From the Department of Ophthalmology (W.P., L.H., D.G.H.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (W.P., L.H., D.G.H.), Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology (W.P.), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
From the Department of Ophthalmology (W.P., L.H., D.G.H.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (W.P., L.H., D.G.H.), Harvard Medical School, Boston, Massachusetts, USA.
Am J Ophthalmol. 2023 May;249:29-38. doi: 10.1016/j.ajo.2022.12.019. Epub 2022 Dec 27.
To report the indications, operative strategies, and surgical outcomes of patients who undergo vertical and horizontal rectus muscle surgery for incomitant strabismus despite being orthophoric in primary gaze.
Retrospective, interventional case series.
The setting for this study was an academic practice at Boston Children's Hospital. The patient population comprised 8 orthophoric patients who underwent strabismus surgery to treat vertical/horizontal incomitance. Observation procedures included review of surgical strategies, strabismus measurements in diagnostic gaze positions, and development of postoperative diplopia. The main outcome measures were preserved single vision in primary gaze, comitance, reoperation rate, and patient/surgeon satisfaction.
Surgical strategies included the following: (1) simultaneous recession of ipsilateral antagonist rectus muscles; (2) recession or resection of 1 rectus muscle with balancing surgery on the fellow eye; (3) restricting the range of 1 muscle (combined resection and recession or posterior fixation suture); and (4) creating an acceptable deviation in primary gaze. Mean follow-up was 5.4 months (median, 2 months; range, 2-25 months). No patient had new-onset primary gaze diplopia. The median incomitance improved by 9.5 prism diopters. No patient required additional surgery. Patient satisfaction and surgeon assessment of outcomes were high.
Although the risk of operating on orthophoric patients with incomitant strabismus may discourage surgeons from offering treatment, the use of specific strategies to address incomitance can preserve alignment in primary gaze while improving patient satisfaction. These strategies may also benefit patients with incomitant strabismus that is symptomatic in primary gaze.
报告尽管在第一眼位正位但存在斜视不等的患者接受垂直和水平直肌手术的适应证、手术策略和手术结果。
回顾性、干预性病例系列。
本研究的地点是波士顿儿童医院的一个学术实践中心。患者人群包括 8 名第一眼位正位但存在斜视不等的患者，他们接受斜视手术以治疗垂直/水平斜视不等。观察程序包括回顾手术策略、诊断注视位的斜视测量以及术后复视的发展。主要观察指标是第一眼位保留单视、共视、再次手术率和患者/医生满意度。
手术策略包括以下几种：（1）同时内收同侧拮抗直肌；（2）内收或切除 1 条直肌，对侧眼进行平衡手术；（3）限制 1 条肌肉的活动范围（联合切除和内收或后固定缝线）；（4）在第一眼位产生可接受的偏斜。平均随访时间为 5.4 个月（中位数为 2 个月；范围为 2-25 个月）。没有患者出现第一眼位新发性复视。斜视不等的中位数改善了 9.5 棱镜度。没有患者需要再次手术。患者满意度和医生对结果的评估都很高。
尽管对存在斜视不等但第一眼位正位的患者进行手术的风险可能会使外科医生不愿意提供治疗，但使用特定的策略来解决斜视不等可以在改善患者满意度的同时保留第一眼位的正位。这些策略也可能有益于第一眼位有症状的斜视不等患者。
