Wei Yan, Kang Xiao Li, Del Monte Monte A
Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.
Br J Ophthalmol. 2016 Sep;100(9):1280-4. doi: 10.1136/bjophthalmol-2015-307704. Epub 2016 Mar 11.
To review the prevalence of preoperative and postoperative intorsion in patients with strabismus and Graves' eye disease (GED), and to correlate the intorsion with coexisting superior rectus (SR) and superior oblique (SO) muscle enlargement as a possible mechanism causing intorsion in these patients.
Charts of consecutive patients with GED who underwent strabismus surgery between 1 January 2010 and 1 April 2013 were retrospectively reviewed. Of these, patients with orbital CT or MRI scan were identified for further analysis. Clinical characteristics documented included age, gender, horizontal and vertical deviation, subjective torsional deviation, specific extraocular muscles (EOMs) operated upon, EOM enlargement on CT/MRI scans and width and thickness of SO, SR group and inferior rectus (IR).
Charts of 45 patients (14 males and 31 females) were reviewed. Mean age was 56.8±12.5 years. Of these, seven (15.6%) patients demonstrated intorsion, and 38 (84.4%) patients demonstrated extorsion preoperatively. But after strabismus surgery, 15 (39.5%) of the 38 patients with preoperative extorsion demonstrated postoperative intorsion and 23 (60.5%) patients continued to show postoperative extorsion. On analysis of CT/MRI scans in these patients, only an increase in the thickness of SR group and the thickness/width of SO muscle were significantly associated with preoperative and postoperative intorsion; while age, gender, preoperative horizontal or vertical deviation and IR recession were unrelated to preoperative or postoperative intorsion. Postoperative intorsion was also associated with smaller degrees of preoperative extorsion (<3.5°).
Preoperative SR and/or SO muscle enlargement appear to be a primary contributing factor relating to preoperative and postoperative intorsion in patients with GED-associated strabismus. Patients with only small amounts of preoperative extorsion (<3.5°) in the presence of tight IRs should be carefully evaluated for possible SR and/or SO involvement by CT or MRI scan to predict those at risk for and plan for prevention/treatment of postoperative intorsion.
回顾斜视和格雷夫斯眼病（GED）患者术前和术后眼球内旋的患病率，并将眼球内旋与并存的上直肌（SR）和上斜肌（SO）肌肉增大相关联，作为这些患者发生眼球内旋的一种可能机制。
回顾性分析2010年1月1日至2013年4月1日期间接受斜视手术的连续性GED患者的病历。其中，确定有眼眶CT或MRI扫描的患者进行进一步分析。记录的临床特征包括年龄、性别、水平和垂直偏斜、主观扭转偏斜、接受手术的特定眼外肌（EOM）、CT/MRI扫描上的EOM增大以及SO、SR组和下直肌（IR）的宽度和厚度。
回顾了45例患者（14例男性和31例女性）的病历。平均年龄为56.8±12.5岁。其中，7例（15.6%）患者表现为眼球内旋，38例（84.4%）患者术前表现为眼球外旋。但斜视手术后，38例术前眼球外旋患者中有15例（39.5%）表现为术后眼球内旋，23例（60.5%）患者继续表现为术后眼球外旋。对这些患者的CT/MRI扫描分析显示，只有SR组厚度和SO肌肉厚度/宽度增加与术前和术后眼球内旋显著相关；而年龄、性别、术前水平或垂直偏斜以及IR后徙与术前或术后眼球内旋无关。术后眼球内旋也与较小程度的术前眼球外旋（<3.5°）相关。
术前SR和/或SO肌肉增大似乎是与GED相关斜视患者术前和术后眼球内旋相关的主要因素。对于存在紧张IR且术前仅有少量眼球外旋（<3.5°）的患者，应通过CT或MRI扫描仔细评估SR和/或SO可能的受累情况，以预测术后眼球内旋的风险并制定预防/治疗计划。
