Hull S, Verity D H, Adams G G W
Departments of Paediatric Ophthalmology, Strabismus and Neuroophthalmology, Moorfields Eye Hospital, City Road, London, UK.
Orbit. 2012 Feb;31(1):1-6. doi: 10.3109/01676830.2011.638098. Epub 2011 Dec 9.
To describe a surgical technique for correcting very large angle exodeviations and determine long term outcomes leading to the evolution of surgical technique.
A consecutive series of seven patients with large angle, incomitant squint were operated on at Moorfields Eye Hospital over a five-year period using periosteal anchoring by a joint Strabismus/Adnexal team. All patients underwent anchoring of the insertion of the medial rectus (MR) muscle to the periosteum of the medial orbital wall via a retrocaruncular approach, with or without lateral rectus (LR) disinsertion and suturing to the lateral orbital rim connective tissue. Retrospective analysis of notes assessed previous procedures, prism dioptre (PD) deviations and complications.
Included were seven eyes (five right, two left) of seven patients (two female, five male). Median age at first anchoring procedure was 25 years (range 4-57). Mean follow up was 34 months (range 8-66). Six patients had long-standing third nerve palsy, one patient had Moebius syndrome. Pre-operative exotropia ranged from 45 to 115 PDs (mean 76, median 75). At the final follow up, all patients had reduced horizontal deviations ranging from 0 to 80 PDs (mean 34, median 30). Further surgery was required in three patients all of whom did not undergo release of the LR muscle at the first procedure.
Large angle incomitant divergent squints present a particularly difficult surgical challenge. We advocate a combined bi-rectus fixation approach to hold the globe in the primary position.
描述一种矫正超大角度外斜视的手术技术，并确定导致手术技术演变的长期结果。
在五年期间，摩尔菲尔德眼科医院的斜视/附属器联合团队对连续的7例大角度、非共同性斜视患者进行了手术，采用骨膜固定术。所有患者均通过泪阜后入路将内直肌（MR）的附着点固定于眶内侧壁骨膜，可选择同时或不同时进行外直肌（LR）的断腱及缝合至眶外侧缘结缔组织。通过回顾性分析病历评估既往手术、棱镜度（PD）偏差及并发症情况。
纳入7例患者的7只眼（5例右眼，2例左眼），其中女性2例，男性5例。首次固定手术的中位年龄为25岁（范围4 - 57岁）。平均随访时间为34个月（范围8 - 66个月）。6例患者有长期的动眼神经麻痹，1例患者有梅比厄斯综合征。术前外斜视范围为45至115棱镜度（平均76，中位75）。在最后一次随访时，所有患者的水平偏差均减小，范围为0至80棱镜度（平均34，中位30）。3例患者需要进一步手术，这3例患者在首次手术时均未进行外直肌松解。
大角度非共同性外斜视是一种特别具有挑战性的手术难题。我们提倡采用双直肌固定联合手术方法将眼球保持在正位。
