Fresina M, Finzi A, Versura P, Campos E C
Department of Specialist, Diagnostics and Experimental Medicine (DIMES), Ophthalmology Service, University of Bologna, Bologna, Italy.
Eye (Lond). 2014 May;28(5):557-61. doi: 10.1038/eye.2014.15. Epub 2014 Feb 14.
To describe the results achieved using muscle belly union associated with the recession of the ipsilateral medial rectus muscle to treat myopic myopathy and restore the normal anatomical relationship of superior and lateral rectus (LR).
A retrospective, nonrandomized study performed on 33 eyes of 26 patients who underwent muscle belly union between January 2004 and October 2012. We preoperatively and postoperatively recorded: best-corrected visual acuity; refraction; intraocular pressure; complete orthoptic assessment, including the angle of deviation and maximal abduction measured using the Goldmann perimeter. Pictures of the eyes in all gaze directions were taken before and after the surgical treatment. Anatomical relationships between muscle cone and eye globe were preoperatively analyzed using magnetic resonance imaging (MRI). Surgical complications were noted.
The follow-up period was 6 months. Preoperative mean BVCA was 0.97 ± 0.96 logMAR (ranging from 0.1 to 3 logMAR) and no changes were detected during postoperative controls. Preoperative mean hypotropia and esotropia were, respectively, 10.2 ± 3.9 prism diopters (PD) and 46.2 ± 15.5 PD. Postoperative mean hypotropia was 2.48 ± 2.00 PD (P<0.001) and mean esotropia was 7.36 ± 9.09 PD (P<0.001). A statistical incrementation of mean maximal abduction (P<0.001) was also noticed.
Muscle belly union-coupled with the recession of the ipsilateral medial rectus muscle when considered convenient-is the elective surgical technique in myopic myopathy, when a downward displacement of LR muscle is shown on MRI with coronal sections.
描述采用肌腹联合同侧内直肌后徙术治疗近视性肌病并恢复上直肌和外直肌（LR）正常解剖关系所取得的结果。
对2004年1月至2012年10月期间接受肌腹联合术的26例患者的33只眼进行回顾性、非随机研究。我们在术前和术后记录：最佳矫正视力；屈光；眼压；全面的视轴矫正评估，包括使用戈德曼视野计测量的斜视角度和最大外展度。在手术治疗前后拍摄所有注视方向的眼部照片。术前使用磁共振成像（MRI）分析肌锥与眼球之间的解剖关系。记录手术并发症。
随访期为6个月。术前平均最佳矫正视力（BVCA）为0.97±0.96 logMAR（范围为0.1至3 logMAR），术后复查未发现变化。术前平均下斜视和内斜视分别为10.2±3.9棱镜度（PD）和46.2±15.5 PD。术后平均下斜视为2.48±2.00 PD（P<0.001），平均内斜视是7.36±9.09 PD（P<0.001）。还观察到平均最大外展度有统计学上的增加（P<0.001）。
当认为方便时，肌腹联合术联合同侧内直肌后徙术是近视性肌病的首选手术技术，前提是在MRI冠状位图像上显示LR肌向下移位。
