Kim Jin-Soo, Yang Hee Kyung, Hwang Jeong-Min
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
PLoS One. 2017 Oct 6;12(10):e0184863. doi: 10.1371/journal.pone.0184863. eCollection 2017.
Initial overcorrection after exotropia surgery has been considered as a desirable result. Recently, there had been several studies that reported better surgical results of augmented bilateral lateral rectus muscle recession procedure over the conventional procedure.
To compare the long-term results of augmented unilateral lateral rectus recession-medial rectus resection procedure (RR) with the original surgery in exotropic children.
A retrospective cohort study was performed on a total of 121 children with exotropia who underwent RR from February 2005 to December 2012 and were followed-up for at least 24 months. In 64 patients, RR was performed based on the original surgical table (original RR group). In 57 patients, the amount of medial rectus muscle resection was increased by 1 mm (augmented RR group).
In the original RR group, 47 of 64 patients (73.4%) had a successful outcome, 13 patients (20.3%) had recurrence, and 4 patients (6.3%) had overcorrection at 2 years after surgery. In the augmented RR group, 45 of 57 patients (79.0%) were successful, 4 patients (7.0%) had recurrence and 8 patients (14.0%) had overcorrection at 2 years after surgery. The recurrence rate was significantly lower in the augmented RR group than the original RR group, whereas the overcorrection rate was not significantly different between two groups at 2 years after surgery (P = 0.036 and P = 0.153, respectively). The cumulative probability of recurrence was lower in the augmented group at 36 months after surgery (P = 0.046, log rank test).
The long-term success rate of augmented RR in exotropic children was 79.0% and the recurrence rate was significantly lower than original RR with comparable overcorrection rates. Augmented RR can be considered as an alternative procedure in children with basic and convergence insufficiency type exotropia.
外斜视手术后的初始过度矫正被认为是一个理想的结果。最近，有几项研究报告称，与传统手术相比，增强型双侧外直肌后徙手术的手术效果更好。
比较增强型单侧外直肌后徙-内直肌切除术（RR）与原手术治疗外斜视患儿的长期效果。
对2005年2月至2012年12月期间接受RR手术并随访至少24个月的121例外斜视患儿进行回顾性队列研究。64例患者按照原手术方案进行RR手术（原RR组）。57例患者的内直肌切除量增加1mm（增强型RR组）。
原RR组64例患者中，47例（73.4%）手术成功，13例（20.3%）复发，4例（6.3%）在术后2年出现过度矫正。增强型RR组57例患者中，45例（79.0%）手术成功，4例（7.0%）复发，8例（14.0%）在术后2年出现过度矫正。增强型RR组的复发率显著低于原RR组，而两组术后2年的过度矫正率无显著差异（P值分别为0.036和0.153）。术后36个月时，增强型组的累积复发概率较低（P = 0.046，对数秩检验）。
增强型RR治疗外斜视患儿的长期成功率为79.0%，复发率显著低于原RR组，过度矫正率相当。对于基本型和集合不足型外斜视患儿，增强型RR可被视为一种替代手术。
