Kushner B J
Pediatric Eye & Adult Strabismus Clinic, Department of Ophthalmology & Visual Sciences, University of Wisconsin, Madison, USA.
Arch Ophthalmol. 1998 Mar;116(3):324-8. doi: 10.1001/archopht.116.3.324.
Classic teaching suggests that surgery for intermittent exotropia should be based on distance/near differences. Divergence excess, according to tradition, should be treated with symmetric lateral rectus recessions; simulated divergence excess and basic deviations should be treated with a recess/resect procedure. This teaching, to our knowledge, has not been systematically tested.
To evaluate the appropriateness of selective surgery based on distance/near differences and to determine if bilateral lateral rectus recessions affect the distance deviation more than the near deviation.
Patients with basic type intermittent exotropia were randomized to 2 groups, those receiving either unilateral recess/resect procedures or symmetric lateral rectus recessions. Patients with simulated divergence excess intermittent exotropia received symmetric lateral rectus recessions. Outcome was observed 1 year after surgery.
Of 19 patients with basic exotropia receiving lateral rectus recessions, 10 patients (52%) had a satisfactory outcome compared with 14 (82%) of the 17 patients who had recess/resect procedures (P<.05). Of the 68 patients with simulated divergence excess, 55 patients (80%) had a satisfactory outcome after bilateral/lateral rectus recessions. This result was significantly better than the outcome for patients with basic exotropia who underwent lateral rectus recessions (P<.05) [corrected]. The decrease in the distance/near difference after surgery was essentially identical for patients with basic exotropia who underwent lateral rectus recessions as for those who received recess/resect procedures (means, 2.4 prism diopters vs 2.1 prism diopters, respectively).
Although this study did not evaluate increasing the amount of symmetric lateral rectus recessions for patients with basic exotropia, these data suggest that patients with basic type intermittent exotropia should be treated with recess/resect procedures. Data also suggest that patients with simulated divergence excess do well with lateral rectus recessions. Recess/resect procedures and symmetric surgery affect distance/near differences equally in patients with basic exotropia.
传统教学认为，间歇性外斜视的手术应基于远距离/近距离差异。按照传统，散开过强型应采用双侧外直肌后徙术治疗；模拟散开过强型和基本型斜视应采用后徙/截除手术治疗。据我们所知，这一教学内容尚未得到系统验证。
评估基于远距离/近距离差异进行选择性手术的合理性，并确定双侧外直肌后徙术对远距离斜视度的影响是否大于近距离斜视度。
基本型间歇性外斜视患者被随机分为两组，一组接受单侧后徙/截除手术，另一组接受双侧对称外直肌后徙术。模拟散开过强型间歇性外斜视患者接受双侧对称外直肌后徙术。术后1年观察结果。
19例接受外直肌后徙术的基本型外斜视患者中，10例（52%）效果满意，而17例接受后徙/截除手术的患者中有14例（82%）效果满意（P<0.05）。68例模拟散开过强型患者中，55例（80%）在接受双侧/外直肌后徙术后效果满意。这一结果明显优于接受外直肌后徙术的基本型外斜视患者（P<0.05）[校正后]。接受外直肌后徙术的基本型外斜视患者术后远距离/近距离差异的减小幅度与接受后徙/截除手术的患者基本相同（平均值分别为2.4棱镜度和2.1棱镜度）。
尽管本研究未评估增加基本型外斜视患者双侧对称外直肌后徙术的量，但这些数据表明，基本型间歇性外斜视患者应采用后徙/截除手术治疗。数据还表明，模拟散开过强型患者接受外直肌后徙术效果良好。后徙/截除手术和对称手术对基本型外斜视患者的远距离/近距离差异影响相同。
