First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital G. Gennimatas, Athens, Greece.
JAMA Ophthalmol. 2013 Aug;131(8):1041-8. doi: 10.1001/jamaophthalmol.2013.704.
Bilateral medial rectus muscle recession and one lateral rectus muscle resection surgery for the correction of large-angle infantile esotropia may be associated with a favorable long-term motor outcome. A consecutive exotropic drift was encountered more commonly than a recurrent esotropic drift in the long run, especially in the smaller (50-69 prism diopters [Δ]) range of preoperative esodeviation.
To outline the short- and long-term motor outcomes of graded bilateral medial rectus muscle recession and one lateral rectus muscle resection for the correction of large-angle esotropia (≥50Δ).
Retrospective analysis.
Strabismus service, tertiary care university referral center.
A total of 194 consecutive patients with infantile or presumed infantile esotropia.
All patients underwent bilateral medial rectus recession and a lateral rectus resection in the nondominant eye by the same surgeon.
Short-term (8 weeks) and long-term rates of postoperative successful alignment (±10Δ), undercorrection, and overcorrection.
The median age of patients at surgery was 2.7 years (range, 20 months-36 years). The median follow-up time was 4.5 years (range, 6 weeks-25 years). The mean preoperative deviation was 68.2Δ. Of the 194 patients, 121 (62.4%) were successfully aligned at the last follow-up visit or prior to reoperation, and 154 (79.4%) were successfully aligned at the 8-week postoperative evaluation. A comparison of early vs late outcomes revealed a higher rate of late overcorrections (5.15% vs 24.1%, respectively; P = .001) but the same rate of undercorrections (15.4% vs 15.1%; P = .85). The outcome of surgery was not associated with the presence of amblyopia, high hyperopia, or the total amount of millimeters of surgery but was adversely influenced by the presence of inferior oblique overaction and the magnitude of the preoperative esodeviation. Delayed consecutive exotropia was more prevalent in the 50Δ to 69Δ range of preoperative esodeviation.
Three horizontal muscle surgery for the correction of large-angle esotropia is associated with a high success rate. Long-term follow-up indicated that an exotropic drift may be expected 3 times more often than an esotropic drift.
对于大角度婴儿性内斜视的矫正，双侧内直肌后退和一侧外直肌切除术可能与良好的长期运动结果相关。从长远来看，与复发性内斜视相比，更常见的是连续的外斜视漂移，尤其是在术前斜视的较小（50-69 棱镜度[Δ]）范围内。
概述分级双侧内直肌后退和一侧外直肌切除术矫正大角度斜视（≥50Δ）的短期和长期运动结果。
回顾性分析。
斜视服务，三级保健大学转诊中心。
共 194 例连续的婴儿性或疑似婴儿性内斜视患者。
所有患者均由同一位外科医生行双侧内直肌后退和非优势眼外直肌切除术。
术后 8 周和长期的成功对线（±10Δ）、欠矫和过矫的比率。
手术时患者的中位年龄为 2.7 岁（范围，20 个月至 36 岁）。中位随访时间为 4.5 年（范围，6 周至 25 年）。术前平均斜视度为 68.2Δ。在 194 例患者中，121 例（62.4%）在最后一次随访或再次手术前成功对线，154 例（79.4%）在术后 8 周评估时成功对线。早期与晚期结果的比较显示，晚期过矫率较高（分别为 5.15%和 24.1%；P=.001），但欠矫率相同（15.4%和 15.1%；P=.85）。手术结果与弱视、高度远视或手术总毫米数无关，但与下斜肌过强和术前斜视度的大小有关。在术前斜视的 50Δ至 69Δ范围内，延迟性连续外斜视更为常见。
用于矫正大角度斜视的 3 条水平肌手术具有很高的成功率。长期随访表明，外斜视漂移的可能性是内斜视漂移的 3 倍。
