Esser J, Schittkowski M, Eckstein A
Orthoptik, Universitäts-Augenklinik Essen, Essen.
Klin Monbl Augenheilkd. 2011 Oct;228(10):880-6. doi: 10.1055/s-0031-1281776. Epub 2011 Oct 13.
In motility disorders related to Graves' orbitopathy, recession of fibrotic eye muscles is the treatment of choice. Correction of very large squint angles can be difficult, since the distance of recession is limited by the necessity to maintain a sufficient arc of contact. A new technique of tendon elongation has been developed in order to maintain sufficient arcs of contact even in patients with large horizontal squint angles, especially after orbital decompression surgery. The established dose-effect relationship cannot simply be conveyed to inferior rectus muscle surgery, due to a different impact of simple recession on inferior and medial rectus muscles.
Recession of the inferior rectus muscle was performed in 10 patients with simultaneous suturing of bovine pericardium (Tutopatch). This procedure was performed as primary surgery in 7 patients (2 after orbital decompression) and as secondary procedure in 3 patients. Squint angle (far distance), bulbus excursion movements and field of binocular single vision were evaluated pre- and postoperatively.
Alignment (far distance) was achieved in 8 of 10 cases at the final follow-up examination. Two patients required corrective prisms. Visual fields were virtually free of diplopia in all patients. The dose-response effect for tendon elongation of the inferior rectus muscle was identical to that for the simple recession of this muscle. There were no complications.
The new technique of tendon elongation using a bovine pericardium graft is applicable in large vertical squint angles (with or without prior bony orbital decompression) as well as for corrections after insufficient simple recessions (by realignment of the muscle and secondary suturing of the graft). Functional improvement can thus be achieved through surgery of a single muscle, keeping the other muscles in reserve for further interventions (lowering the risk of postoperative anterior segment ischaemia). There is a dose effect analogous to large horizontal squint angles in Graves' orbitopathy (dosing formula: 1 mm inferior rectus recession [including graft] leads to 2.0° vertical angle reduction). This corresponds to simple recessions of the inferior rectus muscle but differs from tendon elongations of the medial rectus muscles.
在与格雷夫斯眼眶病相关的眼球运动障碍中，纤维化眼肌后退术是首选治疗方法。由于后退距离受维持足够接触弧的必要性限制，矫正非常大的斜视角度可能会很困难。为了即使在水平斜视角度大的患者中，尤其是在眼眶减压手术后，也能维持足够的接触弧，已经开发出一种新的肌腱延长技术。由于单纯后退对下直肌和内直肌的影响不同，已确立的剂量 - 效应关系不能简单地应用于下直肌手术。
对10例患者进行下直肌后退术并同时缝合牛心包（Tutopatch）。该手术在7例患者中作为初次手术进行（2例在眼眶减压术后），在3例患者中作为二次手术进行。术前和术后评估斜视角度（远距离）、眼球运动和双眼单视视野。
在最后一次随访检查时，10例患者中有8例实现了（远距离）眼位矫正。2例患者需要矫正棱镜。所有患者的视野几乎没有复视。下直肌肌腱延长的剂量 - 反应效应与该肌肉单纯后退的效应相同。没有并发症。
使用牛心包移植物的肌腱延长新技术适用于大的垂直斜视角度（有或没有先前的眼眶减压手术），以及单纯后退不足后的矫正（通过肌肉重新排列和移植物二次缝合）。因此，通过单条肌肉手术可以实现功能改善，保留其他肌肉以备进一步干预（降低术后眼前段缺血的风险）。存在与格雷夫斯眼眶病中水平斜视角度大类似的剂量效应（剂量公式：下直肌后退1毫米[包括移植物]导致垂直角度减少2.0°）。这与下直肌单纯后退相对应，但与内直肌肌腱延长不同。
