Gross N J, Link H, Biermann J, Kiechle M, Lagrèze W A
Klinik für Augenheilkunde, Universitätsklinikum Freiburg.
Praxis für Augenheilkunde, Praxis Prof. Grüb und Kollegen, Breisach.
Klin Monbl Augenheilkd. 2015 Oct;232(10):1174-7. doi: 10.1055/s-0041-104776. Epub 2015 Oct 29.
Surgical correction of intermediate squint angles may be performed on one muscle alone or as a combined unilateral recess-resect procedure. No larger case series has yet systematically measured the amount of induced incomitance that could potentially lead to visual disturbances.
31 patients with strabismus and binocular vision (phoria or intermittent strabismus) were operated on one extraocular eye muscle; 30 patients underwent a unilateral recess-resect procedure. Preoperatively and three months postoperatively, we measured the latent angle of squint on a tangent screen over the horizontal 60° in 10° increments and then calculated the amount of induced incomitance.
After one muscle surgery, the induced incomitance was 1.7° over a 20° gaze range, 3.2° over a 40° gaze range and 3.8° over a 60° gaze range. For recess-resect procedures, the induced incomitance was 1.4°, 2.6° and 3.4°, respectively. A significant correlation between the surgical dose and the induced incomitance was only seen in one muscle surgery for the 40° and 60° gaze range, but not for the 20° gaze range. A subgroup analysis of patients with an identical surgical dose in one and two muscle procedures (6-8 mm) found greater induced incomitance in one muscle procedures, but only for the 40° and 60° gaze range (p = 0.02). Double vision in any gaze direction was reported by 16 % of patients after one muscle surgery and 10 % of patients after unilateral recess-resect surgery (p > 0.05).
One muscle surgery is a viable option in small and intermediate angles of squint. The induced incomitance is rather small and does not lead to significant visual disturbances in the central gaze range.
中度斜视角度的手术矫正可单独对一条肌肉进行，也可作为单侧后徙-切除联合手术进行。尚无更大规模的病例系列系统测量可能导致视觉障碍的诱导性斜视度数。
31例斜视和双眼视（隐斜或间歇性斜视）患者接受了一条眼外肌手术；30例患者接受了单侧后徙-切除手术。术前及术后三个月，我们在切线屏上以10°增量测量水平60°范围内的潜在斜视角度，然后计算诱导性斜视度数。
单条肌肉手术后，在20°注视范围内诱导性斜视度数为1.7°，在40°注视范围内为3.2°，在60°注视范围内为3.8°。对于后徙-切除手术，诱导性斜视度数分别为1.4°、2.6°和3.4°。手术量与诱导性斜视度数之间仅在单条肌肉手术的40°和60°注视范围内存在显著相关性，而在20°注视范围内不存在。对单条和两条肌肉手术中手术量相同（6-8毫米）的患者进行亚组分析发现，单条肌肉手术的诱导性斜视度数更大，但仅在40°和60°注视范围内（p = 0.02）。单条肌肉手术后16% 的患者和单侧后徙-切除手术后10% 的患者报告在任何注视方向出现复视（p>0.05）。
单条肌肉手术是小角度和中度斜视的可行选择。诱导性斜视度数较小，在中央注视范围内不会导致明显的视觉障碍。
