Tejedor Jaime, Gutiérrez-Carmona Francisco J
Department Ophthalmology, Hospital Ramón y Cajal, C Colmenar Km 9100, 28034, Madrid, Spain.
Department Neuroscience, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Ophthalmol Ther. 2023 Oct;12(5):2793-2800. doi: 10.1007/s40123-023-00756-3. Epub 2023 Jul 1.
Anterior segment ischemia may occur when three or more rectus muscles are operated in the same eye. Our purpose was to investigate the efficacy of rectus muscle stretching as a vessel-sparing weakening technique, in comparison with a retrospectively collected series of patients.
Non-operated patients with an indication of medial rectus muscle weakening surgery (deviation up to 20 PD, prism diopters) who could cooperate with topical or sub-Tenon's anesthesia. Clinical workup included routine complete ophthalmological evaluation. One double-needle 6/0 Mersilene suture was used on each side of the muscle at 4 mm distance of the insertion and pulled/stretched to insert in the sclera 3-5 mm posterior to the muscle locking passes. Main outcome measure was distance deviation at 2 months after surgery (alternate prism and cover test).
Seven patients with esotropia of 12-20 PD, recruited in a 20-month period, were included. Preoperative median deviation was 20 PD, whereas postoperative median deviation was 4 PD (range 0-8 PD). On a visual pain scale (1-10) median pain score was 3 (range 2-5). Remarkable postoperative complications did not occur. Significant differences with a retrospectively collected series of patients' data, treated with standard medial rectus recession, were not observed.
Preliminary data indicate that stretching of a rectus muscle has some weakening effect, that could be useful to correct small-angle strabismus, and may be suggested as a vessel-sparing technique when two rectus muscles have previously been operated in the same eye.
ClinicalTrials.gov NCT05778565.
当同一只眼睛的三条或更多直肌接受手术时，可能会发生眼前节缺血。我们的目的是研究直肌拉伸作为一种保留血管的减弱技术的疗效，并与一组回顾性收集的患者系列进行比较。
有内直肌减弱手术指征（斜视度高达20棱镜度）且能配合表面麻醉或球后麻醉的未手术患者。临床检查包括常规的完整眼科评估。在肌肉插入点两侧4毫米处各使用一根双针6/0爱惜邦缝线，牵拉/拉伸后在肌肉锁定穿过点后方3 - 5毫米处插入巩膜。主要观察指标是术后2个月的斜视度（交替棱镜遮盖试验）。
在20个月期间招募了7例斜视度为12 - 20棱镜度的内斜视患者。术前斜视度中位数为20棱镜度，而术后中位数为4棱镜度（范围0 - 8棱镜度）。视觉疼痛评分（1 - 10分）中位数为3分（范围2 - 5分）。未发生明显术后并发症。与一组回顾性收集的数据（采用标准内直肌后徙术治疗的患者）相比，未观察到显著差异。
初步数据表明，直肌拉伸有一定减弱效果，可以用于矫正小角度斜视，并且当同一只眼睛先前已经有两条直肌接受过手术时，可以作为一种保留血管的技术。
ClinicalTrials.gov NCT05778565。
