Nabie Reza, Manouchehri Vahideh, Babaei Ahmad
Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Science, Tabriz, Iran.
Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Science, Tabriz, Iran.
J AAPOS. 2020 Aug;24(4):224.e1-224.e5. doi: 10.1016/j.jaapos.2020.03.013. Epub 2020 Aug 31.
To evaluate the results of inferior oblique anteriorization for the treatment of large-angle hypertropia secondary to superior oblique palsy and to determine predictors of success and the occurrence of antielevation syndrome.
In this prospective study, 25 patients with unilateral congenital and acquired superior oblique palsy who had a primary position hypertropia of at least 25 underwent inferior oblique anteriorization in the paretic eye. Postoperative changes in vertical deviation of primary position and contralateral gaze, abnormal head posture, extorsion, associated horizontal deviation, inferior oblique overaction, superior oblique underaction, and elevation in abduction were examined. Surgical success was defined as residual hypertropia in primary position of ≤4 at final examination.
The mean age of patients at surgery was 19.8 ± 11.9 years (range, 4-49). The mean preoperative deviation in the primary position was 27.6 ± 3.2; in contralateral gaze, 35.0 ± 3.8; these measurements decreased postoperatively to 4.7 ± 5.6 and 7.0 ± 5.5, respectively, after a median follow-up of 8 months. The success rate was 72%, with no difference between patients with a preoperative deviation of 25-29 and those with deviation of 30-35. In a multivariate logistic regression, preoperative extorsion was negatively related to success (OR = 8.01; P = 0.03). At the final follow-up, 4 patients (16%) showed antielevation syndrome and were clinically asymptomatic.
In unilateral superior oblique palsy, one-muscle surgery, including inferior oblique anteriorization, can be conducted to resolve large-angle hypertropia of >25. Excyotorsion is a risk factor that increases the likelihood of failure.
评估下斜肌前徙术治疗上斜肌麻痹继发的大角度垂直斜视的效果，并确定手术成功的预测因素及抗上转综合征的发生率。
在这项前瞻性研究中，25例单侧先天性和后天性上斜肌麻痹且原在位垂直斜视至少25棱镜度的患者接受了患眼下斜肌前徙术。检查原在位和对侧注视时垂直斜视度的术后变化、异常头位、外旋转斜视、相关水平斜视度、下斜肌亢进、上斜肌功能不足以及外展时上转情况。手术成功定义为末次检查时原在位残留垂直斜视度≤4棱镜度。
患者手术时的平均年龄为19.8±11.9岁（范围4 - 49岁）。原在位术前平均斜视度为27.6±3.2棱镜度；对侧注视时为35.0±3.8棱镜度；中位随访8个月后，术后分别降至4.7±5.6棱镜度和7.0±5.5棱镜度。成功率为72%，术前斜视度为25 - 29棱镜度的患者与30 - 35棱镜度的患者之间无差异。多因素逻辑回归分析显示，术前外旋转斜视与手术成功呈负相关（比值比=8.01；P=0.03）。末次随访时，4例患者（16%）出现抗上转综合征，但临床无症状。
在单侧上斜肌麻痹中，可采用包括下斜肌前徙术在内的单肌手术来矫正大于25棱镜度的大角度垂直斜视。外旋转斜视是增加手术失败可能性的危险因素。
