Ameri Ahmad, Akbari Mohammad Reza, Keshtkar Jaafari Ali Reza, Fard Masoud Aghsaei, Eshraghi Bahram, Tavakoli Vida, Mirmohammadsadeghi Arash
Farabi Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Graefes Arch Clin Exp Ophthalmol. 2015 Jul;253(7):1005-11. doi: 10.1007/s00417-015-2992-4. Epub 2015 Apr 7.
The purpose was to describe the medial rectus muscle elongation (MRE) procedure to treat very large-angle esotropia (ET) with surgery on a lower number of muscles.
Twenty patients with very large-angle ET (more than 70 PD) underwent the MRE procedure. In the MRE procedure, the muscle was split longitudinally into three parts. The wider central part was sutured with 6/0 vicryl and disinserted. The distal end of the peripheral parts (still attached to the original insertion), 7-9 mm away from the insertion, was sutured to the proximal end of the central part. At the end of the procedure, the distance of the anastomosis site from the insertion was named as the final elongation. The dose-response effect of the final elongation was calculated in bilateral MRE cases. The mean of the dose-response effect, obtained in the binocular surgery group, was used in the monocular surgery group to calculate the resection effect of lateral rectus (LR) muscle.
Eleven patients underwent bilateral MRE and nine patients underwent unilateral MRE and LR muscle resection. The mean preoperative far and near deviation was 94.10 ± 19.33 PD. The mean postoperative deviation was 14.60 ± 18.07 PD for far and 14.50 ± 18.23 PD for near deviation. In bilateral MRE cases, the mean dose-response effect of the elongation was 5.53 ± 0.67 PD/mm for far and 5.58 ± 0.69 PD/mm for near deviation. The mean LR muscle resection effect was 6.41 ± 1.99 PD/mm for far and 6.28 ± 1.93 PD/mm for near deviation.
The MRE procedure seems an acceptable method to treat very large-angle ET with surgery on a lower number of muscles.
本研究旨在描述内直肌延长术（MRE），该术式通过较少肌肉的手术来治疗大角度内斜视（ET）。
20例大角度ET（超过70棱镜度）患者接受了MRE手术。在MRE手术中，肌肉纵向分为三部分。较宽的中央部分用6/0可吸收缝线缝合并离断。周边部分的远端（仍附着于原附着点），距附着点7 - 9毫米，缝合至中央部分的近端。手术结束时，吻合部位距附着点的距离被命名为最终延长量。在双侧MRE病例中计算最终延长量的剂量反应效应。双眼手术组获得的剂量反应效应均值用于单眼手术组，以计算外直肌（LR）的切除效应。
11例患者接受双侧MRE，9例患者接受单侧MRE及LR肌肉切除术。术前平均远距离和近距离斜视度为94.10 ± 19.33棱镜度。术后平均远距离斜视度为14.60 ± 18.07棱镜度，近距离斜视度为14.50 ± 18.23棱镜度。在双侧MRE病例中，延长量的平均剂量反应效应远距离为5.53 ± 0.67棱镜度/毫米，近距离为5.58 ± 0.69棱镜度/毫米。LR肌肉切除效应远距离平均为为6.41 ± 1.99棱镜度/毫米，近距离为6.28 ± 1.93棱镜度/毫米。
MRE手术似乎是一种通过较少肌肉手术治疗大角度ET的可接受方法。
