Ing M R, Nishimura J, Okino L
Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA.
Trans Am Ophthalmol Soc. 1997;95:433-43; discussion 443-52.
This paper reports an outcome study of 52 consecutive children treated by bilateral lateral rectus recession for intermittent exotropia over a 9 year period (1981-90) with a minimum follow up of 6 months.
Successful alignment was defined as the absence of any postoperative intermittent or constant tropia in any position of gaze. The study examined the variables that might be predictive of successful alignment. The charts were abstracted for age at initial surgery, quantity of initial deviation, initial refraction, motor alignment at 1 week and 6 months, final alignment, secondary surgery results and the incidence of a monofixation syndrome result.
Motor tests demonstrated that 32 (62%) of the patients were successfully aligned by the initial procedure performed for a mean of 25 prism diopters of preoperative deviation while viewing distant targets at a mean age of 4 years 8 months, followed for a mean of 4 years, 4 months. The incidence of undercorrections and overcorrections were approximately equal in quantity suggesting that the current surgical dosage was adequate, but the age at initial surgery, initial deviation, initial refraction and 1 week postoperative alignment results were not predictive of success. Alignment at 6 months, however, was highly correlated with successful alignment by the end of the study (p = 0.002). Secondary surgery was performed for 11 patients and 5 patients were found to have a monofixation syndrome result.
Successful alignment was achieved in the majority of children treated for intermittent exotropia by an initial bilateral lateral rectus recession. However, 20% of the patients received secondary surgery for a residual deviation, and the study confirmed a previously reported 10% incidence of monofixation syndrome result in children surgically treated for this type of strabismus.
本文报告了一项针对52例连续儿童的疗效研究，这些儿童在1981年至1990年的9年期间接受了双侧外直肌后徙术治疗间歇性外斜视，随访时间至少为6个月。
成功矫正定义为在任何注视位置均无术后间歇性或恒定性斜视。该研究检查了可能预测成功矫正的变量。从病历中提取了初次手术时的年龄、初始斜视度、初始验光结果、术后1周和6个月时的眼位矫正情况、最终眼位矫正情况、二次手术结果以及单眼注视综合征结果的发生率。
运动测试表明，32例（62%）患者通过初次手术成功矫正，术前平均斜视度为25棱镜度，平均年龄为4岁8个月，观察远距离目标，平均随访4年4个月。欠矫和过矫的发生率在数量上大致相等，表明当前手术剂量是足够的，但初次手术时的年龄、初始斜视度、初始验光结果和术后1周的眼位矫正结果并不能预测手术成功。然而，术后6个月时的眼位矫正情况与研究结束时的成功矫正高度相关（p = 0.002）。11例患者接受了二次手术，并发现5例患者有单眼注视综合征结果。
大多数接受双侧外直肌后徙术治疗间歇性外斜视的儿童实现了成功矫正。然而，20%的患者因残余斜视接受了二次手术，该研究证实了先前报道的在接受手术治疗此类斜视的儿童中，单眼注视综合征的发生率为10%。
