Swaminathan Meenakshi, Shah Sanil V, Mittal Shruti, Gunasekaran Aarthy
Department of Pediatric Ophthalmology, Medical Research Foundation , Chennai , India.
Strabismus. 2014 Sep;22(3):138-42. doi: 10.3109/09273972.2014.907814. Epub 2014 May 5.
There is paucity of literature on surgical outcomes after strabismus surgery in patients with developmental delay. There is no consensus regarding whether standard surgical tables are applicable to these children. The goal of our study was to determine results of strabismus surgery for esotropia among these children.
Two retrospective cohorts of patients, with developmental delay (excluding Down syndrome) and without developmental delay, who underwent bimedial recession for comitant eso-deviation between January 2005 and January 2011, meeting our criteria, were selected. Amount of surgery performed in these children was compared with standard table. This comparison gave us operated angle of deviation. This operated angle of deviation was expressed as percentage of preoperative angle of deviation to get amount of surgery performed. Response to surgery was defined as percentage of change in angle of deviation after surgery to the operated angle of deviation. Amount of surgery performed, response to surgery, and results were compared between two groups.
This study included 25 patients with developmental delay and 53 normal children with comitant esotropia. Age, refractive error, and preoperative angle of deviation were comparable in patients with and without developmental delay. Among patients with developmental delay, on average 72.13%±16.08 of angle of deviation was operated; response to surgery gained was 134.06%±51.62. In the control group, the average amount of surgery done was 89.08%±10.83; response gained was 89.83%±22.49. Successful outcome (±10 PD of orthophoria) was noted in 60% patients with developmental delay compared to 73.58% in control group. On average 70.67%±17.95 angle of deviation was operated in patients with developmental delay with successful outcome.
Surgical outcome in patients with developmental delay is very unpredictable. An exaggerated response to standard amounts of bimedial recession should be anticipated in these patients. Though there was no statistically significant difference, operating for 70.67%±17.95 angle of deviation is more likely to be successful.
关于发育迟缓患者斜视手术后的手术效果，相关文献较少。对于标准手术台是否适用于这些儿童，目前尚无共识。我们研究的目的是确定这些儿童内斜视斜视手术的效果。
选取2005年1月至2011年1月期间符合我们标准、因共同性内斜视接受双侧内直肌后徙术的两组回顾性队列患者，一组有发育迟缓（不包括唐氏综合征），另一组无发育迟缓。将这些儿童的手术量与标准手术量进行比较。这种比较得出了手术矫正的斜视度数。该手术矫正的斜视度数表示为术前斜视度数的百分比，以得出手术量。手术反应定义为术后斜视度数变化占手术矫正斜视度数的百分比。比较两组的手术量、手术反应和效果。
本研究纳入了25例发育迟缓患者和53例伴有共同性内斜视的正常儿童。有发育迟缓和无发育迟缓的患者在年龄、屈光不正和术前斜视度数方面具有可比性。在发育迟缓患者中，平均手术矫正的斜视度数为72.13%±16.08；手术反应为134.06%±51.62。在对照组中，平均手术量为89.08%±10.83；手术反应为89.83%±22.49。发育迟缓患者中有60%获得成功结果（正位视在±10棱镜度范围内），而对照组为73.58%。发育迟缓且获得成功结果的患者平均手术矫正的斜视度数为70.67%±17.95。
发育迟缓患者的手术效果非常不可预测。应预期这些患者对标准量双侧内直肌后徙术的反应会过度。虽然没有统计学上的显著差异，但手术矫正70.67%±17.95的斜视度数更有可能成功。
