Wang Xi, Chen Bingjie, Liu Longqian
Department of Ophthalmology, West China Hospital, Sichuan University, 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
Int Ophthalmol. 2017 Aug;37(4):1069-1072. doi: 10.1007/s10792-016-0354-9. Epub 2016 Sep 15.
To report a patient with cyclic esotropia with a high accommodative convergence to accommodation (AC/A) ratio after surgical correction of intermittent exotropia who was found to have bilateral anomalous medial rectus muscle insertion sites.
A 5-year-old girl developed intermittent esotropia on alternating days after undergoing bilateral lateral rectus recessions for correction of intermittent exotropia. Alternate prism and cover measurement of ocular alignment and binocular function was assessed on consecutive days. Surgical correction was performed for the full amount measured on a "crossed" day.
On "straight" days, her eyes were orthotropic with normal binocular vision. Examination on "crossed" days revealed a left esotropia of 75 prism diopters (PD) at near fixation and 40 PD at distance fixation in primary gaze without fusion or stereopsis. The patient underwent bilateral medial rectus recessions in conjunction with posterior fixation sutures (MRP). During surgery, the distance from the limbus to the medial rectus muscle insertion was 3.5 mm bilaterally. Postoperatively, the cycle was broken, and the esotropia disappeared with no recurrence at the latest follow-up at 12 months.
MRP is an effective procedure for correction of cyclic esotropia with a high AC/A ratio. Strabismus surgeons should design surgical strategies based on preoperative measurement of deviations at all distances and the anatomy of muscle insertions in patients with cyclic esotropia.
报告一例间歇性外斜视手术矫正后出现周期性内斜视且调节性集合与调节比率（AC/A）较高的患者，该患者被发现双侧内直肌附着点异常。
一名5岁女孩在接受双侧外直肌后徙术矫正间歇性外斜视后，交替出现间歇性内斜视。连续数天对眼位和双眼功能进行交替棱镜遮盖测量。在“交叉”日对测量出的全部度数进行手术矫正。
在“正位”日，她的眼睛正位，双眼视力正常。在“交叉”日检查发现，在原在位近距注视时左眼内斜75棱镜度（PD），远距注视时为40 PD，无融合或立体视。该患者接受了双侧内直肌后徙术联合后固定缝线术（MRP）。手术过程中，双侧角膜缘至内直肌附着点的距离均为3.5 mm。术后，周期被打破，内斜视消失，在12个月的最新随访中无复发。
MRP是矫正高AC/A比率周期性内斜视的有效手术方法。斜视外科医生应根据周期性内斜视患者术前对所有距离斜视度的测量以及肌肉附着点的解剖结构来设计手术策略。
