Magli Adriano, Carelli Roberta, Chiariello Vecchio Elisabetta, Esposito Francesca, Rombetto Luca, Esposito Veneruso Paolo
Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy.
GI. MA Eye Center, Naples 80122, Italy.
Int J Ophthalmol. 2016 Dec 18;9(12):1802-1807. doi: 10.18240/ijo.2016.12.17. eCollection 2016.
To evaluate long term follow-up (10y) of 6 muscle surgical approach in essential infantile esotropia (EIE).
A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique (IO) hyperfunction and lateral rectus (LR) pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach: bilateral medial recti (MR) recession (4-5 mm), bilateral LR resection (lower than 7 mm) and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥+30 prism diopters (PD) and IO hyperfunction were selected from larger cohort of patients (=213, 103 females and 110 males) after excluding patients with: angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package (version 9.1, SAS Institute Inc., Cary, NC, USA).
Ten years follow up data analysis showed the following percentage of orthotropic patients: (0 PD): 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant (<0.01), increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction (=0.04).
Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.
评估6条肌肉手术治疗婴儿型内斜视（EIE）的长期随访（10年）结果。
回顾性评估对患有下斜肌（IO）功能亢进和外直肌（LR）麻痹的EIE患者采用的6条肌肉手术方法，这些患者在不同年龄接受了手术。对年龄≤4岁接受6条肌肉手术的患者术前和术后的不同临床特征进行了分析。所有患者均接受多肌肉手术：双侧内直肌（MR）后徙（4 - 5毫米）、双侧LR缩短（小于7毫米）以及双侧IO后徙和前徙。从更大的患者队列（=213例，103例女性和110例男性）中，排除有以下情况的患者后，选取108例术前斜视度≥ +30三棱镜度（PD）且IO功能亢进的儿童：斜视度不稳定、接受过再次手术以及随访不完整的患者。进行了术前评估和完整的视光学检查。术后3个月、2年（此处原文“2”可能有误，结合上下文推测应为“2年”）、5年和10年进行随访。使用SAS统计软件包（版本9.1，SAS Institute Inc.，美国北卡罗来纳州卡里）进行统计分析。
十年随访数据分析显示正位（0 PD）患者的百分比为：3个月时为22.2%；2年时为16.7%；5年时为25.0%；10年时为27.8%。与3个月时相比，2年随访时残余斜视度有轻微但显著（<0.01）增加。随着时间推移，手术结果稳定，平均残余斜视度呈降低趋势（=0.04）。
我们的结果证实了多肌肉手术方法治疗患有IO功能亢进的EIE患者的可靠性。
