Lam G C, Repka M X, Guyton D L
Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Ophthalmology. 1993 Dec;100(12):1751-6. doi: 10.1016/s0161-6420(13)31403-1.
It is taught that amblyopia must be fully reversed before surgery for esotropia is undertaken to achieve the best surgical outcome. In some cases, this means delaying surgery for many months. The alternative of operating early, before the completion of amblyopia therapy, and continuing to treat the amblyopia postoperatively has not been evaluated previously.
Forty-seven children younger than 8 years of age were identified with a history of both amblyopia and esotropia. They had no other ocular, medical, or neurologic abnormalities. They had no prior strabismus surgery. Of these 47 patients, 26 had their amblyopia fully treated before surgery, and 21 underwent surgery before completing amblyopia therapy. Five of the latter group did not require amblyopia therapy after surgery even though they were still amblyopic before operation. The motor outcome was assessed by comparing the motor alignment at 6 and 0.33 m using accommodative targets in primary position before surgery, at 6 months after surgery, and at the child's most recent visit. Motor success was defined in this study as a postoperative deviation at distance fixation of 8 prism diopters or less. The sensory result was assessed by comparing the frequency of detectable stereoacuity.
The treatment groups did not differ significantly in age, depth of amblyopia, refractive error, or preoperative angle. There was no significant difference detected in motor or sensory outcome whether amblyopia was fully or only partially treated before surgery.
Performing corrective surgery in children with esotropia before full resolution of amblyopia is safe and efficient if the amblyopia therapy is continued after surgery. This strategy permits earlier surgery without postponing the operation until full resolution of amblyopia. The finding that five patients did not require amblyopia therapy after surgery suggests that eye re-alignment itself can help reverse amblyopia in some cases.
传统观念认为，在进行内斜视手术前，弱视必须完全矫正，以获得最佳手术效果。在某些情况下，这意味着要将手术推迟数月。在弱视治疗完成之前早期进行手术，并在术后继续治疗弱视这种替代方案，此前尚未得到评估。
确定了47名8岁以下有弱视和内斜视病史的儿童。他们没有其他眼部、内科或神经方面的异常。他们之前没有进行过斜视手术。在这47名患者中，26名在手术前弱视得到了充分治疗，21名在弱视治疗完成前接受了手术。后一组中有5名患者术后即使术前仍有弱视也不需要弱视治疗。通过比较手术前、术后6个月以及患儿最近一次就诊时在原在位使用调节视标时6米和0.33米处的眼位来评估运动结果。本研究将运动成功定义为远距离注视时术后斜视度为8棱镜度或更小。通过比较可检测立体视锐度的频率来评估感觉结果。
治疗组在年龄、弱视程度、屈光不正或术前斜视角度方面无显著差异。无论弱视在手术前是完全治疗还是仅部分治疗，运动或感觉结果均无显著差异。
如果术后继续进行弱视治疗，在弱视完全矫正之前对患有内斜视的儿童进行矫正手术是安全有效的。这种策略允许更早进行手术，而无需将手术推迟到弱视完全矫正之后。有5名患者术后不需要弱视治疗这一发现表明，在某些情况下，眼睛重新对齐本身有助于逆转弱视。
