Lee Young Bok, Choi Dong Gyu
Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, 948-1 Daerim1-dong, Youngdeungpo-gu, Seoul, 150-950, Korea.
BMC Ophthalmol. 2017 Jul 5;17(1):117. doi: 10.1186/s12886-017-0512-5.
The aim of this study was to compare the primary surgery and reoperation outcomes of unilateral lateral rectus recession and medial rectus resection (R&R) for intermittent exotropia.
We retrospectively reviewed the medical records of 80 patients, all of whom had undergone unilateral R&R for intermittent exotropia as a primary surgery or reoperation and been followed-up on postoperatively for 6 months or more. The patients were divided into two groups: unilateral R&R as primary surgery (group A, 44 patients) and unilateral R&R as reoperation (group B, 36 patients). The outcome measures were postoperative angle of deviation, surgical success rate, and mean dose-effect ratio (PD/mm, corrected angle of deviation / sum of amount of recession of lateral rectus and of resection of medial rectus). Surgical success was defined as exo- or esodeviation within 8 PD.
The mean postoperative follow-up duration was 49.91 ± 14.83 months in group A and 43.17 ± 26.91 months in group B (p = 0.160). The mean angles of deviation at postoperative 1 day were -5.18 PD (overcorrection) in group A and -5.28 PD in group B (p = 0.932). However, there was a significant difference in the mean angle of deviation between the two groups at each visit from postoperative 3 months to final follow-up (p < 0.05): in short, group A had become more exotropic than group B. And the surgical success rate was higher in group B than in group A at each visit from postoperative 12 months to final follow-up (47.7% in group A and 83.3% in group B at final follow-up) (p < 0.05). The mean dose-effect ratio at 6 months after surgery was 1.89 ± 0.58 PD/mm in group A and 2.26 ± 0.32 PD/mm in group B (p = 0.001).
Unilateral R&R as reoperation presented better results for the surgical treatment of recurrent exotropia, showing a smaller exodrift pattern and higher surgical success rates compared with R&R as a primary surgery. The mean effect per millimeter (the mean dose-effect ratio, PD/mm) of R&R as reoperation was significantly greater than that of R&R as primary surgery at postoperative 6 months. These results could serve as useful guidelines in the planning of surgical correction for primary and recurrent exotropia.
本研究旨在比较间歇性外斜视行单眼外直肌后徙术与内直肌切除术（R&R）的初次手术及再次手术效果。
我们回顾性分析了80例患者的病历，所有患者均因间歇性外斜视接受了单眼R&R手术，作为初次手术或再次手术，并术后随访6个月或更长时间。患者分为两组：单眼R&R作为初次手术（A组，44例患者）和单眼R&R作为再次手术（B组，36例患者）。观察指标为术后斜视度、手术成功率和平均剂量效应比（PD/mm，矫正斜视度/外直肌后徙量与内直肌切除量之和）。手术成功定义为斜视度在8棱镜度（PD）以内的外斜视或内斜视。
A组术后平均随访时间为49.91±14.83个月，B组为43.17±26.91个月（p = 0.160）。术后1天A组平均斜视度为-5.18棱镜度（过矫），B组为-5.28棱镜度（p = 0.932）。然而，从术后3个月至末次随访的每次随访中，两组间平均斜视度存在显著差异（p < 0.05）：简而言之，A组比B组外斜更明显。从术后12个月至末次随访的每次随访中，B组手术成功率均高于A组（末次随访时A组为47.7%，B组为83.3%）（p < 0.05）。术后6个月A组平均剂量效应比为1.89±0.58 PD/mm，B组为2.26±0.32 PD/mm（p = 0.001）。
单眼R&R作为再次手术治疗复发性外斜视效果更佳，与初次手术相比，外斜漂移模式更小，手术成功率更高。再次手术的R&R术后6个月每毫米平均效应（平均剂量效应比，PD/mm）显著大于初次手术。这些结果可为原发性和复发性外斜视手术矫正方案的制定提供有用的指导。
