Sonwani Prabha, Amitava Abadan Khan, Khan Adeeb Alam, Gupta Shalini, Grover Shivani, Kumari Namita
Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Indira Gandhi Eye Hospital and Research Centre, Lucknow, Uttar Pradesh, India.
Indian J Ophthalmol. 2017 Sep;65(9):853-858. doi: 10.4103/ijo.IJO_968_16.
Resections and plications tighten recti although the latter are less traumatic, potentially reversible, quicker, and vascularity preserving. To compare inflammation, scarring, and alignment in horizontal strabismus, operated uniocularly by either resections or plications (with recessions): recession and resection (R&R) or recession and plication (R&P) groups. This was a prospective, patient and assessor blind, randomized trial.
All consenting strabismus patients qualifying for the first-time uniocular horizontal rectus surgeries underwent detailed ocular examination and were randomized into standard R&R or R&P groups. For the latter, we folded the tendon-muscle strap the desired amount using 6-0 polyglactin, suturing it to its insertion, entailing no disinsertion. We compared the groups for inflammatory grades (individually for congestion, chemosis, discharge, foreign-body sensation, and drop intolerance and aggregated to a total inflammatory score (TIS), scar visibility (SV) at 1 m, and successful alignment (≤10 prism diopter of orthotropia). We used Mann-Whitney and Fisher's exact tests, with significance at P ≤ 0.05.
We randomized 40 patients: 22 to R&R and 18 to R&P. The groups were comparable in age, strabismus onset and duration, and strabismus amount. The inflammatory scores, both individual and TIS, were comparable at all time-points: all P > 0.05. SV proportions were not significantly different: 16/22 in R&R versus 9/18 in R&P; P = 0.19. There were no significant differences in success rates: 14/22 versus 10/18, P = 0.74.
Our study shows that plication is similarly effective as resection, when combined with recession in horizontal strabismus, and should be resorted to more frequently.
尽管折叠术创伤较小、具有潜在可逆性、操作更快且能保留血管，但切除术和折叠术都可收紧直肌。为比较水平斜视单眼手术采用切除术或折叠术（联合后徙术）后的炎症、瘢痕形成及眼位矫正情况：后徙术与切除术（R&R）组或后徙术与折叠术（R&P）组。这是一项前瞻性、患者及评估者双盲的随机试验。
所有符合首次单眼水平直肌手术条件且同意参与的斜视患者均接受详细眼部检查，并随机分为标准R&R组或R&P组。对于R&P组，我们使用6-0聚乙醇酸将肌腱-肌肉束折叠至所需长度，缝合至其附着点，无需离断。我们比较两组的炎症分级（分别针对充血、球结膜水肿、分泌物、异物感及滴眼液不耐受情况，并汇总为总炎症评分（TIS））、术后1个月时的瘢痕可见度（SV）以及成功矫正眼位（正位视棱镜度≤10）情况。我们采用曼-惠特尼检验和费舍尔精确检验，P≤0.05为有统计学意义。
我们将入组40例患者：22例纳入R&R组，18例纳入R&P组。两组在年龄、斜视发病及持续时间、斜视度数方面具有可比性。所有时间点上，个体炎症评分及TIS均具有可比性：所有P>0.05。SV比例无显著差异：R&R组为16/22，R&P组为9/18；P = 0.19。成功率无显著差异：分别为14/22和10/18，P = 0.74。
我们的研究表明，在水平斜视手术中，折叠术与后徙术联合应用时与切除术效果相似，应更频繁地采用。
