牵拉性瘢痕导致的继发性斜视的处理。

Management of stretched scar- induced secondary strabismus.

机构信息

Department of ophthalmology, Benha University, Benha, Egypt.

Department of ophthalmology, Ain Shams University, Ain Shams, Egypt.

出版信息

BMC Ophthalmol. 2020 Feb 19;20(1):58. doi: 10.1186/s12886-020-01339-7.

DOI:10.1186/s12886-020-01339-7

PMID:32075609

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7031865/

Abstract

BACKGROUND

To determine characteristics and management of consecutive or recurrent strabismus secondary to stretched scar.

METHODS

This is a retrospective review of all patients diagnosed with late secondary consecutive or recurrent strabismus due to stretched scar from 2012 to 2017. The diagnosis of stretched scar was made in any case of late (≥ 1 month) consecutive or recurrent strabismus associated with underaction of the previously operated muscle. The diagnosis was confirmed intraoperatively by negative forced duction test and the characteristic appearance of the scar tissue. Surgical correction involved excision of the scar tissue with muscle re-attachment to the sclera using non-absorbable sutures. Study parameters include improvement in secondary deviations, degree of muscle underaction and diplopia.

RESULTS

21 consecutive and 6 recurrent cases of stretched scar -induced strabismus were identified and all cases were associated with variable degrees of limited ocular duction. After surgical correction of the stretched scar, consecutive deviations in the form of consecutive esotropia and exotropia were corrected by means of 26.1PD and 65.6PD while recurrent deviations in the form recurrent exotropia and recurrent hypertropia were corrected by means of 34.3PD and 11PD respectively with significant improvement of limited ocular ductions. 21 patients had diplopia at presentation and all were improved after surgery.

CONCLUSION

management of stretched scar -induced secondary strabismus by excision of the stretched scar and muscle fixation to the sclera using non-absorbable sutures significantly corrects secondary deviations and improves limitation of ocular duction.

摘要

背景

确定继发于延长瘢痕的连续或复发性斜视的特征和处理方法。

方法

这是对 2012 年至 2017 年期间所有因延长瘢痕导致晚期（≥1 个月）继发连续或复发性斜视的患者进行的回顾性研究。在任何情况下，当出现与先前手术肌肉功能减退相关的晚期（≥1 个月）连续或复发性斜视时，诊断为延长瘢痕。通过负向强制牵引试验和瘢痕组织的特征性外观，术中可确诊。手术矫正包括切除瘢痕组织，并使用不可吸收缝线将肌肉重新附着到巩膜上。研究参数包括继发偏斜的改善、肌肉功能减退的程度和复视。

结果

共发现 21 例连续和 6 例复发性延长瘢痕引起的斜视，所有病例均伴有不同程度的眼球运动受限。在矫正延长的瘢痕后，连续斜视（连续内斜视和外斜视）通过 26.1PD 和 65.6PD 得到矫正，而复发性斜视（复发性外斜视和复发性上斜视）通过 34.3PD 和 11PD 得到矫正，眼球运动受限得到显著改善。21 例患者就诊时有复视，所有患者术后均得到改善。