Pickering J D, Simon J W, Lininger L L, Melsopp K B, Pinto G L
Department of Ophthalmology, Albany Medical College, NY.
J Pediatr Ophthalmol Strabismus. 1994 Nov-Dec;31(6):374-7. doi: 10.3928/0191-3913-19941101-06.
Many have suggested that the esotropia associated with developmental delay should be considered separately. However, the esotropia surgery recommended for developmentally delayed children has been similar to that performed in normal children. We have noticed a tendency for developmentally delayed children to develop consecutive exotropia following bilateral medial rectus recessions. Of 94 children undergoing such surgery between 1981 and 1991, 31 were developmentally delayed. Follow up ranged from 7 months to 202 months (mean 24 months). Surgical effect, defined as the change in alignment following each amount of surgery, was greater in the developmentally delayed group than in control subjects (P = .002). The increase in effect of the same amount of surgery in a developmentally delayed patient averaged 5.28 prism diopters, but was much larger in specific instances. Variability of effect was more marked among developmentally delayed children. We conclude that bilateral medial rectus recessions in developmentally delayed children may be better postponed in some cases, deferred for smaller angles, or decreased in amount.
许多人认为，与发育迟缓相关的内斜视应单独考虑。然而，为发育迟缓儿童推荐的内斜视手术与正常儿童所做的手术相似。我们注意到，发育迟缓儿童在双侧内直肌后徙术后有发生连续性外斜视的倾向。在1981年至1991年间接受此类手术的94名儿童中，31名发育迟缓。随访时间为7个月至202个月（平均24个月）。手术效果定义为每次手术量后眼位的变化，发育迟缓组的手术效果比对照组更大（P = .002）。发育迟缓患者相同手术量的效果增加平均为5.28棱镜度，但在特定情况下要大得多。发育迟缓儿童中效果的变异性更为明显。我们得出结论，在某些情况下，发育迟缓儿童的双侧内直肌后徙术可能最好推迟，对于较小的斜视角度推迟手术，或减少手术量。
