Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
Am J Ophthalmol. 2018 Dec;196:91-95. doi: 10.1016/j.ajo.2018.08.036. Epub 2018 Sep 3.
To report the dose-response relationship of adjustable Harada-Ito surgery, and postoperative stability of cyclodeviation.
Retrospective cohort study.
Twenty patients underwent a unilateral adjustable Harada-Ito advancement of the anterior fibers of the superior oblique tendon, with or without resection. The surgical dose was calculated as resection plus advancement plus adjustment. Cyclodeviation was measured using double Maddox rods at preoperative and postoperative time points. We assessed dose effect by calculating change in cyclodeviation from preoperatively to postadjustment and evaluated the dose-response relationship by Spearman rank methods. Postoperative stability of cyclodeviation was assessed by comparing postadjustment measurements with 1-day and 6-week measurements, and also 1- and 5-year measurements, when available.
Change in cyclodeviation from preoperatively to postadjustment ranged from 7 to 20 degrees of incyclo effect. There was a dose effect of 1.3 degrees per mm (r = 0.52, P = .019). Postoperative incyclodeviation unwound a mean of 3.6 degrees ± 2.5 degrees between postadjustment and day 1. Overall change between postadjustment and the 6-week window was 6.5 ± 2.9 degrees in an excyclo direction. Unwinding continued with a mean change of 0.2 ± 2.6 degrees between the 6-week and 1-year windows, and of 0.4 ± 2.1 degrees between 1-year and 5-years windows.
Adjustable Harada-Ito advancement of the anterior fibers of the superior oblique tendon has a dose response of 1.3 degrees per millimeter, but its effect regresses over time. Based on our data, an immediate postoperative target incyclodeviation of 7 degrees is reasonable.
报告可调节 Harada-Ito 手术的剂量-反应关系，以及术后的偏斜稳定性。
回顾性队列研究。
20 例患者接受单侧可调节 Harada-Ito 前斜肌前纤维亢进手术，可选择联合或不联合肌腱切断术。手术剂量计算为切断术+前徙术+调整术。使用双眼马氏杆测量术前和术后的偏斜度。通过计算术后调整时与术前的偏斜度差值来评估剂量效应，并通过 Spearman 秩相关方法评估剂量-反应关系。通过比较术后调整时的测量值与术后 1 天和 6 周的测量值，以及术后 1 年和 5 年的测量值（如果有），评估术后偏斜的稳定性。
术后调整时的偏斜度从术前到术后的变化范围为 7 到 20 度的内斜效果。每毫米 1.3 度的剂量效应（r=0.52，P=0.019）。术后调整后 1 天，内斜的偏斜度平均回退 3.6±2.5 度。术后调整到 6 周的窗口期间，总的偏斜度向反方向变化 6.5±2.9 度。在 6 周到 1 年的窗口期间，继续回退，平均变化 0.2±2.6 度，在 1 年到 5 年的窗口期间，平均变化 0.4±2.1 度。
可调节 Harada-Ito 前斜肌前纤维亢进手术的剂量-反应关系为每毫米 1.3 度，但效果随时间推移而消退。根据我们的数据，术后立即目标内斜 7 度是合理的。
