Aghdam Kaveh Abri, Asadi Reza, Sanjari Mostafa Soltan, Sadeghi Ali, Razavi Meshkat
Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
J Ophthalmic Vis Res. 2021 Apr 29;16(2):212-218. doi: 10.18502/jovr.v16i2.9085. eCollection 2021 Apr-Jun.
To compare two methods for treating inferior oblique overaction (IOOA): disinsertion versus myectomy of the muscle.
In this prospective interventional case series, patients were randomly assigned to undergo either IO myectomy or disinsertion. The changes in vertical and horizontal deviations following these two surgical procedures were evaluated. The postoperative IO function of grade 0 or +1 and the fundus extorsion of grade 0 or +1 was considered as the successful outcome.
Thirty-six patients (50 eyes) with a mean age of 12.67 4.05 years were included. In the myectomy group, the mean preoperative hyperdeviation in adduction was 29.5 9.32 prism diopter (PD), which decreased to 9.15 7.86 PD after surgery ( = 0.001). In the disinsertion group, these measurements were 32.73 12.42 and 12.65 9.34 PD before and after the surgery, respectively ( = 0.001). The success rate of surgery based on the IOOA grading was 87.4% and 92.3% in the myectomy and disinsertion groups, respectively ( = 0.780). The successful correction rate of abnormal fundus torsion was 91.6% in the myectomy and 88.4% in the disinsertion group ( = 0.821). In comparison, 48% of the cases in the myectomy group and 50% in the disinsertion group were within the normal range of torsional position postoperatively ( = 0.786). There was no statistically significant difference in terms of changes in the horizontal or vertical deviations, V-pattern, and dissociated vertical deviation between the two groups.
Both surgical techniques seem to be effective for treatment of inferior oblique muscle overaction.
比较两种治疗下斜肌亢进（IOOA）的方法：肌肉断腱术与肌肉切除术。
在这个前瞻性干预性病例系列中，患者被随机分配接受下斜肌切除术或断腱术。评估这两种手术操作后垂直和水平斜视度的变化。术后下斜肌功能为0级或+1级且眼底旋转为0级或+1级被视为成功结果。
纳入36例患者（50只眼），平均年龄12.67±4.05岁。在肌肉切除组，术前内收时平均上斜视度为29.5±9.32棱镜度（PD），术后降至9.15±7.86 PD（P = 0.001）。在断腱组，术前和术后这些测量值分别为32.73±12.42和12.65±9.34 PD（P = 0.001）。基于IOOA分级的手术成功率在肌肉切除组和断腱组分别为87.4%和92.3%（P = 0.780）。肌肉切除组异常眼底旋转的成功矫正率为91.6%，断腱组为88.4%（P = 0.821）。相比之下，肌肉切除组48%的病例和断腱组50%的病例术后扭转位置在正常范围内（P = 0.786）。两组在水平或垂直斜视度变化、V型斜视和分离性垂直斜视方面无统计学显著差异。
两种手术技术似乎对治疗下斜肌亢进均有效。
