Pratt-Johnson J A
Department of Ophthalmology, B.C. Children's Hospital, Vancouver, Canada.
Aust N Z J Ophthalmol. 1988 May;16(2):87-92. doi: 10.1111/j.1442-9071.1988.tb01255.x.
Clinical experience in performing over 500 adjustable strabismus operations is mentioned in this paper particularly as it relates to complicated strabismus. A maximum hang-loose recession of a rectus muscle has a limited effect, which is tabulated and the implications discussed. Aids in finding the lost medial rectus muscle are mentioned. Adjustable sutures are then exploited in managing the found "lost" medial rectus. Adjustable recession of both vertical recti in the affected eye were used in some cases of blow-out fracture to manage limitations of upward and downward gaze. Adjustable recession of both yoke medial recti are used in some unilateral superior oblique palsies where the main sequela is hypertropia in downward gaze only. A previously paralysed lateral rectus muscle, which has completely recovered function but has left the patient with a concomitant esotropia with full ductions and normal versions, responds excessively to resection. This should be taken into consideration when planning adjustable strabismus surgery in such a case.
本文提及了超过500例可调式斜视手术的临床经验，特别是与复杂性斜视相关的经验。直肌最大程度的松弛性后徙效果有限，已制成表格并讨论了其影响。文中提到了寻找丢失的内直肌的辅助方法。然后利用可调缝线来处理找到的“丢失”内直肌。在一些爆裂性骨折病例中，对患眼的两条垂直直肌进行可调式后徙，以处理向上和向下注视受限的问题。在一些单侧上斜肌麻痹病例中，主要后遗症仅为向下注视时的上斜视，此时使用两条配偶肌内直肌的可调式后徙。一条先前麻痹的外直肌已完全恢复功能，但使患者伴有全眼球运动和正常转眼时的共同性内斜视，该外直肌对缩短术反应过度。在为这种情况计划可调式斜视手术时应考虑到这一点。
