Wei Yan, Kang Xiao-li, Dong Ling-yan, Cen Jie, Chen Yi-ye, Xu Yu
Xinhua Hospital Affiliated to the Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Zhonghua Yan Ke Za Zhi. 2011 Sep;47(9):797-800.
To investigate cyclotorsion changes after strabismus surgery in superior oblique palsy patients.
Forty patients (50 eyes) underwent myotomy of inferior oblique (15 patients, 15 eyes), partial myectomy of inferior oblique (15 patients, 15 eyes) or myotomy of inferior oblique combined with inferior rectus recession on the other eye (10 patients, 20 eyes) for treatment of monocular superior oblique palsy. Objective cyclotorsion were examined pre-operation, as well as 1, 7, 30, and 90 d post-operation with fundus photograph and quantitive measurement. Vertical deviation and ocular movement were also assessed before and after surgery. Fundus photograph were also examined in 30 normal persons (60 eyes) without strabismus.
The fovea-to-disc angle of normal people was 6.7°±2.5° in the right eye, 5.9°±2.3° in the left eye, and 12.6°±4.3° when combined. The cyclotorsion angle was not statistically significant between two eyes (t=1.29, P=0.20). For the monocular superior oblique palsy patients, preoperative fovea-to-disc angle was 14.3°±6.6° in the affected eyes, 12.2°±4.8° in the fellow eyes, and 26.5°±10.3° when combined. The objective cyclotorsion was also not statistically significant between two eyes (t=1.64, P=0.11). The comparison of total cyclotorsion angle of both eyes showed significant difference between normal people and patients. The fovea-to-disc angle of 1, 7, 30 and 90 d after operation were 11.7°±4.3°, 11.9°±4.9°, 13.5°±5.2° and 15.9°±3.6° respectively. The comparison of objective ocular cyclotorsion for both eyes showed significant difference pre- and post-operation (F=40.13, P<0.01). There is a gradual increasing trend of postoperative excyclotorsion angle with the prolonged time. There were statistically significant difference between 90 d and 1 d, 7 d after surgery. The two inferior oblique weakening procedures, myotomy of inferior oblique and partial myectomy of inferior oblique produced equitable amount of incyclotorsion shift with no statistical difference. The difference between the cyclotorsion change induced by myotomy of inferior oblique and inferior rectus recession in counter side was also not statistically significant.
Monocular superior oblique palsy patients had fundus excyclotorsion change that was nearly equally distributed between two eyes. Weakening the inferior oblique and inferior rectus could correct ocular excyclotorsion, the regression trend was observed 90 d after surgery. Both myotomy and partial myectomy of inferior oblique were equally effective in the correct of ocular cyclotorsion and vertical deviation.
探讨上斜肌麻痹患者斜视手术后的旋转扭转变化。
40例患者（50只眼）接受下斜肌切断术（15例，15只眼）、下斜肌部分切除术（15例，15只眼）或下斜肌切断术联合对侧下直肌后徙术（10例，20只眼）治疗单眼上斜肌麻痹。术前、术后1天、7天、30天和90天采用眼底照相和定量测量检查客观旋转扭转。术前和术后还评估垂直斜视度和眼球运动。对30例无斜视的正常人（60只眼）也进行眼底照相检查。
正常人右眼的黄斑-视盘夹角为6.7°±2.5°，左眼为5.9°±2.3°，双眼合并为12.6°±4.3°。两眼之间的旋转扭转角无统计学差异（t=1.29，P=0.20）。对于单眼上斜肌麻痹患者，患眼术前黄斑-视盘夹角为14.3°±6.6°，健眼为12.2°±4.8°，双眼合并为26.5°±10.3°。两眼之间的客观旋转扭转也无统计学差异（t=1.64，P=0.11）。双眼总旋转扭转角的比较显示，正常人与患者之间存在显著差异。术后1天、7天、30天和90天的黄斑-视盘夹角分别为11.7°±4.3°、11.9°±4.9°、13.5°±5.2°和15.9°±3.6°。双眼客观眼球旋转扭转的术前和术后比较有显著差异（F=40.13，P<0.01）。术后外旋转扭转角随时间延长呈逐渐增加趋势。术后90天与术后1天、7天之间有统计学差异。两种下斜肌减弱手术，即下斜肌切断术和下斜肌部分切除术产生的内旋转扭转移位量相等，无统计学差异。下斜肌切断术与对侧下直肌后徙术引起的旋转扭转变化差异也无统计学意义。
单眼上斜肌麻痹患者眼底存在外旋转扭转变化，两眼之间分布几乎相等。减弱下斜肌和下直肌可纠正眼球外旋转扭转，术后90天观察到回归趋势。下斜肌切断术和下斜肌部分切除术在纠正眼球旋转扭转和垂直斜视方面同样有效。
