Pujari Amar, Modaboyina Sujeeth, Thangavel Rajeswari, Yadav Monika, Phuljhele Swati, Saxena Rohit
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Clin Ophthalmol. 2022 Aug 22;16:2723-2731. doi: 10.2147/OPTH.S381094. eCollection 2022.
To describe novel Y splitting procedure of inferior oblique muscle to mitigate the anti-elevation syndrome.
A pilot, prospective interventional study was undertaken to assess the effect of inferior oblique muscle Y-splitting in patients with unilateral 3+ or more overaction. To correct primary gaze hypertropia and the excyclotorsion, a Y-splitting procedure was performed (along with routine horizontal muscle surgery as per the deviation) in 14 subjects. The effect of surgery was assessed at baseline and at 6 months post-intervention.
The mean age of 14 subjects was 25.14±7.70 years. The mean pre-operative hypertropia, excyclotorsion and inferior oblique muscle over-action was 18.42±3.50 PD, 14.14±2.65 degrees, and +3.21±0.42 respectively. Following surgery, this was reduced to 1.57±1.74 PD of residual hypertropia (a net correction of 16.85±2.31 PD, p = 0.005), 3.85±1.46 degrees of residual excyclotorsion (a net correction of 10.28±1.72 degrees, p < 0.05), and +0.28±0.46 of residual inferior oblique over-action (a net correction ~+3) at the end of 6 months. Amongst fourteen patients, three patients still experienced residual/variable anti-elevation effect, and during the study period none of them experienced any adverse event and none of them required any additional surgeries.
While anteriorizing the inferior oblique muscle to correct primary gaze hypertropia and the excyclotorsion, a novel "Y splitting" procedure can be followed to achieve the desired results with mitigated anti-elevation effect.
描述一种新的下斜肌Y形劈开手术，以减轻上转受限综合征。
开展一项前瞻性干预性初步研究，评估下斜肌Y形劈开术对单侧下斜肌亢进3级及以上患者的效果。为矫正原在位上斜视和外旋转斜视，对14例受试者实施了Y形劈开手术（根据斜视情况同时进行常规水平肌手术）。在基线期和干预后6个月评估手术效果。
14例受试者的平均年龄为25.14±7.70岁。术前平均上斜视、外旋转斜视和下斜肌亢进分别为18.42±3.50三棱镜度、14.14±2.65度和+3.21±0.42。术后6个月末，残余上斜视减少至1.57±1.74三棱镜度（净矫正16.85±2.31三棱镜度，p = 0.005），残余外旋转斜视减少至3.85±1.46度（净矫正10.28±1.72度，p < 0.05），残余下斜肌亢进减少至+0.28±0.46（净矫正约+3）。14例患者中，3例仍有残余/可变的上转受限效应，研究期间无患者发生任何不良事件，也均未需要额外手术。
在下斜肌前徙以矫正原在位上斜视和外旋转斜视时，可采用一种新的“Y形劈开”手术，以减轻上转受限效应并达到预期效果。
