Hao R, Chen L P, Liu Y, Zhang W, Zhao K X
Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China.
Zhonghua Yan Ke Za Zhi. 2021 Sep 11;57(9):685-688. doi: 10.3760/cma.j.cn112142-20201013-00679.
To investigate the clinical effect of anterior 1/3 superior oblique tendon tucking in acquired symptomatic excyclotropia adults. Retrospective case series. Seven patients (7 eyes) with acquired symptomatic excyclotropia who underwent an anterior 1/3 superior oblique tendon tuck procedure in Tianjin Eye Hospital from January 2019 to December 2019 were included. There were 5 male patients and 2 female patients, with an average age of (49±12) years old. All the patients had a history of a closed head injury. There was torsional diplopia in primary position, and eye movement examination showed paralysis of the superior oblique muscle in the affected eye, without obvious hyperactivity of the inferior oblique muscle. The anterior 1/3 tendon of the superior oblique muscle was tucked during surgery according to the relaxation of the superior oblique tendon in the forced duction test. The paired-sample nonparametric rank sum test was used to analyze the preoperative and postoperative (at 1 day after surgery and the last follow-up) excyclotropia angle. The mean tuck amount was (7.7±1.8) mm (range, 6.0 to 10.0 mm). During operation, patients complained that excyclotropia improved markedly. The excyclotropia angle with the double Maddox rod test improved significantly from preoperative 10° (8°, 15°) to 2° (0°, 3°) at 1 day (=-2.379; <0.05) and 2° (2°, 5°) at the last follow-up (=-2.375; <0.05). The follow-up period was (112+38) days. All patients had no complaints of excyclotropia at the last follow-up. The anterior 1/3 superior oblique tendon tucking can effectively improve clinical symptoms in the primary position in adults with acquired excyclotropia and diplopia. The short-term postoperative results seem to be stable, without significant regression. .
探讨上斜肌肌腱前1/3折叠术治疗成人后天性症状性外旋转斜视的临床效果。回顾性病例系列研究。纳入2019年1月至2019年12月在天津眼科医院接受上斜肌肌腱前1/3折叠术的7例（7只眼）后天性症状性外旋转斜视患者。其中男性5例，女性2例，平均年龄（49±12）岁。所有患者均有闭合性颅脑损伤史。原在位有旋转性复视，眼球运动检查显示患眼上斜肌麻痹，下斜肌无明显亢进。术中根据被动牵拉试验中上斜肌腱的松弛情况对其上斜肌肌腱前1/3进行折叠。采用配对样本非参数秩和检验分析术前及术后（术后1天及末次随访）外旋转斜视角度。平均折叠量为（7.7±1.8）mm（范围6.0至10.0 mm）。术中患者主诉外旋转斜视明显改善。双马多克斯杆试验测量的外旋转斜视角度从术前的10°（8°，15°）显著改善至术后1天的2°（0°，3°）（Z=-2.379；P<0.05）及末次随访时的2°（2°，5°）（Z=-2.375；P<0.05）。随访时间为（112±38）天。所有患者在末次随访时均无外旋转斜视相关主诉。上斜肌肌腱前1/3折叠术可有效改善成人后天性外旋转斜视和复视患者原在位的临床症状。术后短期效果似乎稳定，无明显复发。
