Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, Canada; Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, Canada.
Am J Ophthalmol. 2018 May;189:155-159. doi: 10.1016/j.ajo.2017.11.006. Epub 2018 Feb 19.
To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia.
Multicenter, nonrandomized clinical study.
Setting: Two tertiary-care pediatric hospitals.
Children with large-angle (≥55 prism diopters) infantile esotropia.
Surgical treatment of infantile esotropia.
Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment).
A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus muscle recessions in 70 patients, botulinum toxin-augmented surgery in 15 patients, and 3-muscle surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin-augmented surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up.
The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin-augmented surgery was associated with a higher success rate at final follow-up.
报告一组大角度婴幼儿内斜视患者的长期手术结果。
多中心、非随机临床研究。
地点：两家三级儿科医院。
大角度（≥55 棱镜度）婴幼儿内斜视患儿。
婴幼儿内斜视的手术治疗。
最终随访时的成功率（术后斜视度≤10 棱镜度且无需再次治疗）。
在 13 年的研究期间，共有 88 例大角度婴幼儿内斜视患者接受了治疗。70 例患者接受双侧内直肌后徙术，15 例患者接受肉毒杆菌毒素增强手术，3 例患者接受 3 条肌肉手术。平均随访 40 个月后，20 例（23%）患者获得成功，68 例（77%）治疗失败。68 例治疗失败中，59 例有残余或复发内斜视，9 例有继发性外斜视。多变量逻辑回归分析显示，治疗方式是唯一与成功结果显著相关的因素。具体来说，接受肉毒杆菌毒素增强手术治疗的患者比接受双侧内直肌后徙术的患者更有可能获得成功。对于 26 例（30%）接受再次治疗的患者，平均手术次数为 2.1 次，7 例（27%）在最终随访时斜视度≤10 棱镜度。
在本队列中，大角度婴幼儿内斜视的总体治疗成功率较低，大多数失败是由于复发或残余内斜视。肉毒杆菌毒素增强手术与最终随访时更高的成功率相关。
