Ophthalmology Department, Alexandria University, Alexandria, Egypt.
Ophthalmology Department, Alexandria University, Alexandria, Egypt.
J AAPOS. 2022 Feb;26(1):14.e1-14.e5. doi: 10.1016/j.jaapos.2021.08.306. Epub 2021 Dec 29.
To report the results of bilateral fenestration of the medial rectus muscle in cases of partially accommodative esotropia in pediatric patients.
In this fenestration technique, two splitting incisions are made by blunt dissection parallel to the muscle fibers on the superior and inferior borders of the medial rectus muscle, leaving a thin strip of muscle fibers on each edge. The wide, central part of the muscle is excised from its insertion to a point 5-8 mm from the insertion, depending on the angle of the esotropia. Sutures are not used in this procedure. Children with partially accommodative esotropia and no high ratio of accommodative convergence to accommodation who underwent surgery from February 2018 to August 2019 were prospectively enrolled. The success rate was defined as alignment within 8 prism diopters of orthotropia at the last follow up.
A total of 61 children were included. The procedure was well tolerated by patients and reduced the angle of esotropia for distance from 22.20 ± 4.22 to 2.72 ± 4.71 (P < 0.001) and caused no incomitance or distance-near disparity. Satisfactory horizontal alignment defined as alignment within 8 of orthotropia at distance was achieved in 88% of the cases at 3-6 months' follow-up. There were no overcorrections.
In our study cohort, the fenestration technique reduced the angle of deviation in cases of partially accommodative esotropia.
报告儿童部分调节性内斜视患者行内直肌双瓣切开术的结果。
在这种瓣切开技术中，通过钝性分离在眼内直肌的上、下边界平行于肌纤维做两个分裂切口，在每边留下一条薄的肌纤维带。根据斜视角度，从内直肌止点到距止点 5-8mm 的中央宽大部分被切除。该过程中不使用缝线。从 2018 年 2 月至 2019 年 8 月，前瞻性纳入了接受手术的部分调节性内斜视且无高调节性集合/调节比值的儿童。将最后一次随访时达到正位 8 棱镜度以内定义为手术成功。
共纳入 61 例儿童。该手术患者耐受性良好，使远距斜视角度从 22.20±4.22 降至 2.72±4.71（P<0.001），且无斜视和远近不等。3-6 个月随访时，88%的病例达到了满意的水平正位定义（即，远距正位 8 棱镜度以内），无过矫。
在我们的研究队列中，瓣切开技术降低了部分调节性内斜视的偏斜角度。
