Nabie Reza, Manouchehri Vahideh, Meydan Sepideh Rostam
Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Faculty of Medicine, Islamic Azad University, Tabriz Branch, Tabriz, Iran.
J Curr Ophthalmol. 2022 Jul 26;34(2):247-250. doi: 10.4103/joco.joco_320_21. eCollection 2022 Apr-Jun.
To evaluate the success rate, dose-response ratio, and predictive factors of success in patients with residual esotropia (≥25 prism diopter [pd]) following bilateral medial rectus (BMR) recession who underwent bilateral lateral rectus (BLR) resection.
In a retrospective study, medical records were reviewed for 47 patients with equal or more than 25 pd residual esotropia following 6 mm BMR recession. Sex, age at second surgery, the interval between first and second surgery in months, visual acuity, refraction, presence of amblyopia, presence of dissociated vertical deviation or inferior oblique overaction/superior oblique overaction, preoperative and postoperative angle of deviation, amount of BLR resection, and months of follow-up were evaluated. Surgical success was defined as postoperative deviation within 8 pd of orthophoria.
The mean age of patients at reoperation was 48.59 ± 21.46 months. The mean near and far residual esotropia before BLR resection was 34.57 ± 11.02 and 33.83 ± 10.99 pd, respectively, reduced to 8.12 ± 1.43 pd in near and 6.32 ± 2.1 pd in far postoperatively. The mean BLR resection dosage was 5.53 ± 1.22 mm and each millimeter of BLR resection (1 mm for each eye) corrected an average of 7.95 pd of deviation in near and 7.40 pd in far. The success rate was 74.5%. After analysis using multivariate logistic regression, there were no factors associated with success.
Bilateral rectus resection in patients with a previous BMR recession has acceptable outcomes. The recommended surgical table can be used as a guide by strabismus surgeons in patients with residual esotropia.
评估双侧内直肌（BMR）后徙术后仍存在残余内斜视（≥25棱镜度[pd]）并接受双侧外直肌（BLR）缩短术患者的成功率、剂量反应比及成功的预测因素。
在一项回顾性研究中，对47例在BMR 6mm后徙术后残余内斜视等于或超过25pd的患者的病历进行了回顾。评估了患者的性别、二次手术时的年龄、首次和二次手术间隔的月数、视力、屈光状态、弱视情况、有无分离性垂直偏斜或下斜肌亢进/上斜肌亢进、术前和术后的斜视角度、BLR缩短术的量以及随访月数。手术成功定义为术后斜视度在正位视8pd以内。
再次手术患者的平均年龄为48.59±21.46个月。BLR缩短术前近距和远距残余内斜视的平均值分别为34.57±11.02pd和33.83±10.99pd，术后近距降至8.12±1.43pd，远距降至6.32±2.1pd。BLR缩短术的平均量为5.53±1.22mm，每毫米BLR缩短术（每眼1mm）平均矫正近距斜视度7.95pd，远距斜视度7.40pd。成功率为74.5%。经多因素逻辑回归分析，未发现与成功相关的因素。
既往有BMR后徙术的患者行双侧直肌缩短术有可接受的结果。推荐的手术量表可作为斜视外科医生治疗残余内斜视患者的指导。
