Simons B D, Saunders T G, Siatkowski R M, Feuer W J, Lavina A M, Capó H, Muñoz M, Flynn J T
Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
Binocul Vis Strabismus Q. 1998;13(4):273-82.
To determine the outcome of the surgical management of superior oblique palsy at our institution.
Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta).
109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery.
The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery.
Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02).
Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.
确定我院上斜肌麻痹手术治疗的效果。
回顾性分析1976年至1996年在巴斯科姆·帕尔默眼科研究所接受上斜肌麻痹手术矫正的123例患者。对象 - 患者：男性占67%，女性占33%。手术时的平均年龄为30.5岁（范围为2至78岁）。麻痹的病因包括外伤（34%）、先天性（33%）和后天性/非外伤性（33%）。术前第一眼位垂直偏斜的平均角度为14.0棱镜度（范围为0至45棱镜度）。
123例患者中有109例（89%）接受了单条肌肉手术。在这109例中，57例进行了单条斜肌手术：34/57（60%）进行了上斜肌折叠术；22/57（38%）进行了下斜肌减弱术；1/57（2%）进行了原田 - 伊藤手术。另外14例患者（占11%）进行了双眼手术。
60%的患者术后第一眼位垂直偏斜≤3棱镜度，80%的患者≤7棱镜度。术后第一眼位垂直偏斜的平均变化，远距离为10.4棱镜度，近距离为13.0棱镜度。先天性麻痹且接受单纯斜肌手术的患者最常获得“优秀”结果（第一眼位和阅读眼位的最终垂直偏斜≤3棱镜度）。
在接受上斜肌折叠术的72例患者中，43例（60%）出现了具有临床意义的布朗综合征。布朗综合征的发生率与折叠大小无关。外伤病例再次手术的可能性是先天性病例的3倍（35.0%对11.9%，p = 0.02）。
基于这些结果，我们建议在适当情况下，斜肌手术作为矫正上斜肌麻痹的初始手术方法。
