Mireskandari Kamiar, Schofield Jennifer, Cotesta Melissa, Stephens Derek, Kraft Stephen P
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada.
Br J Ophthalmol. 2015 Dec;99(12):1697-701. doi: 10.1136/bjophthalmol-2014-306258. Epub 2015 May 19.
BACKGROUND/AIMS: To evaluate the role of achieving immediate target angles on the success of strabismus surgery.
We performed a retrospective cohort study of all patients over 12 years old undergoing strabismus surgery with either adjustable or non-adjustable sutures. Target angle for patients with esotropia and vertical deviation was within 4 prism dioptres (PD) of orthotropia and for patients with exotropia between orthotropia and 8 PD of esotropia. Success was defined as alignment within 10 PD for horizontal rectus surgery and within 5 PD of orthotropia for vertical rectus surgery, without diplopia or reoperations. The main outcome measure was surgical success rate.
Three hundred and fifty-three patients were included in the study with mean follow-up of 13.9 (4-132) months. Patients achieving the target angle immediately postoperatively had higher success rate than patients who did not (83.6% vs 63.7%, p<0.0001, OR 2.9, 95% CI 1.8 to 4.9). When target angle was achieved, adjustable and non-adjustable sutures had similar success (84.8% and 80.9%, respectively, p=0.46, OR 1.3, CI 0.58 to 2.9). However, patients undergoing adjustable surgery were more likely to obtain the target angle (75.5% vs 54%, p<0.0001, OR 2.7, CI 1.7 to 4.2). Success for exotropia surgery was significantly higher when the immediate target angle was achieved (86.4% vs 58.7%, p<0.0001, OR 4.47, CI 2.3 to 8.6). For esotropia and vertical deviations, a similar beneficial effect was not shown (p=0.31, OR 1.6, CI 0.65 to 4.0 and p=0.33, respectively). On multiple logistic regressions, sex, amblyopia, binocularity and reoperations were not significant factors in surgical success.
Our results suggest that achieving the immediate target angle is the most significant factor in the success of strabismus surgery for exotropia. Adjustable suture surgery results in higher proportion of patients achieving this target angle.
背景/目的：评估达到即刻目标角度对斜视手术成功率的作用。
我们对所有12岁以上接受可调节或不可调节缝线斜视手术的患者进行了一项回顾性队列研究。内斜视和垂直斜视患者的目标角度为正位视偏差在4棱镜度（PD）以内，外斜视患者的目标角度为正位视到内斜视8 PD之间。成功定义为水平直肌手术术后眼位在10 PD以内，垂直直肌手术术后眼位在正位视5 PD以内，且无复视或再次手术。主要结局指标为手术成功率。
353例患者纳入研究，平均随访13.9（4 - 132）个月。术后即刻达到目标角度的患者成功率高于未达到目标角度的患者（83.6% 对63.7%，p<0.0001，OR 2.9，95%CI 1.8至4.9）。当达到目标角度时，可调节缝线和不可调节缝线的成功率相似（分别为84.8%和80.9%，p = 0.46，OR 1.3，CI 0.58至2.9）。然而，接受可调节手术的患者更有可能达到目标角度（75.5% 对54%，p<0.0001，OR 2.7，CI 1.7至4.2）。外斜视手术在达到即刻目标角度时成功率显著更高（86.4% 对58.7%，p<0.0001，OR 4.47，CI 2.3至8.6）。对于内斜视和垂直斜视，未显示出类似的有益效果（p = 0.31，OR 1.6，CI 0.65至4.0以及p分别为0.33）。在多因素逻辑回归分析中，性别、弱视、双眼视和再次手术不是手术成功的显著因素。
我们的结果表明，达到即刻目标角度是外斜视手术成功的最重要因素。可调节缝线手术使更多患者达到该目标角度。
