Liu Yan, Wen Wen, Zou Leilei, Wu Sujia, Wang Shu, Liu Rui, Liu Hong
Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, China.
Graefes Arch Clin Exp Ophthalmol. 2019 Jan;257(1):199-205. doi: 10.1007/s00417-018-4102-x. Epub 2018 Sep 4.
To investigate prognostic factors in patients with augmented superior rectus transposition (SRT) for sixth nerve palsy.
Thirteen patients who were diagnosed with sixth nerve palsy and underwent augmented SRT between January 2015 and February 2017 in EENT Hospital of Fudan University were reviewed retrospectively. Data including age, sex, etiology of the abducens nerve palsy, degree of pre- and postoperative deviation in the primary position, pre- and postoperative abduction deficit, any induced vertical or torsional deviations, reoperations, and other complications was collected. Patients with undercorrection of SRT surgeries received additional inferior rectus transposition (IRT) surgery.
Mean esodeviation in primary position improved from 81.92 to 30.54 (p < 0.001) with a 1.54-unit improvement in abduction (p = 0.001). Six patients achieved alignment defined as esodeviation in primary position within 10 of orthotropia and seven patients were undercorrected after the first SRT surgery. Multivariable linear regression analysis showed that among factors (disease duration, preoperative esodeviation, preoperative abduction deficit), only the degree of preoperative abduction deficit (β = - 13.68) was the prognostic factor for success of SRT surgery. After IRT procedures, the mean esodeviation in primary position improved from 40 to 8 (p < 0.01).
The degree of preoperative abduction deficit is the prognostic factor for augmented SRT for sixth nerve palsy. Patients with worse abduction deficit have a greater likelihood of needing a secondary operation, and IRT could be a good choice for reoperation after SRT.
探讨上直肌加强转位术（SRT）治疗第六脑神经麻痹患者的预后因素。
回顾性分析2015年1月至2017年2月在复旦大学附属眼耳鼻喉科医院诊断为第六脑神经麻痹并接受上直肌加强转位术的13例患者。收集的数据包括年龄、性别、展神经麻痹的病因、术前和术后原在位的斜视度数、术前和术后外展不足、任何诱发的垂直或扭转性斜视、再次手术以及其他并发症。上直肌转位术矫正不足的患者接受了额外的下直肌转位术（IRT）。
原在位平均内斜视度数从81.92改善至30.54（p＜0.001），外展改善1.54单位（p = 0.001）。6例患者达到正位标准，即原在位内斜视度数在正交位10△以内，7例患者首次上直肌转位术后矫正不足。多变量线性回归分析显示，在疾病持续时间、术前内斜视度数、术前外展不足等因素中，仅术前外展不足程度（β = - 13.68）是上直肌转位术成功的预后因素。下直肌转位术后，原在位平均内斜视度数从40改善至8（p＜0.01）。
术前外展不足程度是上直肌加强转位术治疗第六脑神经麻痹的预后因素。外展不足越严重的患者越有可能需要二次手术，下直肌转位术可能是上直肌转位术后再次手术的良好选择。
