 PD。再次手术的 13 例患者获得成功。ROC 曲线分析显示，获得成功手术结果的截断点为 62.5 PD。无患者的眼球运动受到严重限制。
眼周麻醉下单眼手术可作为斜视角度达 60 PD 以内的大角度水平斜视的一种替代治疗方法。对于斜视角度超过 65 PD 的患者，单眼手术无法取得成功的效果。
