Wang Qianqian, Flanders Michael
From the Department of Ophthalmology, University of Montreal, Montreal, Quebec.
From the Department of Ophthalmology, University of Montreal, Montreal, Quebec;
Am Orthopt J. 2016 Jan;66(1):79-86. doi: 10.3368/aoj.66.1.79.
We describe the clinical characteristics of 252 patients with unilateral superior oblique palsy who underwent strabismus surgery. We assess if a predetermined surgical strategy, based on preoperative alignment and motility measurements, was effective in treating these patients. On this basis, the patients were divided into three different treatment groups.
Two-hundred fifty-two patients were identified retrospectively and classified into three groups according to the performed procedures: 1) inferior oblique weakening; 2) inferior rectus recession; 3) combined inferior oblique weakening and inferior rectus recession. Demographic and clinical data were recorded. Criteria for surgical success included good postoperative alignment (distance, primary position alignment ≤5), and improvement of diplopia and of abnormal head posture. Subgroup analyses of surgical outcome were performed for small (<12) versus large (>20) preoperative hypertropia in the group that underwent inferior oblique weakening, and for inferior oblique disinsertion-myectomy versus inferior oblique recession.
Mean forced primary position (PP) hypertropia decreased from 14.3 (range 3-37) to 4.5 (range 0-30) in Group 1, from 13 (range 1-30) to 2 (range -20-20) in Group 2, and from 25.7 (range 6-40) to 1.3 (range -12-18) in Group 3. Group 1 had the lowest re-operation rate (7.6%), followed by Group 2 (16%) and Group 3 (25.9%). Final surgical success rates were similar in three groups. Inferior oblique weakening was more predictable for small primary position hypertropia, but still yielded 85% success rate in large deviations. Inferior oblique disinsertion-myectomy resulted in more favorable results than inferior oblique recession (P < 0.05).
When a predetermined surgical strategy is applied to individual patients with unilateral superior oblique palsy, excellent functional improvement can be achieved in the majority of patients.
我们描述了252例接受斜视手术的单侧上斜肌麻痹患者的临床特征。我们评估基于术前眼位矫正和眼球运动测量结果预先制定的手术策略对治疗这些患者是否有效。在此基础上，将患者分为三个不同的治疗组。
回顾性纳入252例患者，并根据所施行的手术程序分为三组：1）下斜肌减弱术；2）下直肌后徙术；3）下斜肌减弱术联合下直肌后徙术。记录人口统计学和临床数据。手术成功的标准包括术后眼位矫正良好（远距离、第一眼位眼位偏斜≤5），复视及异常头位改善。对接受下斜肌减弱术组中术前上斜视度数小（<12）与度数大（>20）的患者，以及下斜肌断腱-肌切除术与下斜肌后徙术的手术结果进行亚组分析。
第1组平均第一眼位（PP）上斜视度数从14.3（范围3 - 37）降至4.5（范围0 - 30），第2组从13（范围1 - 30）降至2（范围 - 20 - 20），第3组从25.7（范围6 - 40）降至1.3（范围 - 12 - 18）。第1组再次手术率最低（7.6%），其次是第2组（16%）和第3组（25.9%）。三组最终手术成功率相似。下斜肌减弱术对于小度数第一眼位上斜视更具可预测性，但对于大度数偏斜仍有85%的成功率。下斜肌断腱-肌切除术比下斜肌后徙术效果更好（P < 0.05）。
当将预先制定的手术策略应用于单侧上斜肌麻痹的个体患者时，大多数患者可实现良好的功能改善。
