Ohtsuki H, Hasebe S, Hanabusa K, Fujimoto Y, Furuse T
Department of Ophthalmology, Okayama University Medical School, Japan.
Ophthalmology. 1994 Jan;101(1):188-93. doi: 10.1016/s0161-6420(94)31366-2.
The modified Harada-Ito procedure has been reported to be an effective treatment for correction of cyclotorsion in bilateral superior oblique palsy. However, there are no reports regarding its use in intraoperative adjustable suture surgery.
The authors performed a retrospective study of 12 patients with traumatic bilateral superior oblique palsy who were classified as having either symmetric or asymmetric palsy according to the symmetry of the alternate hyperdeviation on side gazes. Cyclotorsion and vertical and horizontal deviation in the nine diagnostic positions were measured preoperatively and postoperatively.
Of the 12 patients, 6 were determined to have symmetric palsy and 6 asymmetric palsy. Intraoperative adjustable suture surgery with the modified Harada-Ito procedure was performed bilaterally in the six patients with symmetric palsy and unilaterally in those with asymmetric palsy. The median measured value of extorsion in the primary position was reduced from 14.5 degrees to 2.5 degrees in patients with symmetric palsy and from 9.5 degrees to 2.0 degrees in those with asymmetric palsy. In downgaze, some degree of residual extorsion remained, and there was no significant change in esodeviation after surgery. In five patients with symmetric palsy and in all of those with asymmetric palsy, normal single binocular vision in the primary position but did not that in downgaze was restored after surgery.
Intraoperative adjustable suture surgery is an effective treatment in correcting torsion, but may not be as effective for esodeviation in downgaze.
改良的原田-伊藤手术已被报道是矫正双侧上斜肌麻痹中旋转性斜视的有效治疗方法。然而，尚无关于其在术中可调节缝线手术中应用的报道。
作者对12例创伤性双侧上斜肌麻痹患者进行了回顾性研究，根据侧方注视时交替上斜视的对称性将其分为对称性或非对称性麻痹。术前和术后测量九个诊断眼位的旋转性斜视以及垂直和水平斜视度。
12例患者中，6例被判定为对称性麻痹，6例为非对称性麻痹。6例对称性麻痹患者双侧进行了改良原田-伊藤手术的术中可调节缝线手术，非对称性麻痹患者单侧进行了该手术。对称性麻痹患者原在位外旋的中位测量值从14.5度降至2.5度，非对称性麻痹患者从9.5度降至2.0度。在向下注视时，仍存在一定程度的残余外旋，术后内斜视无明显变化。5例对称性麻痹患者及所有非对称性麻痹患者术后原在位恢复了正常的单眼双眼视觉，但向下注视时未恢复。
术中可调节缝线手术是矫正扭转的有效治疗方法，但对向下注视时的内斜视可能效果不佳。
