Arici Ceyhun, Oguz Velittin
Department of Ophthalmology, Gulhane Military Medical Faculty, Ankara, Turkey.
J AAPOS. 2012 Feb;16(1):21-5. doi: 10.1016/j.jaapos.2011.09.015.
To compare the effectiveness of superior oblique tuck and inferior oblique weakening procedures on objective and subjective torsion in patients with superior oblique palsy.
Patients with unilateral superior oblique palsy evaluated between September 2007 and October 2009 were treated with one of four surgical procedures on the basis of their preoperative findings: superior oblique tuck, anterior transposition of the inferior oblique muscle, inferior oblique recession, or inferior oblique myectomy. Subjective (double Maddox rods) and objective (fundus photography) torsion were measured pre- and postoperatively.
A total of 28 patients were evaluated (mean age, 16.4 ± 12.4 years; range, 6-51 years). In 15 (53.6%) the superior oblique palsy was congenital; in 13 (46.4%) it was acquired. The mean decrease in subjective extorsion was 6.2° ± 2.3° after superior oblique tuck, 2.3° ± 2.4° after anterior transposition of the inferior oblique, 1.3° ± 2.7° after inferior oblique recession, and 2.6° ± 4.7° after inferior oblique myectomy. Objective extorsion decreased by 5.8° ± 0.8°, 4.4° ± 1.7°, 3.1° ± 3.2°, and 3.4° ± 4.7°, respectively.
Superior oblique tuck appears to correct extorsion more effectively than inferior oblique surgery, but this may be an artifact of performing tucks in patients with greater initial extorsion. The small amount of extorsion correction was similar for all inferior oblique procedures.
比较上斜肌折叠术与下斜肌减弱术对治疗上斜肌麻痹患者客观和主观旋转斜视的有效性。
2007年9月至2009年10月期间接受评估的单侧上斜肌麻痹患者，根据术前检查结果接受以下四种手术之一治疗：上斜肌折叠术、下斜肌前转位术、下斜肌后徙术或下斜肌切除术。术前和术后测量主观（双马多克斯杆）和客观（眼底照相）旋转斜视。
共评估了28例患者（平均年龄16.4±12.4岁；范围6 - 51岁）。其中15例（53.6%）上斜肌麻痹为先天性；13例（46.4%）为后天性。上斜肌折叠术后主观外旋转平均减少6.2°±2.3°，下斜肌前转位术后减少2.3°±2.4°，下斜肌后徙术后减少1.3°±2.7°，下斜肌切除术后减少2.6°±4.7°。客观外旋转分别减少5.8°±0.8°、4.4°±1.7°、3.1°±3.2°和3.4°±4.7°。
上斜肌折叠术似乎比下斜肌手术更有效地矫正旋转斜视，但这可能是对初始旋转斜视较大的患者进行折叠术的一种假象。所有下斜肌手术的旋转斜视矫正量都较小且相似。
