AlSahaf Esra, AlShamlan Fatemah T
Department of Ophthalmology, Division of Pediatric Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia.
Med Hypothesis Discov Innov Ophthalmol. 2024 Aug 14;13(2):82-87. doi: 10.51329/mehdiophthal1498. eCollection 2024 Summer.
Strengthening of extraocular muscles is a conventional procedure in the management of strabismus. Plication may be an alternative strengthening technique, and is less invasive than resection. This study compared plication and resection, each combined with antagonist muscle recession, in terms of success rates and changes in ocular deviation in the management of horizontal strabismus.
This retrospective study recruited individuals with horizontal strabismus who underwent plication (group I) or resection (group II) coupled with antagonist muscle recession. All participants underwent a detailed baseline eye and ocular motility evaluation. Demographic and clinical data were collected, including age, sex, type of preoperative strabismus (exotropia or esotropia), baseline visual acuity, mean follow-up duration, laterality of operated eye, surgical doses of correction (resection, plication, or recession) in millimeters, preoperative strabismus magnitude in prism diopters (PD), and postoperative strabismus magnitude in PD. Successful postoperative deviation was defined as ≤10 PD. At final follow-up, the success rates and degrees of change in angle of deviation were recorded.
Forty-four patients were enrolled: 19 patients in group I (plication) and 25 patients in group II (resection). The groups had comparable ages, sex ratios, types of strabismus, and preoperative and postoperative angles of deviation (all > 0.05). Despite comparable success rates between groups (73.7% in group I versus 64.0% in group II, > 0.05), the difference (9.7%) was marginally close to the predefined clinically meaningful difference of 10%. In the esotropia subgroup, despite comparable alignment between the plication and resection groups ( > 0.05), the difference was clinically meaningful (17.3%), and both groups had higher success rates in the esotropia subtype than in the exotropia subtype. The rate of over- or undercorrection was not statistically or clinically different in the total and in each subtype of strabismus (all > 0.05). Success rates for unilateral and bilateral cases were similar between groups (both > 0.05). Changes in angle of deviation were similar for individuals with esotropia and exotropia between groups (both > 0.05).
In esotropic and exotropic strabismus, plication and resection procedures combined with antagonist recession were similarly effective. However, further randomized, large-scale, longitudinal studies with clinical and subjective evaluations could comitant strabismus, squint, esotropias, primary exotropia, exodeviation, plication, resection, recession, amblyopias.
加强眼外肌是斜视治疗中的传统手术方法。折叠术可能是一种替代性的加强技术，且侵入性比切除术小。本研究比较了折叠术与切除术，二者均联合拮抗肌后徙术，在水平斜视治疗中的成功率及眼位偏斜变化情况。
本回顾性研究纳入了接受折叠术（I组）或切除术（II组）联合拮抗肌后徙术的水平斜视患者。所有参与者均接受了详细的基线眼部及眼球运动评估。收集了人口统计学和临床数据，包括年龄、性别、术前斜视类型（外斜视或内斜视）、基线视力、平均随访时间、手术眼别、以毫米为单位的手术矫正量（切除、折叠或后徙）、术前斜视度数（棱镜度，PD）及术后斜视度数（PD）。术后成功的眼位偏斜定义为≤10 PD。在最终随访时，记录成功率及偏斜角度的变化程度。
共纳入44例患者：I组（折叠术）19例，II组（切除术）25例。两组在年龄、性别比例、斜视类型及术前和术后偏斜角度方面具有可比性（均P>0.05）。尽管两组成功率具有可比性（I组为73.7%，II组为64.0%，P>0.05），但差异（9.7%）略接近预先定义的具有临床意义的10%的差异。在内斜视亚组中，尽管折叠术组与切除术组的眼位矫正情况具有可比性（P>0.05），但差异具有临床意义（17.3%），且内斜视亚型的两组成功率均高于外斜视亚型。在斜视的总体及各亚型中，过矫或欠矫率在统计学及临床上均无差异（均P>0.05）。两组单侧和双侧病例的成功率相似（均P>0.05）。两组内斜视和外斜视患者的偏斜角度变化相似（均P>0.05）。
在内斜视和外斜视中，折叠术和切除术联合拮抗肌后徙术同样有效。然而，需要进一步进行随机、大规模、纵向研究，并进行临床和主观评估，以研究斜视、斜视眼、内斜视、原发性外斜视、外斜视、折叠术、切除术、后徙术、弱视。
