垂直肌肉手术后对上斜肌麻痹患者 Listing 平面方位差的影响。

Effects of vertical muscle surgery on differences in the orientation of Listing's plane in patients with superior oblique palsy.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2013 Oct;251(10):2437-43. doi: 10.1007/s00417-013-2407-3. Epub 2013 Jun 25.

Abstract

BACKGROUND

Although scleral search coils are widely and accurately used for the measurement of Listing's plane in both eyes, they require specialized equipment and are invasive. In this study, we describe a convenient and less invasive method that uses a synoptometer to analyze the differences in orientation of Listing's plane (difLP), and the effects of vertical muscle surgery on the difLP tilt in patients with superior oblique palsy (SOP).

METHODS

Seventeen patients with unilateral congenital SOP (CSOP) and four patients with unilateral acquired SOP (ASOP) who had not undergone any strabismus surgeries were examined. Cyclodeviations of 13 vertical and horizontal gaze points within 30° were measured with a synoptometer, and the difLP tilts in the yaw and pitch planes were analyzed before and after vertical muscle surgery.

RESULTS

The difLP tilt in the CSOP patients was significantly tilted nasally (p = 0.02) and forward on the lower side (p = 0.001), whereas that in ASOP patients tended to tilt temporally (p = 0.15). Ipsilateral inferior oblique recession (IOR) performed in seven CSOP patients tended to improve the difLP tilt in both the yaw (p = 0.07) and pitch (p = 0.09) planes, whereas contralateral inferior rectus recession (IRR) performed in three CSOP patients significantly improved the difLP tilt in the pitch plane (p = 0.015). The mean excyclodeviations in the 13 gaze points were significantly improved with both procedures (p < 0.0001 for both).

CONCLUSIONS

The difLP tilt in the SOP patients could be analyzed with a convenient and less invasive method using a synoptometer, and dissimilar difLP tilts were confirmed in the ASOP and CSOP patients. The results of this study suggest that both IOR and IRR are reasonable treatments for improving the difLP tilt in CSOP patients. IOR should be selected for patients with a steep preoperative difLP tilt to the nasal side, whereas IRR should be selected for patients with a gentle preoperative difLP tilt.

摘要

背景

尽管巩膜搜索线圈被广泛而准确地用于测量双眼的 Listing 平面，但它们需要专门的设备且具有侵入性。在本研究中，我们描述了一种方便且微创的方法，该方法使用同视机来分析 Listing 平面的方位差（difLP），以及垂直肌肉手术对先天性上斜肌麻痹（CSOP）患者的 difLP 倾斜的影响。

方法

对 17 例单侧先天性上斜肌麻痹（CSOP）患者和 4 例单侧获得性上斜肌麻痹（ASOP）患者进行检查。使用同视机测量了 13 个垂直和水平注视点的 30°内的斜视度，分析了垂直肌肉手术后的 yaw 和 pitch 平面上的 difLP 倾斜度。

结果

CSOP 患者的 difLP 倾斜明显向鼻侧（p = 0.02）和下方（p = 0.001）倾斜，而 ASOP 患者的 difLP 倾斜倾向于颞侧（p = 0.15）。在 7 例 CSOP 患者中进行的同侧下斜肌后徙术（IOR）倾向于改善 yaw（p = 0.07）和 pitch（p = 0.09）平面上的 difLP 倾斜，而在 3 例 CSOP 患者中进行的对侧内直肌后徙术（IRR）显著改善了 pitch 平面上的 difLP 倾斜（p = 0.015）。两种手术均明显改善了 13 个注视点的外斜视度（p < 0.0001）。

结论

使用同视机可以方便且微创地分析 SOP 患者的 difLP 倾斜，并且在 ASOP 和 CSOP 患者中确认了不同的 difLP 倾斜。本研究的结果表明，IOR 和 IRR 都是改善 CSOP 患者 difLP 倾斜的合理治疗方法。对于术前 difLP 倾斜较大的患者，应选择 IOR，而对于术前 difLP 倾斜较小的患者，应选择 IRR。