内直肌徙前术治疗继发性外斜视

Medial Rectus Advancement for Secondary Exotropia.

作者信息

Umfress Allison C, Flowers Alexis M, Liu Yuhan, Zheng Yuxi, Chen Qingxia, Donahue Sean P

机构信息

Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

出版信息

Am J Ophthalmol. 2021 Jan;221:65-74. doi: 10.1016/j.ajo.2020.08.029. Epub 2020 Aug 20.

DOI:10.1016/j.ajo.2020.08.029

PMID:32828876

Abstract

PURPOSE

To determine the preoperative characteristics and surgical results after medial rectus advancement in patients with secondary exotropia.

DESIGN

Retrospective, interventional case series.

METHODS

Setting: Tertiary Care University Medical Center. PatientPopulation: 221 patients with a diagnosis of secondary exotropia who underwent medial rectus advancement surgery by a single surgeon.

OBSERVATION

Preoperative demographics, exodeviation and motility, intraoperative findings, and postoperative results were recorded. MainOutcomeMeasure: Success of surgery, defined as Esotropia <15 prism diopters (pd) at postoperative week 1, or any deviation of <8 pd at postoperative month 2 (POM2).

RESULTS

A total of 98 patients underwent unilateral medial rectus advancement (UMRadv), 89 underwent UMRadv with lateral rectus recession (LRc), and 34 underwent bilateral medial rectus advancement (BMRadv). POM2 success rates were 66.7% in UMRadv patients, 62.1% in UMRadv + LRc, and 56% in BMRadv. A total of 117 patients had preoperative adduction deficits, which were significantly associated with the finding of an intraoperative stretched scar (P < .001). Larger preoperative duction deficits were associated with larger stretched scars (P < .001). At POM2, the mean effect of surgery (pd of correction/mm) was 2.3 ± 1.4 pd/mm for UMRadv, 2.5 ± 0.8 pd/mm for UMRadv + LRc, and 2.8 ± 1.1 pd/mm for BMRadv. Patients with a stretched scar had significantly less correction per millimeter (2.2 ± 1.2 pd/mm) compared with those without (2.6 ± 1.2 pd/mm, P < .001). A total of 38.6% of patients experienced exodrift greater than 10 pd. Exodrift was significantly larger in the BMRadv group (P < .005).

DISCUSSION

These results provide guidance for surgical correction based on preoperative deviation and ductions. Adduction deficits indicate a stretched scar, which must be treated with resection and advancement of the medial rectus. A larger amount of surgery is needed in patients with a stretched scar. Exodrift is common, and therefore aiming for approximately 10 pd of overcorrection at postoperative week 1 can improve final outcomes.

CONCLUSION

Medial rectus advancement results in successful surgical results at POM2 for secondary exotropia.

摘要

目的

确定继发性外斜视患者内直肌徙前术的术前特征及手术效果。

设计

回顾性干预病例系列研究。

方法

研究地点：三级医疗大学医学中心。研究对象：221例诊断为继发性外斜视且由同一位外科医生实施内直肌徙前术的患者。

观察指标

记录术前人口统计学资料、外斜视度及眼球运动情况、术中所见以及术后结果。主要观察指标：手术成功，定义为术后第1周内斜视度<15棱镜度（pd），或术后第2个月（POM2）任何斜视度<8 pd。

结果

共有98例患者接受单侧内直肌徙前术（UMRadv），89例接受UMRadv联合外直肌后徙术（LRc），34例接受双侧内直肌徙前术（BMRadv）。POM2时，UMRadv患者的成功率为66.7%，UMRadv + LRc患者为62.1%，BMRadv患者为56%。共有117例患者术前存在内收不足，这与术中发现的瘢痕拉长显著相关（P < 0.001）。术前眼球运动不足越大，瘢痕拉长越明显（P < 0.001）。在POM2时，UMRadv的平均手术效果（每毫米矫正的pd数）为2.3±1.4 pd/mm，UMRadv + LRc为2.5±0.8 pd/mm，BMRadv为2.8±1.1 pd/mm。有瘢痕拉长的患者每毫米的矫正量（2.2±1.2 pd/mm）明显低于无瘢痕拉长的患者（2.6±1.2 pd/mm，P < 0.001）。共有38.6%的患者出现外斜视漂移大于10 pd。BMRadv组的外斜视漂移明显更大（P < 0.005）。