von Noorden G K, Jenkins R H, Chu M W
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.
Am J Ophthalmol. 1996 Sep;122(3):325-30. doi: 10.1016/s0002-9394(14)72058-6.
We studied the effect of horizontal transposition of the vertical rectus muscles on incyclotropia and excyclotropia in terms of the amount of correction obtained and the stability of the outcome.
Preoperative measurements for cyclotropia were compared in 11 patients with measurements during the immediate postoperative period and last follow-up. Excyclotropia was treated with nasal transposition of the inferior rectus muscle and incyclotropia with nasal transposition of the superior rectus muscle, to which we added temporal transposition to the inferior rectus muscle in one patient to enhance the effect.
Fusion in all gaze positions was restored in six patients and functional improvement occurred in five. The average effect of horizontal transposition of one vertical rectus muscle for cyclotropia was a correction of 7 degrees in primary position and of 11 degrees in depression. This effect remained stable after a mean follow-up of 17 months, and additional improvement occurred in one patient. One patient developed a hypertropia, eliminated by an additional operation, in the treated eye.
For excyclotropia, nasal transposition of the inferior rectus muscle is a viable alternative to lateral and anterior transposition of the anterior portion of the superior oblique tendon. It becomes the procedure of choice when surgery on the superior oblique tendon is precluded, either by the tendon's congenital absence or by previous surgery on the tendon. Nasal transposition of the superior rectus muscle or temporal transposition of the inferior rectus muscle is ideally suited for incyclotropia. No comparably effective operation exists.
我们从获得的矫正量和结果的稳定性方面，研究了垂直直肌水平移位对眼球内旋斜视和外旋斜视的影响。
比较了11例患者术前眼球旋转斜视的测量值与术后即刻及末次随访时的测量值。外旋斜视采用下直肌鼻侧移位治疗，内旋斜视采用上直肌鼻侧移位治疗，其中1例患者为增强效果，在下直肌上增加了颞侧移位。
6例患者在所有注视位均恢复融合，5例功能改善。一条垂直直肌水平移位治疗眼球旋转斜视的平均效果是，第一眼位矫正7度，下转位矫正11度。平均随访17个月后，该效果保持稳定，1例患者有进一步改善。1例患者在治疗眼出现上斜视，通过再次手术消除。
对于外旋斜视，下直肌鼻侧移位是上斜肌腱前部外侧和前部移位的可行替代方法。当上斜肌腱先天性缺失或既往曾对上斜肌腱进行手术而无法对上斜肌腱进行手术时，下直肌鼻侧移位成为首选术式。上直肌鼻侧移位或下直肌颞侧移位非常适合内旋斜视。不存在同等有效的手术方法。
