Gokyigit Birsen, Akar Serpil, Kaynak Pelin, Demirok Ahmet, Yilmaz Omer Faruk
J Pediatr Ophthalmol Strabismus. 2014 Jan-Feb;51(1):17-26. doi: 10.3928/01913913-20131029-04. Epub 2013 Nov 5.
To report the efficacy in preventing lower eyelid retraction and long-term results of a new technique of inferior rectus (IR) recession for vertical strabismus and compare this method with the results obtained by a conventional IR recession operation.
This retrospective study included 35 patients who underwent a new IR recession method (study group) and 22 patients who underwent the conventional IR recession (control group) for vertical strabismus. In the study group, an IR recession was applied to the deeper fibers and included approximately 90% of the IR muscle thickness. This group was divided into two subgroups: small IR recessions (4 to 6 mm) and large IR recessions (7 to 8 mm). In the control group, an IR recession of the entire muscle was applied without exceeding 6 mm. The photographs were analyzed for lower eyelid position. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs at final follow-up examination. The main outcome measures were the margin-to-reflex distance, lower eyelid retraction, and vertical deviation angles (at near and distance fixation).
The mean change in margin-to-reflex distance after surgery was 0.03 mm in the small IR recessions group, 0.1 mm in the large IR recessions group, and 2.04 mm in the control group. Postoperatively, the lower eyelid retraction in the study group, which occurred after both small and large IR recessions, was significantly less than that in the control group (P < .001). There was no significant difference between the study and control groups in improvements in near and distance vertical deviations and success ratios (P > .05).
At long-term follow-up, recession of the deeper fibers layer, including approximately 90% of the IR muscle thickness, was a procedure that minimized or eliminated the possibility of lower eyelid retraction and did not limit the success of strabismus surgery.
报告一种用于垂直斜视的下直肌（IR）后徙新技术在预防下睑退缩方面的疗效及长期结果，并将该方法与传统IR后徙手术的结果进行比较。
这项回顾性研究纳入了35例行新型IR后徙方法的患者（研究组）和22例行传统IR后徙手术的患者（对照组），均为垂直斜视患者。在研究组中，对更深层纤维进行IR后徙，约占IR肌厚度的90%。该组又分为两个亚组：小量IR后徙（4至6毫米）和大量IR后徙（7至8毫米）。在对照组中，对整个肌肉进行IR后徙，不超过6毫米。分析照片以评估下睑位置。采用数字图像分析对每位患者最后一次随访检查时的术前和术后照片进行标准化。主要观察指标为边缘至反射距离、下睑退缩及垂直斜视角度（近距和远距注视时）。
小量IR后徙组术后边缘至反射距离的平均变化为0.03毫米，大量IR后徙组为0.1毫米，对照组为2.04毫米。术后，研究组（无论小量还是大量IR后徙）的下睑退缩明显少于对照组（P <.001）。研究组和对照组在近距和远距垂直斜视改善及成功率方面无显著差异（P >.05）。
在长期随访中，对约占IR肌厚度90%的更深层纤维层进行后徙，是一种可将下睑退缩的可能性降至最低或消除的手术方法，且不影响斜视手术的成功率。
