Ellis George S, Pritchard Cindy H, Baham Leonard, Babiuch Allison
Department of Ophthalmology, Children's Hospital, New Orleans, Louisiana 70118, USA.
Am Orthopt J. 2012;62:50-60. doi: 10.3368/aoj.62.1.50.
Richard G. Scobee was an internationally renowned strabismologist whose life was short yet very productive. The first section of this paper describes his life and contributions to strabismology and orthoptics. The second section of this paper reports the results of our strabismological study.
Many different surgical procedures exist for the treatment of children or adults with convergence excess esotropia. We report on our results of augmented recession, slanted recession, and recession with posterior fixation of the medial rectus muscle in such situations. We also report on the incidence of induced vertical deviations.
Using a retrospective chart review of 800 patients, we excluded patients with confounding strabismus conditions and pharmacological treatments leaving 131 patients included in the study. Slanted reinsertion of medial rectus (twenty-seven patients); posterior fixation with recession of medial rectus (twenty-two patients); augmented medial rectus recession (fifty-eight patients); nonaugmented recession of medial rectus (seventy-three patients). The distance near disparity postoperatively was evaluated using a life table analysis in which all patients were grouped according to the length of time postoperatively. Induced vertical deviation was evaluated at least 6 months postoperatively.
At all time periods postoperatively, the patients with slanted recessions showed the greatest reduction in distance near disparity and that reduction was the most stable over time. At 12- 14 months postoperatively, the range in reduction measured 7.9- 11(Δ) among all three procedures. At 15- 18 months postoperatively, the range in reduction measured 16.9- 19.3(Δ) diopters among the three procedures. At greater than 6 months postoperatively, the slanted and augmented recession groups showed up to 1(Δ) of right hypertropia and the posterior fixation and nonaugmented groups showed up to 0.6(Δ) of left hypertropia.
All three medial rectus procedures used in our retrospective study (slanted recession, augmented recession, recession with posterior fixation) reduced the distance near disparity. The greatest and most stable reduction at all time periods postoperatively occurred with the slanted recession. The induced vertical deviation is small in all procedures and is acceptable at 1(Δ) or less. The augmented and slanted recessions are easier to perform than the posterior fixation with recession. We recommend that the slanted reinsertion of the medial rectus recession be considered as a viable option in the surgical correction of esotropia with a distance near disparity.
理查德·G·斯科比是一位国际知名的斜视专家，他的一生虽短暂却成果丰硕。本文第一部分描述了他的生平以及对斜视学和视光学的贡献。本文第二部分报告了我们斜视学研究的结果。
存在多种不同的手术方法用于治疗患有集合过强性内斜视的儿童或成人。我们报告在此类情况下内直肌增强后徙术、倾斜后徙术以及后固定后徙术的结果。我们还报告了诱发垂直斜视的发生率。
通过对800例患者的病历进行回顾性分析，我们排除了患有复杂斜视情况和接受药物治疗的患者，最终131例患者纳入研究。内直肌倾斜重新缝合（27例患者）；内直肌后固定后徙（22例患者）；内直肌增强后徙（58例患者）；内直肌非增强后徙（73例患者）。术后近距离隐斜度采用寿命表分析进行评估，所有患者根据术后时间长短分组。诱发垂直斜视在术后至少6个月进行评估。
在术后所有时间段，倾斜后徙术的患者近距离隐斜度降低幅度最大，且随着时间推移这种降低最为稳定。术后12 - 14个月，所有三种手术方法的降低幅度范围为7.9 - 11（三棱镜度）。术后15 - 18个月，三种手术方法的降低幅度范围为16.9 - 19.3（三棱镜度）。术后超过6个月，倾斜后徙术组和增强后徙术组出现高达1（三棱镜度）的右眼上斜视，后固定术组和非增强后徙术组出现高达0.6（三棱镜度）的左眼上斜视。
我们回顾性研究中使用的所有三种内直肌手术方法（倾斜后徙术、增强后徙术、后固定后徙术）均降低了近距离隐斜度。术后所有时间段内，倾斜后徙术降低幅度最大且最稳定。所有手术方法诱发的垂直斜视均较小，1（三棱镜度）或更小是可接受的。增强后徙术和倾斜后徙术比后固定后徙术更容易实施。我们建议，在内斜视合并近距离隐斜的手术矫正中，可考虑内直肌倾斜重新缝合后徙术作为一种可行的选择。
