改良下斜肌前徙术治疗分离性垂直偏斜合并上斜肌麻痹：一例报告
Modified inferior oblique anterior transposition for dissociated vertical deviation combined with superior oblique palsy: A case report.
作者信息
Zong Yao, Wang Ze, Jiang Wen-Lan, Yang Xian
机构信息
Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
Department of Ophthalmology, Nanjing South East Eye Hospital, Nanjing 210007, Jiangsu Province, China.
出版信息
World J Clin Cases. 2023 Apr 26;11(12):2796-2802. doi: 10.12998/wjcc.v11.i12.2796.
BACKGROUND
Inferior oblique anterior transposition (IOAT) has emerged as an effective surgery in the management of dissociated vertical deviation (DVD) combined with superior oblique palsy (SOP). Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon. However, it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze, especially after the unilateral operation.
CASE SUMMARY
We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP. The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle, the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers. Postoperatively, both hypertropia and floating were improved, and no obvious complications occurred.
CONCLUSION
In these cases, the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.
背景
下斜肌前转位术（IOAT）已成为治疗分离性垂直偏斜（DVD）合并上斜肌麻痹（SOP）的一种有效手术方式。传统的IOAT通常能使第一眼位获得满意的眼位矫正，同时限制上飘现象。然而，它也增加了抗上转综合征的风险以及正前方注视时睑裂变窄的风险，尤其是在单侧手术之后。
病例摘要
我们报告了两例单侧DVD合并SOP患者行改良单侧IOAT的手术结果。下斜肌的前鼻侧纤维附着于角膜缘后9mm处，沿下直肌颞侧附着板，其他纤维附着于前鼻侧纤维颞侧再5mm处。术后，上斜视和上飘均得到改善，且未发生明显并发症。
结论
在这些病例中，改良单侧IOAT是治疗DVD合并SOP的一种有效且安全的手术方法。
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