Astudillo Paulita Pamela, Cotesta Melissa, Schofield Jennifer, Kraft Stephen, Mireskandari Kamiar
Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Canada.
Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Canada.
Am J Ophthalmol. 2015 Nov;160(5):913-8. doi: 10.1016/j.ajo.2015.07.022. Epub 2015 Jul 22.
To determine if achieving the ideal postoperative target range increases the long-term success of pediatric strabismus surgery.
Interventional case series.
Children below 12 years old with horizontal strabismus who underwent surgical correction by recession, resection, advancement, or a combination of both between 1996 and 2011 were included. Alignment was measured within 1 week and at a minimum of 6 months after surgery. The ideal postoperative target range was defined as 0-8 prism diopters (PD) of esotropia in exotropic patients and within 4 PD of orthotropia in esotropic patients measured within 1 week after the surgery. Success was defined as a measurement within 10 PD of orthotropia at the latest postoperative visit. The main outcome measures were surgical success rate and the factors affecting it.
We included 352 patients with mean follow-up of 18 months. Overall, patients within the target range had a higher success rate than those outside it (75.6% vs 57% P = .0004). This was highly significant for exotropia (P = .0002) but not for esotropia (P = .4). Multiple regression analysis revealed that being within target range was the strongest predictor of long-term success (odds ratio [OR] = 2.3, range 1.4-3.7). Overall, surgeries on patients with esotropia were more likely to be successful than on those with exotropia (OR = 1.9, range 1.2-3), and premature patients had poorer outcomes (OR = 0.2, range 0.1-0.8).
Achieving the ideal target range within 1 week after surgery is associated with a high rate of long-term success in exotropia surgery in children.
确定达到理想的术后目标范围是否能提高小儿斜视手术的长期成功率。
干预性病例系列研究。
纳入1996年至2011年间接受后徙、切除、前徙或两者联合手术矫正的12岁以下水平斜视儿童。在术后1周内及至少6个月时测量眼位。理想的术后目标范围定义为：外斜视患者术后1周内测量的内斜视度数为0 - 8棱镜度（PD），内斜视患者为正位眼偏差在4 PD以内。成功定义为术后最后一次随访时眼位偏差在正位眼10 PD以内。主要观察指标为手术成功率及其影响因素。
我们纳入了352例患者，平均随访18个月。总体而言，处于目标范围内的患者成功率高于范围外的患者（75.6%对57%，P = .0004）。这在外斜视中具有高度显著性（P = .0002），但在内斜视中无显著性（P = .4）。多元回归分析显示，处于目标范围内是长期成功的最强预测因素（优势比[OR] = 2.3，范围1.4 - 3.7）。总体而言，内斜视患者手术比外斜视患者更易成功（OR = 1.9，范围1.2 - 3），早产儿预后较差（OR = 0.2，范围0.1 - 0.8）。
术后1周内达到理想目标范围与儿童外斜视手术的高长期成功率相关。
