Pandey Pramod Kumar, Singh Anupam, Jayaraj Sreeram, Verma Rupal, Panyala Rakesh, Mittal Sanjeev Kumar, Kumar Barun
Department of Ophthalmology, ESIC Medical College, Faridabad, Haryana, India.
Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Curr Ophthalmol. 2024 Aug 10;35(4):375-380. doi: 10.4103/joco.joco_175_23. eCollection 2023 Oct-Dec.
To report the long-term outcomes of bilateral symmetrical superior oblique (SO) nasal tenotomy in patients with large A-pattern exotropia (≥25 prism diopter [PD]).
This retrospective study was conducted on 15 patients (aged: 4-28 years) of large A-pattern exotropia. An A-pattern was defined as >10 PD difference between up and down gaze at 6 m by use of the alternate prism cover test. Objective ocular torsion was assessed by fundus photography and subjective torsion by double Maddox rod test. All patients underwent horizontal muscle surgery according to the primary position horizontal deviation and bilateral symmetrical SO nasal tenotomy for A-pattern. Surgical success was defined as postoperative A-pattern of ≤10 PD, the absence of vertical and torsional diplopia, and the absence of V-pattern. The minimum follow-up period was 24 months.
A total of 15 patients of large A-pattern exotropia (7 males and 8 females) with a mean age of 17.09 ± 7.9 years were included in the study. All patients had bilateral SO overaction of grade +3 or +4 with a mean preoperative A-pattern of 30.3 ± 3.9 PD. At 24 months of follow-up, esotropia in down gaze (V-pattern) was present in four patients with a mean of 11.25 ± 2.5 PD, (range, 10-15 PD). The rest of the 11 patients maintained successful alignment with a mean A-pattern of 3.18 ± 1.17 PD, (range, 2-5 PD). There was significant A-pattern collapse with a mean of 31 ± 9.1 PD after 2 years of follow-up, which was significantly associated with preoperative A-pattern (Pearson correlation, = 0.7; [] = 4.0; = 0.002). The mean of pre- and postoperative objective ocular torsion was found to be -0.5 ± 4° and -4.8 ± 3.8° with a mean extorsion effect of 4.67 ± 3.85°. There was a statistically significant difference between pre- and postoperative ocular torsion (°) ( [30] = 5.42; < 0.001), the change in ocular torsion was significantly associated with preoperative torsion (Pearson correlation, = 0.5; [30] = 7.2; < 0.001). None of the patients had subjective torsion on the double Maddox rod test pre- and postoperatively.
Bilateral symmetrical SO nasal tenotomy is effective in cases with large A-pattern (>25 PD). The reduction of A-pattern and postoperative change in fundus torsion have a positive correlation with preoperative A-pattern and preoperative torsion, respectively.
报告双侧对称性上斜肌鼻侧断腱术治疗大度数A征外斜视（≥25棱镜度[PD]）患者的长期疗效。
对15例大度数A征外斜视患者（年龄4 - 28岁）进行回顾性研究。A征定义为使用交替棱镜遮盖试验在6米距离上下注视时斜视度相差>10 PD。通过眼底照相评估客观眼扭转，通过双马多克斯杆试验评估主观扭转。所有患者均根据原在位水平斜视度进行水平肌手术，并针对A征行双侧对称性上斜肌鼻侧断腱术。手术成功定义为术后A征≤10 PD，无垂直和扭转复视，且无V征。最短随访期为24个月。
本研究共纳入15例大度数A征外斜视患者（7例男性，8例女性），平均年龄17.09±7.9岁。所有患者均有双侧上斜肌亢进+3级或+4级，术前平均A征为30.3±3.9 PD。随访24个月时，4例患者下注视时出现内斜视（V征），平均为11.25±2.5 PD（范围10 - 15 PD）。其余11例患者维持手术成功的眼位，平均A征为3.18±1.17 PD（范围2 - 5 PD）。随访2年后A征明显减轻，平均为31±9.1 PD，这与术前A征显著相关（Pearson相关性，r = 0.7；[t] = 4.0；P = 0.002）。术前和术后客观眼扭转平均值分别为-0.5±4°和-4.8±3.8°，平均外旋效应为4.67±3.85°。术前和术后眼扭转（°）有统计学显著差异（[30] = 5.42；P < 0.001），眼扭转变化与术前扭转显著相关（Pearson相关性，r = 0.5；[t30] = 7.2；P < 0.001）。所有患者术前和术后双马多克斯杆试验均无主观扭转。
双侧对称性上斜肌鼻侧断腱术治疗大度数A征（>25 PD）有效。A征的减轻和术后眼底扭转变化分别与术前A征和术前扭转呈正相关。
