Honglertnapakul Worawalun, Sawanwattanakul Sirinuch, Pukrushpan Parnchat, Praneeprachachon Pokpong, Jariyakosol Supharat
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,
Ophthalmology Department, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand,
Clin Ophthalmol. 2019 Mar 18;13:515-519. doi: 10.2147/OPTH.S193751. eCollection 2019.
To evaluate the success rate and long-term motor and sensory outcomes of the full tendon vertical rectus transposition (VRT) with Foster suture for unilateral complete sixth cranial nerve palsy.
We reviewed the medical records of patients with unilateral acquired sixth cranial nerve palsy who underwent unilateral full tendon VRT with Foster suture between 2005 and 2016 and had a follow-up of ≥2 years. Data on pre- and postoperative diplopia, face turn, ocular deviation, and limitation of abduction were collected. A successful outcome was defined as a horizontal deviation ≤10 prism diopter (PD) of ortho in a primary position at distance and absence of diplopia.
A total of 20 patients were included in this study. Median (IQR) preoperative deviation was esotropia 65 (40-130) PD, which improved to 10 (-4 to 45) PD postoperatively. Median (IQR) improvement of esotropia was 54 (30-76) PD (<0.001). Median (IQR) preoperative limitation of abduction was -15° (-22.5° to 10°; negative value means before reaching midline), which improved to 15° (7.5°-45°) pass midline postoperatively. Median (IQR) improvement of abduction deficit was 26° (15°-35°) (<0.001). Successful surgical outcomes were obtained in eleven patients (55%). All patients in the non-successful group (n=9, 45%) had residual esotropia. Two of them underwent additional bilateral medial rectus recession. No postoperative vertical deviation or torsional diplopia was observed.
In our series, the full tendon VRT with Foster suture in unilateral complete sixth cranial nerve palsy resulted in significant improvement of the ocular alignment and range of abduction over the 2-year follow-up period.
评估采用福斯特缝合法进行全肌腱垂直直肌转位术（VRT）治疗单侧完全性第六颅神经麻痹的成功率以及长期运动和感觉结果。
我们回顾了2005年至2016年间接受单侧全肌腱VRT并采用福斯特缝合法治疗单侧后天性第六颅神经麻痹且随访时间≥2年的患者的病历。收集了术前和术后复视、面转、眼位偏斜及外展受限的数据。成功结果定义为远距离原在位水平斜视度≤10棱镜度（PD）且无复视。
本研究共纳入20例患者。术前斜视的中位数（四分位间距）为内斜视65（40 - 130）PD，术后改善至10（-4至45）PD。内斜视改善的中位数（四分位间距）为54（30 - 76）PD（<0.001）。术前外展受限中位数（四分位间距）为-15°（-22.5°至10°；负值表示未达中线前），术后改善至超过中线15°（7.5° - 45°）。外展缺陷改善的中位数（四分位间距）为26°（15° - 35°）（<0.001）。11例患者（55%）获得了成功的手术结果。未成功组（n = 9，45%）的所有患者均有残余内斜视。其中2例患者接受了额外的双侧内直肌后徙术。未观察到术后垂直斜视或旋转性复视。
在我们的系列研究中，采用福斯特缝合法进行全肌腱VRT治疗单侧完全性第六颅神经麻痹在2年随访期内使眼位矫正和外展范围有显著改善。
