Saxena Rohit, Sinha Ankur, Sharma Pradeep, Phuljhele Swati, Menon Vimla
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
J AAPOS. 2009 Dec;13(6):578-82. doi: 10.1016/j.jaapos.2009.11.003.
To evaluate a precaruncular approach for fixation of the globe to the medial orbital wall periosteum for management of complete third (oculomotor) nerve palsy.
Consecutive patients with severe unilateral oculomotor nerve palsy present for at least 2 years were prospectively treated and evaluated. In all patients, a 12-16 mm recession of the lateral rectus muscle was performed along with the precaruncular anchoring procedure. Follow-up evaluations were performed at 1 week, and at 1, 2, and 3 months after surgery, with ongoing follow-up at 3 month intervals.
Fourteen eyes of 14 patients with complete oculomotor nerve palsy were included in the series. The median horizontal preoperative deviation of -90(Delta) +/- 4.8(Delta) reduced to -10(Delta) +/- 8.3(Delta). The vertical deviation reduced from 24(Delta) +/- 7.4(Delta) to 12.8(Delta) +/- 6.0(Delta). Mean follow-up was 8.9 +/- 5.5 months (range, 6-21 months). A slight exotropic drift was observed over 4 to 6 weeks following surgery in all cases. Satisfactory alignment was observed in 13 of the 14 cases (92.85%) over the duration of the follow-up period.
Anchoring the globe to the medial orbital wall using a precaruncular approach is a viable option in the management of complete external oculomotor nerve palsy.
评估采用泪阜前入路将眼球固定于眶内侧壁骨膜治疗完全性动眼神经麻痹的效果。
对连续就诊的严重单侧动眼神经麻痹且病程至少2年的患者进行前瞻性治疗及评估。所有患者均行外直肌后退12 - 16 mm并联合泪阜前固定术。术后1周、1个月、2个月和3个月进行随访评估，之后每3个月进行一次随访。
该系列纳入了14例完全性动眼神经麻痹患者的14只眼。术前水平位平均斜视度为-90（三棱镜度）±4.8（三棱镜度），术后降至-10（三棱镜度）±8.3（三棱镜度）。垂直斜视度从24（三棱镜度）±7.4（三棱镜度）降至12.8（三棱镜度）±6.0（三棱镜度）。平均随访时间为8.9±5.5个月（范围6 - 21个月）。所有病例术后4至6周均观察到轻微外斜漂移。随访期间14例中有13例（92.85%）眼位矫正满意。
采用泪阜前入路将眼球固定于眶内侧壁是治疗完全性动眼神经麻痹的一种可行方法。
