Department of Ophthalmology and Vision Science, University of Arizona-Tucson, Tucson, Arizona.
J Binocul Vis Ocul Motil. 2022 Oct-Dec;72(4):230-233.
Divergence insufficiency-type ET is a common cause of distance diplopia in elderly adults. A recent prospective multicenter data collection study has provided additional guidance on management. Either base-out prism glasses or strabismus surgery were found to have high success rates, based on patient report of diplopia, and health-related quality-of-life domain scores. It was concluded that either prism or surgery were reasonable initial treatment strategies. Although allocation bias precluded formal comparison of prism versus surgery (evident in baseline differences between groups), there were hints that surgery may yield superior outcomes. For surgery, the most common approach was bilateral medial rectus recession, which was highly successful when assessed 10 weeks and 12 months postoperatively. It was unclear whether adjustable sutures were helpful, but in the vast majority of adjustable cases, additional recession at the time of adjustment was performed, suggesting that larger than standard surgical doses are needed.
发散不足型 ET 是老年人远距离复视的常见原因。最近一项前瞻性多中心数据收集研究为其管理提供了额外的指导。基于患者对复视的报告和健康相关生活质量领域的评分，发现底向外棱镜或斜视手术都有很高的成功率。研究得出的结论是棱镜或手术都是合理的初始治疗策略。尽管分配偏倚排除了棱镜与手术的正式比较（从组间基线差异中可以明显看出），但有迹象表明手术可能会产生更好的结果。对于手术，最常见的方法是双侧内直肌后退，术后 10 周和 12 个月评估时非常成功。尚不清楚可调节缝线是否有帮助，但在绝大多数可调节病例中，在调整时都进行了额外的后退，这表明需要比标准手术剂量更大的手术剂量。
