Cifuentes Diana L, Pineles Stacy L, Demer Joseph L, Velez Federico G
Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, California.
Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, California; Department of Mechanical Engineering, University of California Los Angeles, California; Biomedical Engineering Interdepartmental Program, University of California Los Angeles, California; Neuroscience Interdepartmental Program, University of California Los Angeles, California; Department of Neurology, University of California Los Angeles, California.
J AAPOS. 2018 Feb;22(1):17-21. doi: 10.1016/j.jaapos.2017.10.005. Epub 2017 Dec 1.
To evaluate motor alignment, motility, and sensorial outcomes of simultaneous three-muscle surgery for large-angle horizontal strabismus, with special attention to lateral incomitance and long-term success.
The medical records of consecutive patients with large-angle deviations (≥30) who underwent simultaneous surgery on three horizontal muscles to correct esotropia or exotropia were reviewed retrospectively. Successful motor alignment was defined as residual deviation of ≤10 and consecutive deviation in primary position of ≤4, with no induced lateral incomitance >5 between lateral gazes. Sensory success was defined as an improvement in stereopsis of ≥2 octaves. Surgical procedures included a combination of recessions and resections/plications depending on surgeon preference. The majority of cases were two-muscle recessions combined with one-muscle resection or plication.
A total of 19 patients with exotropia and 9 patients with esotropia were included. In the esotropic group, the mean age at surgery was 48 ± 15 years and the mean preoperative deviation improved from 45.6 ± 11.9 to 1.5 ± 1.6 (P < 0.001); there was no undercorrection, recurrence or overcorrection. In the exotropic group, the mean age at surgery was 44 ± 25 years, and the mean preoperative deviation improved from 44.1 ± 8.7 to 5.8 ± 9.6 (P < 0.001), recurrence occurred in 2 (22%). Overall motor success at distance was 85%, with 1 (3.8%) unsuccessful patient due to induced incomitance. Sensory success was 44% for esotropia and 31% for exotropia. No patient lost stereopsis.
Patients undergoing three-muscle surgery for horizontal strabismus had good motor outcomes with low incidence of induced lateral incomitance. Motor and sensorial outcomes for esotropia were very stable.
评估同时进行三条肌肉手术治疗大角度水平斜视的眼球运动对齐、运动功能和感觉功能结果，特别关注外展功能不全和长期成功率。
回顾性分析连续接受三条水平肌肉同时手术以矫正内斜视或外斜视的大角度斜视（≥30）患者的病历。成功的眼球运动对齐定义为残余斜视度≤10，原在位连续斜视度≤4，且双眼外转时诱导性外展功能不全>5。感觉功能成功定义为立体视提高≥2个视标。手术方式包括根据手术医生的偏好进行的后徙术和切除术/折叠术的组合。大多数病例为两条肌肉后徙术联合一条肌肉切除术或折叠术。
共纳入19例外斜视患者和9例内斜视患者。在内斜视组，手术时的平均年龄为48±15岁，术前平均斜视度从45.6±11.9改善至1.5±1.6（P<0.001）；无矫正不足、复发或过度矫正。在外斜视组，手术时的平均年龄为44±25岁，术前平均斜视度从44.1±8.7改善至5.8±9.6（P<0.001），2例（22%）复发。远距离总体眼球运动成功率为85%，1例（3.8%）患者因诱导性外展功能不全手术失败。内斜视的感觉功能成功率为44%，外斜视的感觉功能成功率为31%。无患者立体视丧失。
接受水平斜视三条肌肉手术的患者眼球运动结果良好，诱导性外展功能不全发生率低。内斜视的眼球运动和感觉功能结果非常稳定。
