Morrison David, McSwain William, Donahue Sean
Departments of Ophthalmology and Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
J AAPOS. 2010 Feb;14(1):47-51. doi: 10.1016/j.jaapos.2009.11.015.
The predictive value of preoperative stereopsis on the surgical outcome of patients with intermittent exotropia is unknown. We hypothesize that it may predict motor and sensory outcome. We report our experience with fusional status at near measured using Titmus circles before and after eye muscle surgery for intermittent exotropia.
In this retrospective case series, 95 children underwent bilateral lateral rectus muscle recession. Visual acuity, near stereoacuity, and ocular alignment were measured before surgery and 2 months postoperatively.
Testing variability by use of Titmus circles was examined. A change of greater than 3 stereo circles was found to be substantial (90% confidence interval). Of the 42 children with poor-to-nondetectable stereopsis preoperatively (400 arcsec or worse), 3 improved substantially (140, 140, 60 arcsec). The remaining 53 had moderate- (200 arcsec) to high-grade (60 arcsec or better) stereopsis preoperatively. The majority of children had no change in stereopsis after surgery. Only 4 children had improved stereopsis after surgery; 6 lost stereopsis, of whom 4 had persistent small-angle esodeviations, whereas 1 child had a large overcorrection requiring additional surgery. All children who maintained or improved their stereopsis postoperatively were orthotropic or had persistent exodeviation after surgery. No child with high-grade stereopsis at 2 consecutive preoperative visits lost stereoacuity after surgery.
A persistent small-angle esotropia at the 2-month postoperative visit is associated with a loss of near stereopsis (p=0.0001) and may occur more frequently in children with subnormal stereopsis preoperatively than in patients with bifoveal fixation. Prism or reoperation may be necessary to treat this complication.
术前立体视对间歇性外斜视患者手术结果的预测价值尚不清楚。我们假设它可能预测运动和感觉结果。我们报告了在间歇性外斜视眼肌手术前后使用Titmus视标测量近距融合状态的经验。
在这个回顾性病例系列中，95名儿童接受了双侧外直肌后徙术。在手术前和术后2个月测量视力、近距立体视和眼位。
检查了使用Titmus视标测试的变异性。发现变化大于3个视标具有显著意义（90%置信区间）。术前立体视差至无法检测（400角秒或更差）的42名儿童中，3名有显著改善（140、140、60角秒）。其余53名术前有中度（200角秒）至高等级（60角秒或更好）立体视。大多数儿童术后立体视无变化。术后只有4名儿童立体视改善；6名丧失立体视，其中4名有持续性小角度内斜视，而1名儿童有大度数过矫需要再次手术。术后保持或改善立体视的所有儿童眼位正位或术后有持续性外斜视。术前连续两次检查有高等级立体视的儿童术后无一丧失立体视。
术后2个月持续性小角度内斜视与近距立体视丧失相关（p=0.0001），术前立体视异常的儿童比双眼黄斑中心凹注视患者更易发生。可能需要使用棱镜或再次手术来治疗这种并发症。
