Alkharashi Maan, Hunter David G
Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
J AAPOS. 2017 Jun;21(3):201-204. doi: 10.1016/j.jaapos.2017.05.012. Epub 2017 May 20.
To evaluate the surgical success of rectus muscle plication compared to resection and to compare the short- and long-term changes in ocular alignment after both procedures.
The medical records of all patients who underwent a rectus muscle tightening procedure (resection or plication) at a single institution over a 5-year period by a single surgeon were reviewed retrospectively. Binocular alignment was recorded before and immediately after surgery and again at 6-12 weeks and final follow-up visit. Primary outcome was surgical success rate, defined as distance alignment of ≤10 for horizontal and ≤6 for vertical strabismus. Secondary outcomes were reoperation rate and postoperative alignment drift.
A total of 72 surgeries were identified for inclusion: 48 resections and 24 plications. Surgical success was significantly higher in the resection group than in the plication group (89% vs 58%; P = 0.005) at both 6-12 weeks' follow-up (P = 0.005) and at mean final follow-up of 19 ± 13 months (range, 3-56 months [n = 48]; P = 0.03). Reoperations were performed in 3 patients in the plication group (12.5%), all for undercorrection; there were no reoperations in the resection group (P = 0.03).
Rectus muscle plication has many potential advantages over resection, including sparing of the ciliary circulation. In our experience, however, patients treated with plication had lower surgical success rates and a higher reoperation rate. Surgeons should monitor their long-term results before considering plication as their procedure of choice over resection.
评估与直肌切除术相比，直肌折叠术的手术成功率，并比较两种手术术后眼位的短期和长期变化。
回顾性分析一名外科医生在5年期间于单一机构对所有接受直肌收紧手术（切除术或折叠术）患者的病历。记录术前、术后即刻、术后6 - 12周以及最终随访时的双眼眼位。主要结局指标为手术成功率，定义为水平斜视眼位距离≤10，垂直斜视眼位距离≤6。次要结局指标为再次手术率和术后眼位漂移。
共确定72例手术纳入研究：48例切除术和24例折叠术。在术后6 - 12周随访时（P = 0.005）以及平均19 ± 13个月（范围3 - 56个月[n = 48]）的最终随访时，切除术组的手术成功率显著高于折叠术组（89%对58%；P = 0.005）（P = 0.03）。折叠术组有3例患者（12.5%）进行了再次手术，均因矫正不足；切除术组无再次手术病例（P = 0.03）。
与切除术相比，直肌折叠术有许多潜在优势，包括保留睫状循环。然而，根据我们的经验，接受折叠术治疗的患者手术成功率较低，再次手术率较高。在考虑将折叠术作为首选手术方式而非切除术之前，外科医生应监测其长期效果。
