Morrison David G, Emanuel Matthew, Donahue Sean P
Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, 2311 Pierce Ave., Nashville, TN 37232-8808, USA.
Arch Ophthalmol. 2011 Feb;129(2):173-5. doi: 10.1001/archophthalmol.2010.361.
To describe the effect of graded unilateral vs bilateral lateral rectus resection in the treatment of residual or recurrent esotropia after maximal medial rectus muscle recession.
Retrospective case series of children with residual or recurrent esotropia. All children underwent initial eye muscle surgery for angles of 40 to 60 prism diopters (medial rectus recession of 5.5-6.5 mm; 11.0-11.5 mm from surgical limbus). If significant esotropia persisted or recurred, surgical results from graded lateral rectus resection were recorded.
Thirty-eight children were identified for the study. Unilateral lateral rectus resection ranging from 4 to 7 mm resulted in mean esotropic corrections of 10.5 to 14.9 prism diopters. Differences in surgical response per millimeter of unilateral lateral rectus resection were not significant. Bilateral lateral rectus resection of 5, 6, and 7 mm resulted in a mean correction of 19.75, 28.75, and 33.5 prism diopters, respectively.
Graded lateral rectus resection can produce highly variable results on a case-to-case basis, but mean values trend in the expected direction. Residual deviations larger than 15 prism diopters need to be addressed with bilateral surgery.
描述分级单侧与双侧外直肌切除术在治疗最大程度内直肌后徙术后残留或复发性内斜视中的效果。
对残留或复发性内斜视患儿的回顾性病例系列研究。所有患儿最初均接受了眼肌手术，斜视角度为40至60棱镜度（内直肌后徙5.5 - 6.5毫米；距手术角膜缘11.0 - 11.5毫米）。若仍存在明显内斜视或复发，则记录分级外直肌切除术的手术结果。
共纳入38名患儿进行研究。单侧外直肌切除术范围为4至7毫米，平均内斜视矫正量为10.5至14.9棱镜度。每毫米单侧外直肌切除术的手术反应差异无统计学意义。双侧外直肌切除术分别切除5、6和7毫米，平均矫正量分别为19.75、28.75和33.5棱镜度。
分级外直肌切除术在不同病例中可能产生高度可变的结果，但平均值呈预期方向变化。大于15棱镜度的残留斜视度需要通过双侧手术进行处理。
