Coats David K
Cullen Eye Institute, Departments of Ophthalmology and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
Binocul Vis Strabismus Q. 2009;24(4):233-5.
A limbal surgical approach for strabismus surgery is often recommended for older patients, in the belief that the conjunctiva of older patients is too thin and prone to tear during surgery performed through a cul-de-sac incision. The purpose of this study was to evaluate the use of the cul-de-sac approach in patients more than 40 years of age.
This is a retrospective analysis of consecutive patients more than 40 years of age who underwent strabismus surgery using a modified cul-de-sac approach to reduce manipulation of the conjunctiva during surgery.
A total of 32 cul-de-sac incisions were used to operate on 37 muscles in 19 consecutive patients more than 40 years old. The man age was 58 yeasr (41-77 years) with 8 patients (12 incisions) more than 60 years old. Absorbable sutures were used to close 28 of the incisions, with 19 incisions requiring 1 suture, 7 requiring 2 sutures, and 2 incisions in 2 patients requiring more than 2 sutures. Tears resulting in extension of the conjunctival incision occurred in several patients, but no other complications were encountered. One week following surgery, 28 (87.5%) of the incisions were well closed, while a small opening was noted with 4 (12.5%) of the incisions, but none required further intervention, and all healed well.
Strabismus surgery can be performed through a cul-de-sac incision in older patients. Slight modifications of the surgical technique to prevent excessive manipulation of the incision and to reduce the risk of tearing the conjunctiva are helpful. The cul-de-sac approach offers some important potential advantages to older patients undergoing strabismus surgery.
对于老年患者，通常建议采用角膜缘手术入路进行斜视手术，因为人们认为老年患者的结膜过薄，在通过结膜囊切口进行手术时容易撕裂。本研究的目的是评估在40岁以上患者中使用结膜囊入路的情况。
这是一项对连续40岁以上患者的回顾性分析，这些患者采用改良的结膜囊入路进行斜视手术，以减少手术过程中对结膜的操作。
共对19例连续40岁以上患者的37条肌肉进行了32次结膜囊切口手术。平均年龄为58岁（41 - 77岁），其中8例患者（12个切口）年龄超过60岁。28个切口使用可吸收缝线缝合，19个切口需要1根缝线，7个切口需要2根缝线，2例患者的2个切口需要2根以上缝线。几名患者出现了导致结膜切口延长的撕裂，但未遇到其他并发症。术后1周，28个（87.5%）切口愈合良好，4个（12.5%）切口有小开口，但均无需进一步干预，且全部愈合良好。
老年患者可通过结膜囊切口进行斜视手术。对手术技术进行轻微改良以防止对切口的过度操作并降低结膜撕裂的风险是有帮助的。结膜囊入路为接受斜视手术的老年患者提供了一些重要的潜在优势。
