Gómez-Mariscal Marta, Hernández-Martínez P, Rodríguez-Del Valle J M, Ruiz-Guerrero M, Márquez-González C, Rodríguez-Sánchez J M
Ramón y Cajal University Hospital, Universidad de Alcalá, Carretera Colmenar Viejo, km 9.100, 28034, Madrid, Spain.
Clínica Dr. Rodríguez, Madrid, Spain.
Graefes Arch Clin Exp Ophthalmol. 2020 Jul;258(7):1549-1554. doi: 10.1007/s00417-020-04686-9. Epub 2020 Apr 20.
The aim of this study is to evaluate the incidence of consecutive strabismus after infantile nystagmus surgery and its potential risk factors.
A retrospective study including 89 patients was conducted. Patients presented infantile nystagmus (idiopathic or ocular disease-associated nystagmus) without previous or coincidental strabismus. Sex, age at surgery, amblyopia, botulinum toxin (BT) injection before surgery, spherical equivalent, anisometropia, surgery procedure (Anderson's or retroequatorial recessions of four horizontal recti), and follow-up were analyzed. Kaplan-Meier and univariate Cox regression were performed.
The median age at surgery was 5 years. The median follow-up was 36 months. The incidence of consecutive strabismus was 11.2%. There were eight patients with exotropia and two patients with esotropia. Consecutive strabismus was associated with severe bilateral amblyopia (p = 0.036), previous treatment with BT injection (p = 0.025), and large recessions of the four horizontal muscles (p = 0.001). The hazard ratio for patients with severe bilateral amblyopia was 5.4 (95% CI 1.1-25.8), and for patients previously treated with BT was 6.1 (1.3-29.3). The survival rate was 95.4% at 6 months and 88.5% at 3 years.
Severe bilateral amblyopia, previous BT treatment, and type of surgery seem to be associated with consecutive strabismus after infantile nystagmus surgery. Most cases appear within the first months after surgery.
本研究旨在评估婴儿型眼球震颤手术后连续性斜视的发生率及其潜在危险因素。
进行了一项回顾性研究，纳入89例患者。患者患有婴儿型眼球震颤（特发性或与眼病相关的眼球震颤），术前无斜视且无并发斜视。分析了患者的性别、手术年龄、弱视、术前肉毒杆菌毒素（BT）注射、等效球镜度、屈光参差、手术方式（安德森手术或四条水平直肌后徙术）及随访情况。采用Kaplan-Meier法和单因素Cox回归分析。
手术年龄中位数为5岁。随访时间中位数为36个月。连续性斜视的发生率为11.2%。其中8例为外斜视，2例为内斜视。连续性斜视与严重双侧弱视（p = 0.036）、术前BT注射治疗（p = 0.025）以及四条水平肌的大幅度后徙（p = 0.001）相关。严重双侧弱视患者的风险比为5.4（95%可信区间1.1 - 25.8），术前接受BT治疗的患者风险比为6.1（1.3 - 29.3）。6个月时生存率为95.4%，3年时为88.5%。
严重双侧弱视、术前BT治疗及手术方式似乎与婴儿型眼球震颤手术后的连续性斜视有关。大多数病例出现在手术后的头几个月内。
