Chaudhuri Zia, Demer Joseph L
Jules Stein Eye Institute, University of California, Los Angeles, USA.
Arch Ophthalmol. 2012 Oct;130(10):1280-4. doi: 10.1001/archophthalmol.2012.1389.
To propose medial rectus (MR) recession to be equally as effective as lateral rectus (LR) resection, which has heretofore been the preferred treatment for divergence paralysis esotropia (DPE).
We examined a 17-year surgical experience comparing LR resection with MR recession in adults with DPE, defined as symptomatic distance esotropia (ET) at least double the asymptomatic ET of 10 or less prism diopters() at near.
Twenty-four patients with DPE underwent surgery. Six patients underwent bilateral LR resection and 2 underwent unilateral LR resection (group L), while 13 underwent bilateral MR recession and 3 underwent unilateral MR recession,with the target angle double the distance ET (group M). One of 8 patients in group L and 15 of 16 patients in group M underwent intra operative adjustable surgery under topical anesthesia. Mean (SD) preoperative central gaze ET measured 15.0 (7.7) Δ at distance and 4.1 (3.4) Δ at near in group L, but 10.4 (6.8) Δ at distance and 0.6 (1.7) Δ at near in group M (P=.15; distance, 0.003, near). Postoperatively, no patient in either group had symptomatic diplopia or convergence insufficiency in follow-up from 8.5 to 40 months. Twice the usual surgical dose of MR recession per prism diopter was required to achieve correction of the distance deviation in DPE as compared with that recommended for ET generally and also for LR resection in the same condition.
Recession of the MR provides binocular single vision in DPE without convergence insufficiency at near, and it is convenient for intraoperative adjustment under topical anesthesia.
提出内直肌（MR）后徙术与外直肌（LR）切除术效果相同，而LR切除术一直是散开麻痹性内斜视（DPE）的首选治疗方法。
我们回顾了17年的手术经验，比较成人DPE患者中LR切除术与MR后徙术的效果，DPE定义为有症状的远距离内斜视（ET）至少是近距离无症状ET（棱镜度为10或更小）的两倍。
24例DPE患者接受了手术。6例患者接受双侧LR切除术，2例接受单侧LR切除术（L组），而13例接受双侧MR后徙术，3例接受单侧MR后徙术，目标角度为远距离ET的两倍（M组）。L组8例患者中的1例和M组16例患者中的15例在表面麻醉下接受了术中可调整手术。L组术前平均（标准差）远距离中央注视ET为15.0（7.7）Δ，近距离为4.1（3.4）Δ，而M组远距离为10.4（6.8）Δ，近距离为0.6（1.7）Δ（P = 0.15；远距离，P = 0.003，近距离）。术后，两组患者在8.5至40个月的随访中均无有症状的复视或集合不足。与一般ET推荐剂量以及相同情况下LR切除术相比，DPE中矫正远距离斜视偏差需要的MR后徙术剂量是通常手术剂量的两倍。
MR后徙术可使DPE患者获得双眼单视，且近距离无集合不足，便于在表面麻醉下进行术中调整。
