Beneish R, Flanders M
Department of Ophthalmology, Montreal Children's Hospital, Que.
Can J Ophthalmol. 1994 Jun;29(3):119-24.
Despite the presence of good stereopsis, surgically corrected intermittent exotropes may show a gradual outward shift with time. The purpose of this study was to identify early factors that influence the success of corrective surgery. Sixty-seven consecutive patients treated surgically for intermittent exotropia (age range 1.9 to 76 years) constituted our final sample. Sensory status was evaluated with the Titmus stereotest. A successful surgical result was defined as phoria or intermittent tropia of +/- 10 prism dioptres or less for near and distance with maintained or improved stereopsis, 6 months or more after surgery. The average postoperative follow-up period was 3.3 (range 0.5 to 11) years. Good stereopsis (60 seconds of arc or better) was present in only 42% of the patients preoperatively and 61% postoperatively. The overall surgical success rate was 60%. Early overcorrection, defined as an esodeviation present within the first 4 weeks after surgery, caused a significant improvement in the success rate, to 79% (p = 0.03). Poor preoperative stereopsis combined with early overcorrection resulted in a further significant improvement in the surgical success rate, to 92% (p = 0.07). This suggests that poor preoperative stereopsis does not necessarily preclude, and may enhance, long-term alignment stability postoperatively. We suggest that it is peripheral rather than central fusion that keeps the eyes well aligned after surgery and prevents recurrence of the exodeviation.
尽管存在良好的立体视，但手术矫正的间歇性外斜视可能会随着时间逐渐向外偏移。本研究的目的是确定影响矫正手术成功的早期因素。我们的最终样本包括67例连续接受手术治疗的间歇性外斜视患者（年龄范围1.9至76岁）。使用Titmus立体视测试评估感觉状态。手术成功的结果定义为术后6个月或更长时间，近距和远距时斜视度为±10棱镜度或更小的隐斜视或间歇性斜视，且立体视保持或改善。术后平均随访期为3.3年（范围0.5至11年）。术前仅42%的患者存在良好的立体视（60秒弧度或更好），术后为61%。总体手术成功率为60%。早期过矫定义为术后前4周内出现的内斜视，使成功率显著提高至79%（p = 0.03）。术前立体视差合并早期过矫使手术成功率进一步显著提高至92%（p = 0.07）。这表明术前立体视差不一定会妨碍术后长期眼位稳定，反而可能会增强这种稳定性。我们认为，术后保持双眼良好眼位并防止外斜视复发的是周边融合而非中央融合。
