Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Eur J Ophthalmol. 2022 Jan;32(1):580-586. doi: 10.1177/1120672121997664. Epub 2021 Feb 24.
To evaluate the effectiveness of inferior oblique recession with contralateral partial temporal inferior rectus recession in patients with decompensated congenital unilateral superior oblique palsy (SOP) in correcting moderate vertical deviations in primary position.
The medical records of patients with SOP who underwent inferior oblique recession with contralateral partial temporal inferior rectus recession were reviewed retrospectively. Vertical deviation in primary position, subjective torsion, diplopia, residual deviation, and the deviation decrease were evaluated.
Four patients (three males and one female, age range 29-56 years) with congenital unilateral SOP and mean vertical deviation of 21.0 ± 5.3PD (range 14-25D) in primary position were included. Mean correction of hypertropia in primary position with this technique was 15.5 ± 5.3PD (range 10-20PD). The mean hypertropia on gaze to the contralateral side changed from 30.0 ± 10.8D before surgery to 9.3 ± 7.9D after surgery. Torsion had a mean change of 4.8° of incyclodeviation. Preoperatively, all patients had head tilt and diplopia, which was resolved in all but one patient, who will need surgery. Patients were followed an average of 18 months. No adverse events were reported in any subjects.
When performing recession of inferior oblique muscles in SOP associated to a full recession of the contralateral inferior rectus, there is a risk of overcorrection in those with moderate angles. Performing a partial recession in the contralateral inferior rectus eye corrected up to 20PD in primary position in our series, reducing this risk.
评估下斜肌后退术联合对侧部分颞侧下直肌后退术治疗代偿性先天性单侧上斜肌麻痹（SOP）患者中、重度原发性垂直斜视的疗效。
回顾性分析 SOP 患者行下斜肌后退术联合对侧部分颞侧下直肌后退术的病历资料。评估患者在主位的垂直斜视度、主观扭转、复视、残余斜视度和斜视度的减小。
纳入 4 例（3 例男性，1 例女性，年龄 29-56 岁）先天性单侧 SOP 患者，平均垂直斜视度为 21.0±5.3PD（范围 14-25D）。该技术治疗主位上斜视的平均矫正值为 15.5±5.3PD（范围 10-20PD）。手术前，向对侧注视时的平均外转斜视度为 30.0±10.8D，手术后为 9.3±7.9D。扭转的平均变化为 4.8°内旋。术前所有患者均有头位倾斜和复视，除 1 例患者仍需手术外，其余患者均得到解决。患者平均随访 18 个月。所有患者均未出现不良事件。
在 SOP 患者中，当进行下斜肌后退术联合对侧下直肌完全后退时，对于中度斜视患者，存在过矫正的风险。在本系列中，对侧下直肌进行部分后退术，可在主位矫正高达 20PD 的斜视，降低了这种风险。
