Rajavi Zhale, Feizi Mohadeseh, Naderi Ali, Sabbaghi Hamideh, Behradfar Narges, Yaseri Mehdi, Faghihi Mohammad
Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J AAPOS. 2017 Dec;21(6):476-479.e1. doi: 10.1016/j.jaapos.2017.07.213. Epub 2017 Oct 27.
To report the surgical outcomes of graded versus ungraded inferior oblique anterior transposition (IOAT) in treatment of patients with asymmetric dissociated vertical deviation (DVD) and bilateral inferior oblique overaction (IOOA).
A total of 74 eyes of 37 patients with asymmetric DVD (interocular difference of ≥5) and bilateral IOOA of > +1 were included in this randomized clinical trial. In the ungraded group (n = 18), both inferior oblique muscles were sutured at the inferior rectus level; in the graded group (n = 19), the inferior oblique muscles of eyes with more DVD were sutured at the level of the inferior rectus and inferior oblique muscles of eyes with less DVD were sutured 2 mm posterior to the level of the inferior rectus muscle.
DVD was significantly reduced in each group (P < 0.001 for both). Although the postoperative mean difference of asymmetry of DVD was less in the ungraded group compared to the graded group (1.2 ± 1.9 vs 3.2 ± 1.2 [P = 0.001]), the absolute amounts of reduction of DVD asymmetry were similar (4.3 ± 2.3 vs 4.4 ± 3.1 [P = 0.78]). IOOA and V patterns were also reduced postoperatively.
Each method of IOAT was effective in reducing DVD, asymmetry, IOOA, and V patterns.
报告分级与未分级下斜肌前转位术（IOAT）治疗不对称性分离性垂直偏斜（DVD）和双侧下斜肌亢进（IOOA）患者的手术效果。
本随机临床试验纳入了37例不对称性DVD（双眼差值≥5）且双侧IOOA>+1的患者共74只眼。在未分级组（n = 18）中，两条下斜肌均在直肌水平缝合；在分级组（n = 19）中，DVD较重眼的下斜肌在直肌水平缝合，而DVD较轻眼的下斜肌在直肌水平后2mm处缝合。
两组的DVD均显著降低（两组P均<0.001）。虽然未分级组术后DVD不对称性的平均差值低于分级组（1.2±1.9对比3.2±1.2 [P = 0.001]），但DVD不对称性的绝对降低量相似（4.3±2.3对比4.4±3.1 [P = 0.78]）。术后IOOA和V征也有所减轻。
每种IOAT方法在减轻DVD、不对称性、IOOA和V征方面均有效。
