Department of Ophthalmology, Penteli General Hospital for Children, Athens, Greece.
First Ophthalmology Department, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Strabismus. 2022 Jun;30(2):90-98. doi: 10.1080/09273972.2022.2062008. Epub 2022 Apr 28.
Strabismus surgery may cause refractive changes, particularly in astigmatism. The aim of this study is to evaluate those changes in astigmatism two and 12 months following unilateral recession of horizontal rectus muscles in children. The authors prospectively evaluated 66 children with esotropia or exotropia, that would undergo a unilateral recession strabismus surgery. Comparisons were made between the 66 eyes that would undergo strabismus surgery and the fellow unoperated 66 eyes of the same children. The 66 eyes that would undergo strabismus surgery were divided into medial (38 eyes) and lateral (28 eyes) rectus muscle subgroups, and further, into subgroups based on the astigmatism axis preoperatively (with-the-rule astigmatism: 35 eyes, no astigmatism: 20 eyes, oblique astigmatism: 10 eyes, against-the-rule astigmatism: 1 eye). All patients were examined one day preoperatively, and then, two and 12 months postoperatively. Paired tests were conducted, and the significant level was set to 0.05 or was adjusted for subgroups. Mean age of children included was 6.73 years (SD = 3.19). Mean astigmatism values preoperatively, 2 and 12 months postoperatively were 0.92D (SD = 0.95), 1.45D (SD = 1.04) and 1.50D (SD = 1.10), respectively, for the eyes that underwent strabismus surgery. A statistically significant mean increase of 0.58D in astigmatism values in the eyes that underwent strabismus surgery was observed 12 months postoperatively (p < .005). Astigmatism values in the eyes that did not undergo strabismus surgery did not statistically significantly change during the observation period. The increase of the absolute values of astigmatism in medial and lateral rectus muscle subgroups was similar, 0.59D (SD = 0.10) and 0.57D (SD = 0.11), respectively. For the eyes that had with-the-rule astigmatism and no astigmatism preoperatively, a statistically significant increase was shown 12 months postoperatively (0.64D and 0.66D respectively) (p < .005). Changes in astigmatism were observed in the eyes which underwent recession of horizontal rectus muscles compared to the fellow eyes, which did not undergo any intervention. An increase in cylindrical power was noted in the eyes that had with-the-rule and no astigmatism prior to surgery. This increase may be interpreted by the decreased tension of the recessed rectus muscle following strabismus surgery. Decreased forces, caused by the recessed horizontal rectus muscle, acting on the sclera on 180-degree meridian may lead to corneal flattening on this particular meridian and consequently, a corneal steepening on the 90-degree meridian. These changes seem to be stable during the first 12 postoperative months.
斜视手术可能会引起屈光变化，尤其是散光。本研究旨在评估儿童单侧水平直肌后退术后 2 个月和 12 个月散光的变化。作者前瞻性评估了 66 例患有内斜视或外斜视的儿童，这些儿童将接受单侧直肌后退斜视手术。将 66 只接受斜视手术的眼与同儿童的 66 只未手术的对侧眼进行比较。将接受斜视手术的 66 只眼分为内直肌（38 只眼）和外直肌（28 只眼）亚组，并进一步根据术前散光轴（顺规散光：35 只眼，无散光：20 只眼，斜散光：10 只眼，逆规散光：1 只眼）分为亚组。所有患者均于术前 1 天、术后 2 天和 12 个月进行检查。进行了配对检验，显著性水平设为 0.05 或按亚组进行调整。纳入儿童的平均年龄为 6.73 岁（标准差=3.19）。接受斜视手术的眼术前、术后 2 个月和 12 个月的平均散光值分别为 0.92D（标准差=0.95）、1.45D（标准差=1.04）和 1.50D（标准差=1.10）。接受斜视手术的眼术后 12 个月散光值平均增加 0.58D，具有统计学意义（p<.005）。未接受斜视手术的眼在观察期间散光值无统计学意义的变化。内直肌和外直肌亚组的散光绝对值增加相似，分别为 0.59D（标准差=0.10）和 0.57D（标准差=0.11）。对于术前有顺规散光和无散光的眼，术后 12 个月观察到统计学显著增加（分别为 0.64D 和 0.66D）（p<.005）。与未接受任何干预的对侧眼相比，接受水平直肌后退术的眼发生了散光变化。术前有顺规散光和无散光的眼，术后散光圆柱力增加。这种增加可能是由于斜视手术后被退缩的直肌张力降低所致。退缩的水平直肌在 180 度子午线处对巩膜的作用力减小，可能导致该子午线处的角膜变平，从而导致 90 度子午线处的角膜变陡峭。这些变化在术后 12 个月内似乎是稳定的。
