Fard Masoud A, Ameri Ahmad, Anvari Faramaz, Jafari Alireza K, Yazdian Ziaeddin
Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Ophthalmol. 2010 Jul-Aug;20(4):659-63. doi: 10.1177/112067211002000402.
To evaluate and report the outcomes of a superior oblique tendon spacer procedure using nonabsorbable adjustable sutures in patients with inferior oblique (10) paresis.
This interventional case series included 6 eyes of 6 patients with 10 paresis. All met Bielschowsky/Parks Three-step Test criteria to identify an isolated 10 paresis. In all patients, the superior oblique tendon was exposed; 2 nonabsorbable polyester sutures were placed 3 mm apart, and the tendon was cut. With the use of a slipknot, the cut ends of the tendon were separated 5 to 7 mm. Tendon separation was adjusted intraoperatively according to the fundus torsion and exaggerated traction test.
The mean duration of follow-up was 8.1 months (range, 5-12 [corrected] months). Four patients had congenital 10 paresis and 2 had iatrogenic 10 paresis following denervation/myectomy of 10. Mean primary position hypotropia improved from 15.2 prism diopters (PD) before surgery to 2.7 PD in congenital 10 paresis and from 11.5 PD to 2.5 PD in iatrogenic 10 paresis. In congenital 10 paresis, mean preoperative superior oblique overaction and 10 underaction was +2 and -2, which decreased to 0 and -1.25 respectively; fundus incyclotorsion resolved in all patients. Superior oblique overaction and 10 underaction improved in iatrogenic 10 paresis as well. In no patient did an overcorrection develop.
The adjustable superior oblique tendon suture spacer procedure is an effective and safe option for correcting 10 paresis without developing iatrogenic superior oblique paresis.
评估并报告使用不可吸收可调节缝线行上斜肌腱间隔手术治疗下斜肌麻痹患者的疗效。
该介入性病例系列研究纳入了6例下斜肌麻痹患者的6只眼。所有患者均符合Bielschowsky/Parks三步试验标准，以确定单纯性下斜肌麻痹。所有患者均暴露上斜肌腱；放置两根相距3 mm的不可吸收聚酯缝线，然后切断肌腱。使用活结将肌腱断端分开5至7 mm。术中根据眼底扭转和夸张牵引试验调整肌腱间距。
平均随访时间为8.1个月（范围5 - 12[校正后]个月）。4例患者为先天性下斜肌麻痹，2例为下斜肌去神经/切除术后医源性下斜肌麻痹。先天性下斜肌麻痹患者的平均原在位下斜视度从术前的15.2棱镜度（PD）改善至2.7 PD，医源性下斜肌麻痹患者从11.5 PD改善至2.5 PD。在先天性下斜肌麻痹患者中，术前平均上斜肌亢进和下斜肌功能不足分别为+2和 - 2，术后分别降至0和 - 1.25；所有患者的眼底内旋扭转均得到解决。医源性下斜肌麻痹患者的上斜肌亢进和下斜肌功能不足也有所改善。所有患者均未出现过矫。
可调节上斜肌腱缝线间隔手术是一种有效且安全的治疗下斜肌麻痹的方法，不会导致医源性上斜肌麻痹。
