Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int Ophthalmol. 2021 Jan;41(1):11-19. doi: 10.1007/s10792-020-01546-7. Epub 2020 Oct 18.
To compare the surgical outcomes of the plication technique with the resection method to treat exotropic patients.
In this prospective randomized clinical trial, a total of 52 exotropic patients (27 females and 25 males) who were candidates for medial rectus resection were randomly classified into the plication (n = 24) and resection (n = 28) groups. Comprehensive ophthalmic examination included cyclorefraction, assessment of the best corrected visual acuity (BCVA), evaluation of the extraocular muscle, ocular deviation measurement and stereopsis measured using a Titmus test. Ocular anterior and posterior segments were examined using slit-lamp and indirect ophthalmoscopy. Patients were randomly divided to medial rectus plication and medial rectus resection groups. The plication technique was the same as for resection, but in the last step the muscle was folded. Examinations were repeated at the 1- and 3-day as well as 1-, 2-, 3- and 6-month follow-ups. If the postoperative ocular deviation was in the range of 5 PD esotropia to 10 PD exotropia, it was considered a successful surgical outcome.
Results show that there was no statistically significant difference between the two groups regarding near and far deviations (P = 0.298, P = 0.103), surgical dose response (P = 0.904) and postoperative success rate (plication, 87% and resection, 89.3%, P > 0.99). Reoperation was needed in 13% and 10.7% of the plication and resection groups, respectively (P > 0.05).
Medial rectus plication is an effective and appropriate alternative option for medial rectus resection in exotropic patients.
比较折叠术与切除术治疗外斜视患者的手术效果。
前瞻性随机临床试验中，共纳入 52 例外斜视患者（27 名女性，25 名男性），这些患者均为内直肌切除术候选者，随机分为折叠组（n=24）和切除组（n=28）。全面眼科检查包括环规折射、最佳矫正视力（BCVA）评估、眼外肌评估、眼位测量和Titmus 测试评估立体视。使用裂隙灯和间接检眼镜检查眼前段和眼后段。患者随机分为内直肌折叠和内直肌切除两组。折叠术与切除术相同，但在最后一步将肌肉折叠。在术后 1 天、3 天以及 1 个月、2 个月、3 个月和 6 个月时进行重复检查。如果术后眼位在 5 PD 内斜视到 10 PD 外斜视范围内，则认为手术结果成功。
结果显示，两组在近距和远距偏斜（P=0.298，P=0.103）、手术剂量反应（P=0.904）和术后成功率（折叠组 87%，切除组 89.3%，P＞0.99）方面无统计学差异。折叠组和切除组分别有 13%和 10.7%的患者需要再次手术（P＞0.05）。
内直肌折叠术是外斜视患者内直肌切除术的有效替代方法。
