Department of Strabismus and Pediatric Ophthalmology, The Eye Foundation, Coimbatore, Tamil Nadu, India.
Indian J Ophthalmol. 2021 Dec;69(12):3592-3597. doi: 10.4103/ijo.IJO_85_21.
:To evaluate the outcomes of large-angle exotropia by single-stage adjustable strabismus surgery (SSASS) under monitored conscious anesthesia.
A prospective study was done in 33 patients above 14 years with ≥40 prism diopters (PD) of exotropia. All patients underwent SSASS under monitored conscious anesthesia (topical anesthesia plus intravenous sedation). For deviations of ≤55 PD, two horizontal rectus muscles, and for >55 PD, three rectus muscles were operated and a decision on adjustment/operating on an additional rectus muscle was taken after assessing the alignment. Monitored conscious anesthesia allowed us to check our results after surgery and plan further surgery/adjustment to achieve the desired alignment.
Mean preoperative deviation for distance was 52 ± 11.1 PD. The target alignment was achieved with the initial surgical plan in 10/21 patients with <55 PD exotropia and 4/12 patients with >55 PD exotropia, and one patient in each group needed adjustment. The remaining patients needed additional rectus muscle surgery. One patient with >55 PD exotropia needed both adjustment and additional rectus surgery. The success rate for distance correction was 85% at 6 months and 1 year. The overall success rate was 71% at 6 months. Percentage of patients with binocular single vision improved from 31% preoperatively to 78% by 6 months. Incidence of oculocardiac reflex was 6.1%.
SSASS under monitored conscious anesthesia is a viable option for large-angle strabismus correction with good patient comfort and safety.
评估在监测下的清醒麻醉下进行单阶段可调节斜视手术（SSASS）治疗大角度外斜视的结果。
对 33 名年龄在 14 岁以上、外斜视≥40 棱镜度（PD）的患者进行了前瞻性研究。所有患者均在监测下的清醒麻醉（局部麻醉加静脉镇静）下接受 SSASS。对于≤55 PD 的斜视，行两条水平直肌手术，对于>55 PD 的斜视，行三条直肌手术，并在评估眼位后决定是否调整/行额外的直肌手术。监测下的清醒麻醉使我们能够在手术后检查结果，并计划进一步的手术/调整以达到预期的眼位。
平均术前远距斜视度为 52±11.1 PD。在初始手术计划中，10/21 名<55 PD 外斜视患者和 4/12 名>55 PD 外斜视患者达到了目标眼位，每组中有 1 名患者需要调整。其余患者需要额外的直肌手术。1 名>55 PD 外斜视患者需要调整和额外的直肌手术。6 个月和 1 年时，远距矫正的成功率分别为 85%和 71%。6 个月时的总体成功率为 71%。术前双眼单视的患者比例从 31%提高到 6 个月时的 78%。眼心反射的发生率为 6.1%。
在监测下的清醒麻醉下进行 SSASS 是治疗大角度斜视的一种可行选择，具有良好的患者舒适度和安全性。
