ElKamshoushy Amr A
University of Alexandria, Alexandria, Egypt.
J AAPOS. 2017 Apr;21(2):112-116. doi: 10.1016/j.jaapos.2017.03.003. Epub 2017 Mar 9.
Surgical treatments for large-angle exotropia include bilateral lateral rectus recession, recession-resection procedures, and three- and four-muscle surgery. Undercorrection and limitation of abduction are common complications of these procedures. This study reports the results of bilateral medial rectus resection as a first procedure for primary large-angle exotropia.
The medical records of patients who underwent bilateral medial rectus resection for angles ≥60 in the period from 2006 till 2016 with a minimum follow-up period of 6 months were reviewed retrospectively. The amount of resection ranged from 8 mm to 12 mm according to the preoperative angle. Success was defined as a final outcome within the range of 8 of esotropia to 10 of exotropia.
A total of 64 patients were included, in whom angles ranged from 60 to 140. The overall success rate was 77%, and there was no significant difference in success rate between classes of smaller and larger angles. Limitation of abduction was seen in first postoperative week. At 6 months' follow-up 64% of eyes had no limitation of abduction.
In our patient cohort bilateral medial rectus resection successfully corrected large-angle exotropia of up to 140, with results comparable to three- and four-muscle procedures. It has the advantage of not causing significant abduction deficits, even with resections up to 12 mm.
大角度外斜视的手术治疗方法包括双侧外直肌后徙术、后徙-切除术以及三肌和四肌手术。这些手术常见的并发症是矫正不足和外展受限。本研究报告了双侧内直肌切除术作为原发性大角度外斜视首次手术的结果。
回顾性分析2006年至2016年期间接受双侧内直肌切除术、斜视角度≥60°且随访期至少6个月的患者的病历。根据术前角度，切除量为8毫米至12毫米。成功定义为最终结果在8°内斜视至10°外斜视范围内。
共纳入64例患者，斜视角度为60°至140°。总体成功率为77%，较小角度组和较大角度组的成功率无显著差异。术后第一周出现外展受限。在6个月的随访中，64%的眼睛没有外展受限。
在我们的患者队列中，双侧内直肌切除术成功矫正了高达140°的大角度外斜视，结果与三肌和四肌手术相当。即使切除量达到12毫米，它也具有不会导致明显外展缺陷的优点。
