Wright Foundation for Pediatric Ophthalmology and Strabismus, Los Angeles, CA.
Department of Ophthalmology, Queen's University, Kingston, Ont..
Can J Ophthalmol. 2020 Feb;55(1):58-62. doi: 10.1016/j.jcjo.2019.07.003. Epub 2019 Aug 21.
Standard rectus muscle recessions require suturing muscle to sclera posterior to the insertion, which is dangerous as the sclera is thin. Extraocular muscle hang-back recession can avoid the posterior scleral needle pass but has been reported to be unstable. The purpose of this study is to assess the use of N-butyl-2-cyanoacrylate to aid reattachment of rectus muscle to sclera during hang-back recession.
2 Phase Study: Phase 1 was a wet lab animal study; Phase 2 was a small case series.
Phase 1, 14 frozen bank rabbit heads; Phase 2, 4 human adult patients with myopia and large exotropia.
Phase 1: Frozen bank rabbit heads were used to simulate human hang-back rectus muscle recession. Fourteen rectus muscles were recessed by hang-back and glued to sclera with either cyanoacrylate glue alone (group 1) or glue over prolene mesh for greater stability (group 2). Primary outcome was muscle detachment force measured at 20, 30, and 40 seconds. Phase 2: Four patients with myopia and large exotropia who underwent bilateral hang-back lateral rectus recessions with cyanoacrylate glue were retrospectively studied.
Phase 1: Group 1 mean detachment force measured at 30 seconds was 172.07 g versus 376.5 g in group 2 (p < 0.01). Phase 2: All patients had excellent postoperative alignment within 5 PD of orthophoria and no overcorrections. Two patients had unilateral glue extrusion at 1 month requiring in-office removal under topical anaesthesia.
Cyanoacrylate glue with or without mesh resulted in adequate muscle-to-sclera adhesion with a detachment force at least 2 times the force of a normal rectus muscle contraction. Patients undergoing hang-back lateral rectus recession with cyanoacrylate glue had excellent stable postoperative alignment; however, half had the complication of late extrusion of glue foreign body.
标准直肌后退术需要将肌肉缝合到巩膜后插入部位，由于巩膜较薄，因此存在一定风险。眼外肌后退悬挂术可以避免后巩膜穿针，但已有报道称其不稳定。本研究旨在评估使用 N-丁基-2-氰基丙烯酸酯辅助悬挂后退时直肌与巩膜重新附着。
2 期研究：第 1 期为湿实验室动物研究；第 2 期为小病例系列研究。
第 1 期，14 个冷冻银行兔头；第 2 期，4 名近视和大外斜视的成年患者。
第 1 期：使用冷冻银行兔头模拟人眼悬挂后退直肌后退。14 条直肌通过悬挂后退并用氰基丙烯酸酯胶单独（第 1 组）或胶上覆盖 prolene 网以增加稳定性（第 2 组）粘到巩膜上。主要结果是在 20、30 和 40 秒时测量的肌肉分离力。第 2 期：回顾性研究了 4 名近视和大外斜视患者，行双侧悬挂后退外侧直肌后退并用氰基丙烯酸酯胶。
第 1 期：第 1 组 30 秒时的平均分离力为 172.07 g，第 2 组为 376.5 g（p < 0.01）。第 2 期：所有患者术后均在 5 PD 内获得良好的正位，无过矫。2 名患者在 1 个月时出现单侧胶外溢，需要在局部麻醉下门诊取出。
带有或不带有网的氰基丙烯酸酯胶可实现足够的肌肉-巩膜附着，分离力至少是正常直肌收缩力的 2 倍。接受氰基丙烯酸酯胶悬挂后退外侧直肌后退的患者术后获得了极好的稳定正位；然而，有一半患者出现迟发性胶异物外溢的并发症。
