Adio Adedayo O, Ezisi Chinyelu N, Nkanga Elizabeth D
Pediatric Eye Clinic, Department of Ophthalmology, University of Port Harcourt Teaching Hospital Port Harcourt, Rivers State, Nigeria.
Pediatric Eye Clinic, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
J Ophthalmic Vis Res. 2024 Jun 21;19(2):205-218. doi: 10.18502/jovr.v19i2.12791. eCollection 2024 Apr-Jun.
Large-angle horizontal ocular deviations will commonly require bilateral surgery to correct the primary ocular deviation. However, considering the need for full correction with one surgical procedure and patients' reluctance to be operated on the good eye, such large horizontal ocular deviations may be managed with true muscle transplantation. The authors present a case series of patients who underwent this procedure and develop a surgical table to guide management.
Patients with horizontal squints measuring 80 prism diopters (PD) or larger in all age groups who underwent extraocular muscle transplantation surgery between January 2019 and June 2022 in Nigeria were included. Preoperative deviation of the squint, sensory evaluation, surgical dosage, and outcomes were documented. Part of the resected muscle was transplanted to give additional recession in the antagonist muscle. Success was defined as deviation corrected by 60% or more or postoperative ocular alignment within 10 PD or less, six weeks postoperatively.
Fourteen patients with extra-large-angle strabismus were operated. Male/female ratio was 0.6:1. Mean preoperative deviation of 89.6 9.3 collapsed to 6.6 1.8 PD at six weeks and continued to improve to a mean deviation of 2.5 PD at six months postoperatively. When the subgroup of patients who were 18 years were analyzed, the outcome was equally successful; preoperative deviation of 89.4 PD collapsed to 1.4 PD, six months postoperatively. There were equal success rates when those with sensory strabismus were compared with those with binocular vision; preoperative deviation of 92.5 PD in the sensory group and 88.5 PD in the binocular group collapsed to 5.9 PD and 1 PD, respectively, six months after surgery.
A viable alternative for treating extra-large-angle strabismus in adults and children in developing countries was described with good postoperative outcome. In addition, a new expanded surgical dosage table for muscle transplantation surgery corrections of up to 130 PD was developed.
大角度水平性眼位偏斜通常需要双侧手术来矫正主要眼位偏斜。然而，考虑到需要通过一次手术实现完全矫正，以及患者不愿对好眼进行手术，这种大角度水平性眼位偏斜可采用真正的肌肉移植来处理。作者介绍了一系列接受该手术的患者病例，并制定了一个手术表来指导治疗。
纳入2019年1月至2022年6月在尼日利亚接受眼外肌移植手术的所有年龄组水平斜视度数达80棱镜度（PD）或更大的患者。记录斜视的术前偏斜度、感觉评估、手术剂量和结果。将部分切除的肌肉进行移植，以使拮抗肌获得额外的后徙。成功定义为术后六周偏斜度矫正60%或更多，或术后眼位在10 PD以内。
对14例超大角度斜视患者进行了手术。男女比例为0.6:1。术前平均偏斜度为89.6±9.3 PD，术后六周降至6.6±1.8 PD，并在术后六个月继续改善至平均偏斜度2.5 PD。对18岁及以下患者亚组进行分析时，结果同样成功；术后六个月，术前89.4 PD的偏斜度降至1.4 PD。感觉性斜视患者与双眼视力患者的成功率相同；感觉性组术前92.5 PD和双眼组术前88.5 PD在术后六个月分别降至5.9 PD和1 PD。
描述了一种在发展中国家治疗成人和儿童超大角度斜视的可行替代方法，术后效果良好。此外，还制定了一个新的扩展手术剂量表，用于矫正高达130 PD的肌肉移植手术。
