Department of Paediatric Ophthalmology and Strabismus, K.B. Haji Bachooali Eye Hospital; Department of Paediatric Ophthalmology and Strabismus, Advanced Eye Hospital, Navi Mumbai; Department of Paediatric Ophthalmology and Strabismus, Agashe Hospital, Kurla, India.
Department of Paediatric Ophthalmology and Strabismus, K.B. Haji Bachooali Eye Hospital, Navi Mumbai, India.
Indian J Ophthalmol. 2020 Jan;68(1):170-173. doi: 10.4103/ijo.IJO_196_19.
To report the surgical outcomes in six patients of Helveston syndrome using a "four oblique" procedure. The popular methods for surgical management include superior rectus recessions alone or combined with superior oblique tenectomy. However, large angle exotropia correction would entail a higher risk of anterior segment ischemia when the superior rectus needs to be operated along with the horizontal recti. Hence, we evaluated the long-term results of this uncommon procedure.
This was a retrospective review of six patients diagnosed to have manifest dissociated vertical deviation (DVD) with A pattern exotropia with bilateral superior oblique over action. All patients underwent horizontal muscle recessions/resections for exotropia along with bilateral posterior tenectomy of the superior oblique with inferior oblique anterior transpositioning.
The median age was 10 years (Range 5-26 years). The mean postoperative follow-up was 26 ± 14.02 months (Range 12-48 months). The mean reduction in exotropia was from 36.5 ± 21.06 PD (Range 15-65 PD) to 6.1 ± 3.06 PD (Range 3-10 PD). The procedure corrected the A pattern from a mean 23 ± 7 PD (Range 15-35 PD) to 7.6 ± 3.2 PD (Range 3-10 PD). The average DVD in the right eye reduced from 14 ± 4.3 PD (Range 8-20 PD) to 5.3 ± 1.2 PD and in the left eye from 14.33 ± 3.6 PD (Range 10-18 PD) to 4.1 ± 1.1 PD. The DVD asymmetry reduced from 6.33 ± 3.4 PD to 1.5 ± 1.3 PD.
"Four oblique" procedure with horizontal muscle surgery seems to be an effective method for significantly correcting the A pattern as well as reducing the DVD with good long-term outcome in our case series.
报告 6 例 Helveston 综合征患者采用“四斜”手术的手术结果。手术治疗的常用方法包括单独行上直肌后退术或联合上斜肌肌腱切断术。然而，当需要同时对上直肌和水平直肌进行手术时，大角度外斜视矫正会增加前段缺血的风险。因此，我们评估了这种不常见手术的长期效果。
这是一项回顾性研究，纳入 6 例诊断为显性分离性垂直偏斜（DVD）伴 A 型外斜视和双侧上斜肌亢进的患者。所有患者均行水平肌后退/切除术矫正外斜视，同时行双侧上斜肌后肌腱切断术和下斜肌前转位术。
患者中位年龄为 10 岁（范围 5-26 岁）。平均术后随访时间为 26 ± 14.02 个月（范围 12-48 个月）。外斜视的平均矫正量为 36.5 ± 21.06 PD（范围 15-65 PD）至 6.1 ± 3.06 PD（范围 3-10 PD）。该手术将 A 型斜视从平均 23 ± 7 PD（范围 15-35 PD）矫正至 7.6 ± 3.2 PD（范围 3-10 PD）。右眼的 DVD 平均从 14 ± 4.3 PD（范围 8-20 PD）减少至 5.3 ± 1.2 PD，左眼从 14.33 ± 3.6 PD（范围 10-18 PD）减少至 4.1 ± 1.1 PD。DVD 不对称性从 6.33 ± 3.4 PD 减少至 1.5 ± 1.3 PD。
在我们的病例系列中，“四斜”手术联合水平肌手术似乎是一种有效方法，可显著矫正 A 型斜视，同时减少 DVD，且长期效果良好。
