Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.
Graefes Arch Clin Exp Ophthalmol. 2020 Apr;258(4):899-908. doi: 10.1007/s00417-019-04599-2. Epub 2020 Jan 14.
A-pattern exotropia, superior oblique muscle overaction, and dissociated vertical deviation may coexist and are referred to as triad exotropia. The present study evaluated the postoperative stability of horizontal ocular alignment of triad exotropia and possible prognostic factors.
Medical records of patients with triad exotropia who had one-step triple surgery of superior oblique muscle weakening, superior rectus muscle recession, and lateral rectus muscle recession were reviewed. The horizontal alignment and postoperative drift of triad exotropia were analyzed and compared with constant exotropia.
The triad exotropia showed a mean of 7.7 (± 8.5) eso-drift, while the constant exotropia was (3.5 ± 3.4) exo-drift. Multiple linear regression analysis showed that the degree of superior oblique muscle overaction after surgery (P = 0.011) was the only factor associated with horizontal drift. Patients with superior oblique muscle underaction showed larger eso-drift when compared to patients without superior oblique muscle underaction (- 18.0 ± 11.1 vs. - 5.1 ± 5.7; P = 0.024). The final success rates of the triad exotropia and constant exotropia groups were 53.3% and 69.2%, respectively, and the overcorrection rates were 26.7% and 2.6% (P = 0.035).
An overall trend of eso-drift in primary position occurred in triad exotropia after triple surgery up to a follow-up of 25 months. Patients presenting superior oblique muscle underaction after surgery seemed to have large angles of eso-drift, which might be taken into account in surgical planning and follow-up.
A 型外斜视、上斜肌亢进和分离性垂直斜视可能同时存在，被称为三联外斜视。本研究评估了三联外斜视一次三步手术（上斜肌减弱、上直肌后退和外直肌后退）后水平眼球位置的稳定性和可能的预后因素。
回顾性分析了三联外斜视患者一次三步手术（上斜肌减弱、上直肌后退和外直肌后退）的病历。分析并比较了三联外斜视的水平斜视和术后漂移与恒定性外斜视的差异。
三联外斜视平均有 7.7（±8.5）度的内斜视漂移，而恒定性外斜视为（3.5±3.4）度的外斜视漂移。多元线性回归分析显示，术后上斜肌亢进的程度（P=0.011）是与水平漂移相关的唯一因素。与无上斜肌过弱的患者相比，下斜肌过弱的患者内斜视漂移更大（-18.0±11.1 与-5.1±5.7；P=0.024）。三联外斜视和恒定性外斜视组的最终成功率分别为 53.3%和 69.2%，过矫正率分别为 26.7%和 2.6%（P=0.035）。
在 25 个月的随访中，三联外斜视患者在一次三步手术后出现了原发性内斜视漂移的总体趋势。术后出现上斜肌过弱的患者似乎有较大的内斜视漂移角度，这在手术计划和随访中需要考虑。
