Serafino Massimiliano, Scaramuzzi Matteo, Villani Edoardo, Nucci Paolo
Department of Clinical Science and Community Health, University of Milan, Milan, Italy.
University Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.
Eur J Ophthalmol. 2020 Jul;30(4):676-679. doi: 10.1177/1120672119850684. Epub 2019 May 20.
To assess the efficacy of "Yokoyama Procedure," on non-highly myopic patients with acquired esotropia and hypotropia.
The study involved 10 eyes of 5 patients with eso-hypotropia. Inclusion criteria were acquired esotropic-hypotropic strabismus with lateral rectus inferior displacement and superior rectus nasal displacement confirmed by magnetic resonance imaging, refractive errors between ±6 D, and axial length < 27 mm. Range of full duction movements and maximum angles of abduction-sursumduction was measured in each eye before and after surgery. All patients underwent T1- and T2-weighted magnetic resonance imaging. The surgery was aimed at creating a junction between the muscle bellies of the superior and lateral rectus muscles. This junction was made approximately 14 mm behind the insertions using a non-absorbable mersilene 5/0 suture (Yokoyama procedure).
Mean patient age was 64.8 ± 4.8 years. The mean globe axial length was 25.4 ± 0.76 mm and a mean corresponding spherical equivalent refraction of -3.7 ± 1.7 D was observed. Eight eyes on 10 had mild limitation in abduction, while the remaining 2 had no limitation. Three out of 10 eyes showed a moderate limited sursumduction, 5 eyes were categorized as mild, and the remaining 2 had no limitation. No evident post-operative limitation was present in any eye, in both abduction and sursumduction (p < 0.01). Pre-operative esotropia and hypotropia were, respectively, 32 ± 11 prismatic diopters and 25 ± 5 prismatic diopters, and they were significantly reduced after surgery as 9 ± 1.7 prismatic diopters and 6 ±1 prismatic diopters (p = 0.043), respectively.
Yokoyama procedure is an effective, fast, reversible procedure to face eso-hypotropic acquired strabismus, even in patients with a clear magnetic resonance imaging displacement of superior and lateral rectus muscles, and absence of globe dislocation and of elevated myopia.
评估“横山手术”对非高度近视获得性内斜视和下斜视患者的疗效。
该研究纳入了5例患有内下斜视患者的10只眼。纳入标准为经磁共振成像证实为获得性内斜下斜伴外直肌下移和上直肌内移、屈光不正±6D且眼轴长度<27mm。在手术前后测量每只眼的全眼球运动范围和最大外展 - 上转角度。所有患者均接受T1加权和T2加权磁共振成像检查。手术旨在在上直肌和外直肌肌腹之间形成连接。使用不可吸收的5/0丝裂霉素缝线（横山手术）在插入点后方约14mm处进行此连接。
患者平均年龄为64.8±4.8岁。平均眼轴长度为25.4±0.76mm，平均等效球镜度为-3.7±1.7D。10只眼中有8只眼外展轻度受限，其余2只眼无受限。10只眼中有3只眼上转中度受限，5只眼为轻度，其余2只眼无受限。术后任何一只眼在外展和上转方面均无明显受限（p<0.01）。术前内斜视和下斜视分别为32±11棱镜度和25±5棱镜度，术后显著降低，分别为9±1.7棱镜度和6±1棱镜度（p = 0.043）。
横山手术是一种有效、快速且可逆的治疗获得性内下斜视的手术方法，即使在磁共振成像显示上直肌和外直肌明显移位且无眼球脱位和高度近视的患者中也是如此。
