Bhatta Sudipto, Auger Graham, Ung Tsiang, Burke John
Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
J Pediatr Ophthalmol Strabismus. 2012 Jan-Feb;49(1):43-8. doi: 10.3928/01913913-20110208-02. Epub 2011 Feb 15.
To assess the incidence and investigate the functional impact of postoperative overcorrection following primary unilateral inferior oblique muscle recession and myectomy for inferior oblique overaction.
A retrospective study of 79 consecutive patients undergoing inferior oblique myectomy (43) or recession (36) with a minimum 6 months of postoperative follow-up. All underwent ocular motility examinations preoperatively and postoperatively at approximately 2 weeks and 6 months. The vertical deviation in primary position and on contralateral gaze and inferior oblique versions and ductions on contralateral elevation were analyzed.
At 6 months, 51 patients had no inferior oblique underaction (group 1), 23 of 28 who had developed inferior oblique underaction were asymptomatic (group 2), and the remaining 5 were symptomatic (group 3). The mean preoperative hyperdeviation was 12.9 (group 1), 13.1 (group 2), and 15 (group 3) prism diopters (PD) in primary position. Postoperatively, these measured 3.8 (group 1), 3.8 (group 2), and -7.8 (group 3) PD (- indicates deviation reversal). The mean preoperative and postoperative inferior oblique versions for these three groups were +2.7, +2.2, +2.2 units and +0.9, -1.0, -1.4 units, respectively.
Inferior oblique underaction was common (28 patients, 35.4%), generally mild, persistent, and usually asymptomatic 6 months following surgery. Although uncommon (5 patients, 6.3%), symptomatic inferior oblique underaction required further surgery with a successful outcome. They included 2 patients with a history of head or orbital trauma and one with masked and one with highly asymmetric bilateral inferior oblique overaction.
评估原发性单侧下斜肌后徙术和切除术治疗下斜肌亢进术后过矫的发生率，并研究其对功能的影响。
对79例连续接受下斜肌切除术（43例）或后徙术（36例）的患者进行回顾性研究，术后随访至少6个月。所有患者术前、术后约2周和6个月均接受眼动检查。分析原在位和对侧注视时的垂直偏斜以及对侧上转时的下斜肌斜视角和运动。
术后6个月时，51例患者无下斜肌功能不足（第1组），28例出现下斜肌功能不足的患者中有23例无症状（第2组），其余5例有症状（第3组）。原在位时，三组患者术前平均上斜度分别为12.9（第1组）、13.1（第2组）和15（第3组）三棱镜度（PD）。术后，这些数值分别为3.8（第1组）、3.8（第2组）和-7.8（第3组）PD（“-”表示偏斜反转）。这三组患者术前和术后下斜肌斜视角的平均值分别为+2.7、+2.2、+2.2和+0.9、-1.0、-1.4。
下斜肌功能不足很常见（28例患者，35.4%），通常较轻、持续存在，且术后6个月通常无症状。虽然有症状的下斜肌功能不足不常见（5例患者，6.3%），但需要进一步手术且预后良好。这些患者包括2例有头部或眼眶外伤史的患者，1例有隐匿性和1例有高度不对称双侧下斜肌亢进的患者。
