Garrick Adesuwa, Durnian Jonathan, Hewitt Gareth, Marsh Ian
Department of Ophthalmology, University Hospital, Aintree, Livepool, UK.
Strabismus. 2013 Mar;21(1):29-32. doi: 10.3109/09273972.2012.762719.
Superior oblique posterior tenotomy (SOPT) is a recognized surgical treatment to weaken the depressor effect of the superior oblique muscle without causing excyclotropia. We analyzed its use in the management of diplopia in downgaze due to contralateral blowout orbital fracture.
We performed a retrospective case note review of patients that had undergone an SOPT as a primary surgical option in the management of diplopia in down gaze caused by contralateral blowout orbital fracture. The study covered a 17-year period from 1993 and 2010. These cases had diplopia maximal to the side of the orbital blowout. Pre- and postoperative orthoptic measurements were compared. Surgical complications were noted.
Five patients who fulfilled the entry criteria were identified. The mean follow-up period was 15.2 months (range 6-20 months). Preoperatively, the median |dev| was 2 prism diopters (PD) in primary position (range, 0-2) and 8 PD in downgaze (range, 2-18). At the final follow-up, the median |dev| in primary position was 0 PD (range, 0-2) and 2 PD in downgaze (range, 0-12). There were no significant differences pre- and postoperatively in both the primary position (p=0.19) or in downgaze (p=0.25) despite the large reduction in deviation size. Two patients needed a second procedure following SOPT. No patients complained of torsion, not in the primary position or in downgaze following the surgery.
Contralateral SOPT can be a useful and simple primary treatment option for patients with moderate vertical deviations in downgaze to the same side of the orbital fracture. Larger deviations may require second surgeries. SOPT does not cause iatrogenic excyclotorsion and avoids surgery to a potentially much scarred inferior rectus area.
上斜肌后徙术（SOPT）是一种公认的手术治疗方法，可减弱上斜肌的下转作用而不引起外旋转斜视。我们分析了其在治疗对侧爆裂性眼眶骨折所致下视复视中的应用。
我们对因对侧爆裂性眼眶骨折导致下视复视而接受SOPT作为主要手术选择的患者进行了回顾性病例记录分析。该研究涵盖了1993年至2010年的17年时间。这些病例的复视在眼眶爆裂侧最为明显。比较了术前和术后的眼位测量结果。记录手术并发症。
确定了5例符合入选标准的患者。平均随访期为15.2个月（范围6 - 20个月）。术前，原在位的中位|斜视度|为2棱镜度（PD）（范围0 - 2），下视时为8 PD（范围2 - 18）。在最后随访时，原在位的中位|斜视度|为0 PD（范围0 - 2），下视时为2 PD（范围0 - 12）。尽管斜视度大幅降低，但原在位（p = 0.19）或下视时（p = 0.25）术前和术后均无显著差异。2例患者在SOPT后需要二次手术。术后无患者主诉在原在位或下视时有旋转斜视。
对于眼眶骨折同侧下视时存在中度垂直斜视的患者，对侧SOPT可以是一种有用且简单的主要治疗选择。较大的斜视度可能需要二次手术。SOPT不会引起医源性外旋转斜视，且避免了对可能瘢痕较多的下直肌区域进行手术。
