Gogate Parikshit M, Rishikeshi Nikhil, Taras Sudhir, Aghor Megha, Deshpande Madan D
H. V. Desai Eye Hospital, Pune, India.
Strabismus. 2010 Mar;18(1):13-7. doi: 10.3109/09273970903567618.
The study aimed to audit the results of horizontal strabismus surgery in the hospital's pediatric ophthalmology department in Maharashtra, India.
Medical records of strabismus surgeries done over 3 years were collated. Preoperative visual acuity, deviation, refraction, and orthoptic evaluation were noted as well as post-operative residual deviation and patient satisfaction. Post-operative residual deviation < or = 10Delta was considered good outcome, 11-20Delta borderline, and > 20Delta was considered poor outcome. The surgeons were briefed about their results periodically and the cause of poor outcomes discussed.
Between March 2004 and December 2007, 529 children were operated upon, of whom 461 (87.1%) completed the 6-week follow-up. Average age was 9 years 7 months (range 1-19 years). 260/461 (56.3%) patients had good, 100/461 (21.6%) borderline, and 101/461 (21.9%) had poor outcome. 133/231 (57.6%) cases of esotropia and 127/230 (55.2%) cases of exotropia had a good outcome, while the poor outcome was 50/231 (21.6%) and 51/230 (22.1%), respectively. Bilateral medial rectus recession for esotropia had 25/56 (44.6%) good outcome and 15/56 (26.7%) poor outcome, while recess-resect procedures (R/R) for esotropia had 108/175 (61.7%) good and 35/175 (20%) poor outcome (p = 0.062). Bilateral lateral rectus recession for exotropia had 30/56 (53.6%) good and 12/56 (21.4%) had poor outcome, while for recess-resect procedures for exotropia it was 97/174 (55.7%) good and 39/174 (22.4%) poor outcome (p = 0.97). The result did not significantly change over 3 years. 433/461 (93.9%) expressed satisfaction about the surgery on 6-week follow-up. Large pre-operative deviations and amblyopic eyes accounted for 63/101 (62.3%) cases of poor outcome. Fifty-seven patients recorded an improvement in stereopsis.
Recess-resect procedures had better outcome as compared to bilateral recess procedures, but it was not statistically significant. Clinical audit helped maintain and improve good outcome over the 3 years.
本研究旨在审核印度马哈拉施特拉邦某医院儿科眼科水平斜视手术的结果。
整理了3年期间斜视手术的病历。记录术前视力、斜视度、屈光状态及视功能评估情况，以及术后残余斜视度和患者满意度。术后残余斜视度≤10棱镜度被视为良好结果，11 - 20棱镜度为临界结果，＞20棱镜度为不良结果。定期向外科医生通报其手术结果，并讨论不良结果的原因。
2004年3月至2007年12月期间，529名儿童接受了手术，其中461名（87.1%）完成了6周的随访。平均年龄为9岁7个月（范围1 - 19岁）。461名患者中，260名（56.3%）结果良好，100名（21.6%）为临界结果，101名（21.9%）结果不良。内斜视手术中，133/231例（57.6%）结果良好，50/231例（21.6%）结果不良；外斜视手术中，127/230例（55.2%）结果良好，51/230例（22.1%）结果不良。内斜视双侧内直肌后徙术良好结果占25/56（44.6%），不良结果占15/56（26.7%）；内斜视后徙 - 截除术（R/R）良好结果占108/175（61.7%），不良结果占35/175（20%）（p = 0.062）。外斜视双侧外直肌后徙术良好结果占30/56（53.6%），不良结果占12/56（21.4%）；外斜视后徙 - 截除术良好结果占97/174（55.7%），不良结果占39/174（22.4%）（p = 0.97）。3年期间结果无显著变化。461名患者中433名（93.9%）在6周随访时对手术表示满意。术前斜视度大及弱视眼占不良结果的63/101例（62.3%）。57名患者立体视有所改善。
与双侧后徙术相比，后徙 - 截除术结果更好，但无统计学意义。临床审核有助于在3年期间维持并改善良好结果。
