Jabroun Mireille N, Marsh Justin, Guyton David L
The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J AAPOS. 2021 Dec;25(6):338.e1-338.e6. doi: 10.1016/j.jaapos.2021.07.014. Epub 2021 Nov 18.
Adjustable bilateral Harada-Ito procedures have been described, sometimes with asymmetric adjustment used to correct vertical misalignment when coexisting with torsional strabismus. We investigated the causes of significant postoperative torsional incomitance noted in some patients undergoing these procedures.
The medical records of patients who underwent bilateral Harada-Ito procedures for bilateral trochlear nerve palsy between 1980 and 2018 were reviewed retrospectively. Cases with simultaneous operation on any other oblique or vertical rectus muscle were excluded. Surgical results, especially using Lancaster red-green (Lan R-G) plots, were correlated with the procedures performed.
A total of 17 patients were included. At their last follow-up visit (mean, 12 months after surgery), 9 were diplopia free. Of the 8 with continuing diplopia, 2 had undercorrection and 1 had Brown syndrome. In 5 patients with continuing diplopia, there was relative intorsion of the eye movement paths in upgaze and relative extorsion of these paths in downgaze, a type of torsional incomitance. Asymmetric adjustment with tightening of one superior oblique tendon, and often loosening of the contralateral superior oblique tendon, had been performed in those 5 cases. Only 1 of the successful cases had the same type of asymmetric adjustment. There was a positive association between the severity of the preoperative Lan R-G pattern and postoperative diplopia.
Asymmetric adjustment of bilateral Harada-Ito procedures when attempting to correct the coexisting vertical misalignment can cause significant torsional incomitance with incomplete correction of extorsion in downgaze and intorsion in upgaze. This pattern may result in postoperative diplopia that is surgically challenging to correct.
可调节性双侧原田-伊藤手术已被描述，有时在与扭转性斜视共存时采用不对称调节来纠正垂直斜视。我们调查了一些接受这些手术的患者术后出现明显扭转不一致的原因。
回顾性分析1980年至2018年间因双侧滑车神经麻痹接受双侧原田-伊藤手术的患者的病历。排除同时对任何其他斜肌或垂直直肌进行手术的病例。手术结果，特别是使用兰开斯特红绿（Lan R-G）图的结果，与所进行的手术相关。
共纳入17例患者。在他们的最后一次随访（平均术后12个月）时，9例无复视。在8例仍有复视的患者中，2例矫正不足，1例有布朗综合征。在5例仍有复视的患者中，上视时眼球运动路径有相对内旋，下视时这些路径有相对外旋，这是一种扭转不一致。在这5例病例中，进行了不对称调节，即一侧上斜肌腱收紧，对侧上斜肌腱常松弛。只有1例成功病例有相同类型的不对称调节。术前Lan R-G模式的严重程度与术后复视之间存在正相关。
在试图纠正共存的垂直斜视时，双侧原田-伊藤手术的不对称调节可导致明显的扭转不一致，下视时外旋和上视时内旋矫正不完全。这种模式可能导致术后复视，手术矫正具有挑战性。
