Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami, Florida.
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, and Ophthalmology Department, King Chulalongkorn Memorial Hospital the Thai Red Cross Society , Bangkok.
Strabismus. 2020 Jun;28(2):85-90. doi: 10.1080/09273972.2020.1720746. Epub 2020 Feb 21.
To quantify the amount of insertion shift after disinsertion of the rectus muscles and identify factors that may influence the shift.
Patients who underwent rectus muscle surgery between November 2018 and April 2019 were included. During surgery, the limbal-insertion distance (LID) distance was measured in millimeters with calipers from the limbus to the center of the insertion at the anterior border of the rectus muscle prior to and after disinsertion. The primary outcome was the shift of the rectus muscle insertion after disinsertion. This was calculated by subtracting the LID after disinsertion from the LID before disinsertion. The secondary outcome was the identification of preoperative and intraoperative factors that influenced insertion shift. Randomization was performed to select one rectus muscle per patient. Patients with a history of prior scleral buckle procedure, glaucoma drainage device, orbital wall fracture and strabismus surgery in the same rectus muscle were excluded.
110 patients were included. The median (Q, Q) LID before disinsertion was shortest for the medial rectus muscle [5.0 (4.5, 6.0)], followed by lateral rectus muscle [6.0 (6.0, 7.0)] and inferior rectus muscle [6.0 (5.5, 7.0)]. The overall median (Q, Q) insertion shift was 1.0 (0.8, 1.0) mm ( < .001), which did not significantly differ between each rectus muscle subgroup ( = .158). Factors that influenced the amount of shift were moderate to severe restriction on forced duction testing (FDT) ( = 0.320, = 0.105, = .003) and longer LID before disinsertion ( = 0.172, = 0.036, < .001).
We found a significant anterior insertion shift after disinsertion of rectus muscles. Moderate to severe restriction on FDT and longer LID before disinsertion can result in larger insertion shifts.
定量测量直肌切除后插入移位的程度，并确定可能影响移位的因素。
纳入 2018 年 11 月至 2019 年 4 月期间行直肌手术的患者。手术中，使用卡尺从前部直肌的巩膜缘到插入前界的插入中心测量角膜缘插入距离（LIM），分别在切除前和切除后进行测量。主要结果是直肌切除后的插入移位。这通过从切除前的 LIM 中减去切除后的 LIM 来计算。次要结果是确定影响插入移位的术前和术中因素。随机选择每位患者的一条直肌。排除既往巩膜扣带术、青光眼引流装置、眼眶壁骨折和同一条直肌斜视手术的患者。
共纳入 110 例患者。在未切除时，内侧直肌的 LIM 中位数（Q，Q）最短[5.0（4.5，6.0）]，其次是外侧直肌[6.0（6.0，7.0）]和下直肌[6.0（5.5，7.0）]。总的中位数（Q，Q）插入移位为 1.0（0.8，1.0）mm（<0.001），但在每个直肌亚组之间没有显著差异（=0.158）。影响移位量的因素是强制牵张试验（FDT）有中度至重度限制（=0.320，=0.105，=0.003）和未切除前 LIM 较长（=0.172，=0.036，<0.001）。
我们发现直肌切除后存在明显的前向插入移位。FDT 中度至重度受限和未切除前 LIM 较长可导致较大的插入移位。
