Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil.
Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil.
J AAPOS. 2020 Aug;24(4):222.e1-222.e4. doi: 10.1016/j.jaapos.2020.04.012. Epub 2020 Aug 27.
To assess the efficacy of superior oblique temporal tenectomy 6.0 mm from its insertion to treat A-pattern strabismus of all magnitudes.
The clinical records of patients with A-pattern eso- or exotropia associated with bilateral superior oblique overaction who underwent bilateral superior oblique 6.0 mm temporal tenectomy at a single institution over a 17-year period were reviewed retrospectively. Outcome measures were change in the A pattern and correlation with preoperative A pattern.
A total of 102 patients were included. The mean preoperative A-pattern deviation was 21 ± 9, with a postoperative pattern collapse of 18 ± 10. Change in A pattern was significantly correlated with the preoperative A pattern (r = 0.70; P <0.001). In patients with an A pattern of ≥25, the preoperative deviation was 31 ± 7, with a postoperative pattern collapse of 27 ± 9. In 76% of patients with A pattern of <25 and in 72% of patients with A pattern ≥25, the A pattern was corrected to <10. The average percentage of A pattern correction was 89% in patients with pattern deviation <25 and 86% in patients with pattern deviation ≥25.
In our study cohort, bilateral superior oblique temporal tenectomy was an effective and self-adjusting procedure for A-pattern strabismus associated with superior oblique overaction. Larger preoperative A patterns did not show a significant trend toward larger residual postoperative deviations compared with smaller preoperative patterns. A uniform dose of bilateral superior oblique temporal tenectomy collapses A patterns of all magnitudes.
评估从附着点起离断 6.0mm 的上斜肌颞侧肌腱以治疗各种程度 A 型斜视的疗效。
回顾性分析了 17 年间在一家医院因双侧上斜肌亢进而行双侧上斜肌 6.0mm 颞侧肌腱离断术的 A 型内斜视或外斜视患者的临床资料。观察指标为 A 型斜视的变化及与术前 A 型斜视的相关性。
共纳入 102 例患者。平均术前 A 型斜视度为 21±9，术后斜视度平均下降 18±10。A 型斜视的变化与术前 A 型斜视显著相关（r=0.70；P<0.001）。术前 A 型斜视≥25 的患者，术前斜视度为 31±7，术后斜视度平均下降 27±9。76%的 A 型斜视<25 的患者和 72%的 A 型斜视≥25 的患者，A 型斜视矫正至<10。A 型斜视度<25 的患者 A 型斜视平均矫正率为 89%，A 型斜视度≥25 的患者为 86%。
在本研究队列中，双侧上斜肌颞侧肌腱离断术是治疗上斜肌亢进相关 A 型斜视的有效且可自我调整的方法。与较小的术前 A 型斜视相比，较大的术前 A 型斜视并未显示出明显的术后残余斜视增大趋势。双侧上斜肌颞侧肌腱离断术可使所有程度的 A 型斜视均得到矫正。
