Ha Suk-Gyu, Suh Young-Woo, Kim Seung-Hyun
J Pediatr Ophthalmol Strabismus. 2017 Nov 1;54(6):363-368. doi: 10.3928/01913913-20170329-03. Epub 2017 Jul 5.
To describe the clinical features and surgical outcome of A-pattern exotropia combined with dissociated vertical deviation and superior oblique overaction.
The medical records of patients with A-pattern exotropia combined with dissociated vertical deviation and superior oblique overaction who underwent horizontal muscle surgery alone or in combination with superior oblique muscle weakening surgery were retrospectively reviewed. The patients were divided into two groups according to their surgery: the horizontal muscle surgery alone group and the horizontal muscle surgery with bilateral superior oblique weakening surgery (combined surgery) group. The preoperative clinical features and postoperative surgical outcomes at the patients' final follow-up visits were analyzed.
A total of 40 patients were included. The mean age at diagnosis was 5.5 ± 4.6 years. Amblyopia and latent nystagmus were observed in 18 (45%) and 10 (25%) patients, respectively. Six (15%) patients were associated with delayed development and hemiplegia. The mean angle of exodeviation was 27.7 ± 11.2 and 28.5 ± 10.9 prism diopters (PD) for distance and near, respectively. The mean degree of superior oblique overaction was 1.9 ± 1.1 and asymmetrical dissociated vertical deviation was observed in 24 (60%) patients. At the final follow-up visit, the horizontal angle of deviation was not significantly different between the groups. The success rates were 57.1% and 80% in the horizontal muscle surgery alone and combined surgery groups, respectively. These differences were statistically significant (P = .04).
Amblyopia was common and the prognosis of binocularity was poor in triad exotropia. Some patients had neurological deficits. The surgical success rate in this study was variable, ranging from 57.1% to 80%. [J Pediatr Ophthalmol Strabismus. 2017;54(6):363-368.].
描述A型外斜视合并分离性垂直偏斜和上斜肌亢进的临床特征及手术效果。
回顾性分析单独接受水平肌手术或联合上斜肌减弱术治疗的A型外斜视合并分离性垂直偏斜和上斜肌亢进患者的病历。根据手术方式将患者分为两组：单纯水平肌手术组和水平肌手术联合双侧上斜肌减弱术（联合手术）组。分析患者术前临床特征及末次随访时的手术效果。
共纳入40例患者。诊断时的平均年龄为5.5±4.6岁。分别有18例（45%）和10例（25%）患者存在弱视和潜在性眼球震颤。6例（15%）患者伴有发育迟缓及偏瘫。远距离和近距离的平均外斜视角分别为27.7±11.2和28.5±10.9棱镜度（PD）。上斜肌亢进的平均程度为1.9±1.1，24例（60%）患者观察到不对称性分离性垂直偏斜。在末次随访时，两组间的水平偏斜角度无显著差异。单纯水平肌手术组和联合手术组的成功率分别为57.1%和80%。这些差异具有统计学意义（P = 0.04）。
在三联征性外斜视中，弱视常见且双眼视预后较差。部分患者存在神经功能缺损。本研究中的手术成功率各不相同，范围为57.1%至80%。[《小儿眼科与斜视杂志》。2017；54(6):363 - 368。]
