Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
PLoS One. 2023 Jan 12;18(1):e0280274. doi: 10.1371/journal.pone.0280274. eCollection 2023.
To evaluate the long-term refractive changes after horizontal muscle surgery in patients with intermittent exotropia and investigate the correlation between changes in the postoperative refractive error and clinical factors.
We retrospectively reviewed the clinical data of patients aged < 15 years who underwent unilateral strabismus surgery (lateral rectus recession and medial rectus resection [RR, n = 47], lateral rectus recession and medial rectus plication [RP, n = 81], or lateral rectus recession [LRc, n = 68]). Preoperative and postoperative refractive errors up to four years after surgery were recorded. A mixed model was applied to compare the refractive error between the operated and fellow eyes and identify the factors associated with postoperative refractive changes.
The mean age at surgery was 7.5±2.4years, and girls accounted for 56.1% of the study population. There was no significant difference in the change in the spherical equivalent of refractive error between both eyes throughout the postoperative period. In contrast, the operated eyes consistently and significantly showed higher cylindrical power in with-the-rule astigmatism by 0.25D than in fellow eyes. Age, sex, and preoperative refractive error were not correlated with changes in postoperative astigmatism. Meanwhile, the type of surgery showed a significant interaction with the astigmatism changes. RP had less effect on the changes in astigmatism than RR and LRc (p = 0.001 and p = 0.022, respectively).
Horizontal muscle surgery has no long-term effect on the change in the spherical equivalent. However, mild with-the-rule astigmatism is induced and sustained after surgery, and the type of surgery affects the postoperative change of astigmatism.
评估间歇性外斜视患者水平肌手术后的长期屈光变化，并探讨术后屈光不正变化与临床因素之间的相关性。
我们回顾性分析了 47 例接受单侧斜视手术（外直肌后退和内直肌切除术 [RR]、81 例接受外直肌后退和内直肌折叠术 [RP]、68 例接受外直肌后退术 [LRc]）的年龄＜15 岁患者的临床资料。记录了术前和术后 4 年内的屈光不正。采用混合模型比较手术眼和对侧眼的屈光误差，并确定与术后屈光变化相关的因素。
手术时的平均年龄为 7.5±2.4 岁，女孩占研究人群的 56.1%。在整个术后期间，双眼的球镜等效屈光变化无显著差异。相比之下，手术眼的规则性散光的柱镜力始终显著高于对侧眼，高 0.25D。年龄、性别和术前屈光不正与术后散光变化无关。同时，手术类型与散光变化有显著的交互作用。RP 对散光变化的影响明显小于 RR 和 LRc（p = 0.001 和 p = 0.022）。
水平肌手术对球镜等效的变化没有长期影响。然而，手术后会诱导并持续出现轻度规则性散光，且手术类型会影响术后散光的变化。
