Flodin Sara, Karlsson Per, Rydberg Agneta, Andersson Grönlund Marita, Pansell Tony
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal.
Strabismus. 2022 Mar;30(1):8-17. doi: 10.1080/09273972.2021.2022717. Epub 2022 Jan 9.
To review and evaluate the surgical outcomes of the Fells-modified Harada-Ito procedure using a dosage scale approach with long-term follow up in patients with torsional diplopia. The records of patients who underwent the modified Harada-Ito procedure by the same surgeon during 2012-2019 were retrospectively reviewed regarding pre- and post-operative data and individual dose-scale used for the surgery. The modified Harada-Ito procedure involved advancing the anterior half of the superior oblique tendon toward the inferior edge of the lateral rectus muscle by a distance determined using a five-graded scale. A total of 27 patients (mean age 57.6 years, range, 22-81 years; 10 female) were included. Evaluating surgical outcome showed a significant difference in pre- to post-operative cyclodeviation (p = <0.001). Pre-operative mean extorsion was -10.4° and mean torsional correction achieved was 7.7°. The dose-effect relationship showed a wide spread effect, yet yielded a high success rate. All but two patients were symptom free from their torsional diplopia at the last post-operative evaluation, on average 24 months after surgery. Post-operative results and the dose-effect of the modified Harada-Ito corresponded with the aimed-for correction of torsional diplopia.. Fusion evaluation and individually based pre-operative assessments proved essential in determining individual doses for successful surgical outcomes.
回顾并评估采用剂量量表法的Fells改良Harada-Ito手术治疗旋转性复视患者的手术效果，并进行长期随访。回顾性分析了2012年至2019年间由同一位外科医生进行改良Harada-Ito手术的患者的术前和术后数据以及手术中使用的个体剂量量表。改良Harada-Ito手术包括将上斜肌腱的前半部分向外侧直肌下缘推进一段距离，该距离通过五级量表确定。共纳入27例患者（平均年龄57.6岁，范围22 - 81岁；女性10例）。评估手术效果显示，术前与术后旋转斜视存在显著差异（p = <0.001）。术前平均外旋为-10.4°，平均旋转矫正度数为7.7°。剂量-效应关系显示出广泛的效果，但成功率较高。在最后一次术后评估时，平均术后24个月，除2例患者外，所有患者的旋转性复视症状均消失。改良Harada-Ito手术的术后结果和剂量-效应与旋转性复视的预期矫正效果相符。融合评估和基于个体的术前评估被证明对于确定成功手术结果的个体剂量至关重要。
