不对称性下斜肌前转位术治疗非共同性分离性垂直斜视。

Asymmetric inferior oblique anterior transposition for incomitant asymmetric dissociated vertical deviation.

机构信息

Jules Stein Eye Institute and Department of Ophthalmology, University of California, Los Angeles, CA, U.S.A..

出版信息

Graefes Arch Clin Exp Ophthalmol. 2013 Nov;251(11):2639-42. doi: 10.1007/s00417-013-2445-x. Epub 2013 Aug 24.

DOI:10.1007/s00417-013-2445-x

PMID:23974702

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4098929/

Abstract

BACKGROUND

Inferior oblique anterior transposition (IOAT) is indicated in patients with incomitant dissociated vertical deviation (DVD) larger in adduction. In general, bilateral surgery is recommended in patients with DVD unless there is deep monocular amblyopia. The purpose of this study is to evaluate the results of asymmetric IOAT in patients with asymmetric incomitant DVD larger in adduction.

METHODS

Retrospective chart review of the records of all patients with incomitant asymmetric DVD associated with inferior oblique (IO) overaction who underwent asymmetric IO weakening procedure. In all patients, the eye with more DVD in adduction underwent IOAT to the temporal corner of the insertion of the inferior rectus (IR) muscle, and the eye with less DVD underwent IOAT to a position 3-4 mm posterior to the insertion of the IR. No other muscles were operated simultaneously. No patient had previous surgery on any cyclovertical extracular muscle.

RESULTS

Fourteen patients were included. Mean age at surgery was 10.3 ± 8.8 years (range 4-33). Primary position DVD preoperatively was 18 ± 2 PD in the eye with the larger DVD compared to 1.1 ± 1.0 PD postoperatively (p < 0.0001). DVD asymmetry between the lateral gaze with the largest DVD and the lateral gaze with the smallest DVD was 9.8 ± 3.1 PD (range 5-14 PD) preoperatively vs 1.1 ± 1.0 PD (range 0-2 PD), (p < 0.0001). Ten patients had preoperative V-pattern >10 PD (24.7 ± 8.7 PD, range 12-50 PD) preoperatively vs no patients postoperatively (mean V-pattern 4.4 ± 2.0 PD), (p < 0.0001). Postoperative follow up was 1.6 ± 0.7 years (range 1-3 years).

CONCLUSION

In patients with asymmetric incomitant DVD, asymmetric IOAT improves lateral incomitance without increasing the risk of antielevation, limitation in upgaze rotation, or hypertropia, or worsening the DVD in the eye with less deviation preoperatively.

摘要

背景

下斜肌前移位术（IOAT）适用于内收时分离垂直斜视（DVD）较大的非共同性斜视患者。一般来说，对于 DVD 患者，除非存在深度单眼弱视，否则建议进行双侧手术。本研究旨在评估内收时不对称 DVD 较大的非共同性斜视患者行不对称 IOAT 的结果。

方法

回顾性分析所有患有下斜肌亢进相关非共同性不对称 DVD 的患者的病历，这些患者均接受了不对称下斜肌减弱手术。所有患者中，内收时 DVD 较大的眼行 IOAT 至下直肌（IR）插入颞角，DVD 较小的眼行 IOAT 至 IR 插入后 3-4mm 处。没有同时对其他肌肉进行手术。没有患者以前对任何水平直肌外肌进行过手术。

结果

纳入 14 名患者。手术时的平均年龄为 10.3±8.8 岁（4-33 岁）。术前第一眼位 DVD 较大的眼为 18±2PD，术后为 1.1±1.0PD（p＜0.0001）。在最大 DVD 的侧方注视和最小 DVD 的侧方注视之间，DVD 的不对称性术前为 9.8±3.1PD（5-14PD），术后为 1.1±1.0PD（0-2PD），（p＜0.0001）。10 名患者术前 V 型斜视＞10PD（24.7±8.7PD，范围 12-50PD），术后无一例患者（平均 V 型斜视 4.4±2.0PD），（p＜0.0001）。术后随访 1.6±0.7 年（1-3 年）。