Tibrewal Shailja, Singh Nishtha, Bhuiyan Marazul Islam, Ganesh Suma
Pediatric Ophthalmology and Strabismology Services, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi 110 002, India.
Chittagong Eye Infirmary & Training Complex, Pahartali, Chittagong 4202, Bangladesh.
Int J Ophthalmol. 2017 Jul 18;10(7):1120-1125. doi: 10.18240/ijo.2017.07.16. eCollection 2017.
To study the factors affecting residual exotropia (>10 PD) at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus (LR) recession or unilateral recess resect procedure].
A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia (>10 PD) and successful outcome (within 10 PD of orthotropia) at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount (mm) of muscle surgery done.
One hundred and fifty-seven patients with mean age of 14y (range 3-53y) were included. Twenty-seven patients (17.2%) had residual exotropia at 4-6wk postoperative follow up. Age at surgery (=0.009) and preoperative deviation for distance (≤0.001) and near (=0.001) were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done (recess-resect or bilateral LR recession). The effect/dose ratio was more in deviations >40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group (1.36 PD/mm 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm 2.63 PD/mm in the unilateral recess-resect surgery).
Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.
研究间歇性外斜视行双眼直肌手术（双侧外直肌后徙或单眼后徙-截除术）后4至6周随访时残余外斜视（＞10棱镜度）的影响因素。
对2011年1月至2013年12月期间接受双眼直肌手术的间歇性外斜视≤50棱镜度患者进行回顾性病历分析。比较术后4至6周随访时残余外斜视（＞10棱镜度）患者与手术成功（正位视在10棱镜度范围内）患者的可能影响因素。通过将手术效果除以所做肌肉手术的总量（毫米）来计算效果/剂量比。
纳入157例平均年龄14岁（范围3至53岁）的患者。27例患者（17.2%）术后4至6周随访时有残余外斜视。手术年龄（=0.009）、术前远距离（≤0.001）和近距离（=0.001）斜视度被确定为手术失败的重要预测因素。残余外斜视的发生不受弱视、屈光参差、外展功能不全、斜视类型、垂直斜视、外斜视类型或手术方式（后徙-截除或双侧外直肌后徙）的影响。在截除-后徙术和双侧外直肌后徙术两种手术方式中，斜视度＞40棱镜度时效果/剂量比更高。与手术成功组相比，残余外斜视患者的效果/剂量比更低（双侧外直肌后徙手术中为1.36棱镜度/毫米对2.05棱镜度/毫米，单眼后徙-截除手术中为1.93棱镜度/毫米对2.63棱镜度/毫米）。
间歇性外斜视双眼直肌手术后17%的患者出现残余外斜视。年龄较大和术前斜视度较大的患者，间歇性外斜视双眼直肌斜视手术失败的可能性更大。
