Gesite-de Leon Bhambi, Demer Joseph L
Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Biomedical Engineering Interdepartmental Program, University of California, Los Angeles, Los Angeles, California; Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, California; Department of Neurology, University of California, Los Angeles, Los Angeles, California.
J AAPOS. 2014 Dec;18(6):554-8. doi: 10.1016/j.jaapos.2014.08.004. Epub 2014 Nov 12.
To investigate whether consecutive exotropia following medial rectus muscle recession is associated with muscle slippage and to assess the effectiveness of treating the condition with medial rectus advancement.
The records of patients with consecutive exotropia after medial rectus recession were reviewed to determine medial rectus muscle insertion location at the time of advancement surgery. Measurements before and after medial rectus advancement were compared. Success was defined as alignment within 10(Δ) of orthotropia. The dose effect of medial rectus advancement was determined by nonlinear regression.
A total of 20 patients were included. The mean age (± standard deviation) at time of surgery was 19 ± 19 years (range, 1.1-65.4). The mean preoperative exotropia was 28(Δ) ± 16(Δ) (range, 12(Δ)-60(Δ)). Medial rectus slippage of 2.5 ± 1.7 mm (range, 1.0-5.0 mm) was found in 14 patients (36%) who had previously undergone medial rectus recession. Surgery corrected about 4(Δ) of exotropia per mm total medial rectus advancement. Although 95% of patients were aligned successfully immediately after surgery, averaging 2(Δ) ± 4(Δ) esotropia, there was significant late exodrift, averaging 17(Δ) at final follow-up. At final follow-up, 1.6 ± 1.8 (range, 0.10-6.2) years after surgery, 50% of patients maintained alignment within 10(Δ) of orthotropia (mean, 3(Δ) ± 4(Δ) exotropia); the rest experienced recurrent exotropia of 25(Δ) ± 8(Δ).
Medial rectus slippage is common in consecutive exotropia. Medial rectus advancement effectively treated consecutive exotropia, whether or not there was muscle slippage. It is however, associated with late exodrift; hence patients should be warned about potential for further XT recurrence.
探讨内直肌后徙术后相继发生的外斜视是否与肌肉滑脱有关，并评估内直肌前徙治疗该病症的有效性。
回顾内直肌后徙术后相继发生外斜视患者的病历，以确定前徙手术时内直肌附着位置。比较内直肌前徙前后的测量结果。成功定义为正位视偏差在10（Δ）以内。通过非线性回归确定内直肌前徙的剂量效应。
共纳入20例患者。手术时的平均年龄（±标准差）为19±19岁（范围1.1 - 65.4岁）。术前平均外斜视度为28（Δ）±16（Δ）（范围12（Δ） - 60（Δ））。在14例（36%）既往接受过内直肌后徙术的患者中发现内直肌滑脱2.5±1.7mm（范围1.0 - 5.0mm）。手术每使内直肌总前徙1mm可矫正约4（Δ）的外斜视。尽管95%的患者术后即刻成功矫正，平均内斜视2（Δ）±4（Δ），但后期有明显的外斜视漂移，末次随访时平均为17（Δ）。在术后1.6±1.8（范围0.10 - 6.2）年的末次随访中，50%的患者维持正位视偏差在10（Δ）以内（平均外斜视3（Δ）±4（Δ））；其余患者复发性外斜视度为25（Δ）±8（Δ）。
内直肌滑脱在相继发生的外斜视中很常见。内直肌前徙可有效治疗相继发生的外斜视，无论是否存在肌肉滑脱。然而，它与后期外斜视漂移有关；因此应告知患者有进一步发生外斜视复发的可能性。
