Elkamshoushy Amr, Kassem Ahmed
Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
Clin Ophthalmol. 2021 Apr 28;15:1783-1789. doi: 10.2147/OPTH.S304798. eCollection 2021.
To present stepped strabismus surgery as a novel technique in cases of small to moderate angle strabismus.
Retrospective chart review of cases of stepped strabismus surgery from 2010 untill 2018. In stepped surgery, the first muscle is operated on under rapid induction-recovery IV propofol infusion. Patient is assessed in the OR. If deemed necessary, other muscles are operated on under general anesthesia. No adjustable sutures are used.
The technique was used in 22 cases of superior oblique palsy (SOP) (primary position hypertropia in the range of 12-25 prism diopters) and 29 horizontal strabismus cases (angles in the range 12-20 prism diopters). The first step was an inferior oblique myectomy in the SOP cases and a single rectus recession in the horizontal cases. After intraoperative assessment, 31% (16/51) needed additional muscle surgery. After 6 months of follow up, the overall reoperation rate was 9%. The technique was well tolerated by all patients.
Stepped strabismus surgery is a useful technique for small to moderate angle strabismus cases with the potential for reducing the number of extraocular muscles operated on without compromising the surgical outcome.
介绍阶梯式斜视手术，这是一种用于治疗小至中度斜视病例的新技术。
对2010年至2018年期间进行阶梯式斜视手术的病例进行回顾性病历审查。在阶梯式手术中，第一块肌肉在快速诱导-恢复静脉注射丙泊酚的情况下进行操作。患者在手术室进行评估。如有必要，其他肌肉在全身麻醉下进行操作。不使用可调节缝线。
该技术用于22例上斜肌麻痹（SOP）（原在位垂直斜视度数在12-25棱镜度范围内）和29例水平斜视病例（斜视度数在12-20棱镜度范围内）。第一步在SOP病例中是下斜肌切除术，在水平斜视病例中是单条直肌后徙术。术中评估后，31%（16/51）的患者需要额外的肌肉手术。随访6个月后，总体再次手术率为9%。所有患者对该技术耐受性良好。
阶梯式斜视手术对于小至中度斜视病例是一种有用的技术，有可能在不影响手术效果的情况下减少手术的眼外肌数量。
