Mikhail Mikel, Flanders Michael
Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, Que.
Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, Que; Department of Ophthalmology, Faculty of Medicine, University of Montreal, Montreal, Que..
Can J Ophthalmol. 2017 Aug;52(4):403-408. doi: 10.1016/j.jcjo.2016.11.035. Epub 2017 Feb 20.
The aim of this study was to describe the clinical features and surgical outcomes of teenage and adult patients with esotropia undergoing strabismus surgery with adjustable sutures.
Seventy-three patients were included in this retrospective, cohort study. Patients were stratified into group 1 (35 with childhood-onset esotropia [CET]) and group 2 (38 with adult-onset esophoria-tropia [EPT]). Preoperative immediate, 2-week, and 4-6-month postoperative measurements of ocular alignment, as well as fusional testing, were performed. Postoperative success was defined as distant (6 m) and near (33 cm) alignment within 12 prism diopters (PDs) of orthotropia in the primary position at 2 weeks and at 4-6 months with a single surgery.
Patients with CET more frequently had hyperopia and amblyopia and were more likely to present for surgery because of psychosocial strabismus-related problems. Patients with EPT predominantly had myopia and were more likely to experience diplopia and asthenopia. In group 1, the mean preoperative distance deviation improved from 30 PDs to 4 PDs at 2 weeks and to 4 PDs at 4-6 months (p < 0.001). In group 2, mean preoperative distance alignment improved from 22 to 3 PDs at 2 weeks and to 3 PDs at 4-6 months (p < 0.001). The mean objective, single-surgery success rate at 2 weeks was 88% and 97% in groups 1 and 2, respectively. At 4-6 months, postoperative success was 71% in group 1 and 80% in group 2. The majority of patients reported subjective improvement.
There are distinct preoperative differences between CET and EPT patients. Adjustable, strabismus surgery in this cohort is safe and effective in achieving subjective and objective success.
本研究旨在描述接受可调节缝线斜视手术的青少年和成年内斜视患者的临床特征及手术效果。
本回顾性队列研究纳入了73例患者。患者被分为1组（35例儿童期起病的内斜视[CET]）和2组（38例成年期起病的隐斜-斜视[EPT]）。进行了术前即刻、术后2周以及4 - 6个月时的眼位测量和融合功能测试。术后成功定义为单次手术后2周及4 - 6个月时，在第一眼位远距（6米）和近距（33厘米）眼位矫正至12棱镜度（PD）以内。
CET患者更常伴有远视和弱视，且因与斜视相关的心理社会问题更倾向于接受手术。EPT患者主要为近视，更易出现复视和视疲劳。在1组中，术前平均远距离斜视度从30 PD在术后2周改善至4 PD，4 - 6个月时为4 PD（p < 0.001）。在2组中，术前平均远距离眼位从22 PD在术后2周改善至3 PD，4 - 6个月时为3 PD（p < 0.001）。1组和2组术后2周时单次手术的客观成功率分别为88%和97%。在4 - 6个月时，1组术后成功率为71%，2组为80%。大多数患者报告主观症状有所改善。
CET和EPT患者术前存在明显差异。在该队列中，可调节缝线斜视手术在实现主观和客观成功方面是安全有效的。
