Strabismus surgery for adults - A report by the American Academy of Ophthalmology
Strabismus surgery for adults - A report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2004.03.013
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发表时间：
2004-06-01
期刊：
影响因子：
13.7
通讯作者：
Wheeler, DT
中科院分区：
文献类型：
--
作者：
Mills, MD;Coats, DK;Wheeler, DT
目的：描述手术治疗成人斜视患者的有效性和安全性，并回顾报道的功能性优势和并发症的斜视手术为adults.Methods：文献检索进行了2001年9月。2003年4月，该报告被重新印发并更新，并检索了相关引文。小组成员审查的文章，并根据其相关性的主题和methods.Results：文献检索确定了49份报告，描述了手术治疗成人患者斜视，并满足预定的审查标准。在这些报告中，2份是随机对照试验，1份涉及本综述的主要目的。在这项对斜视成人的随机研究中，手术矫正与肉毒杆菌毒素A化学去神经治疗的直接比较表明，手术治疗在重新排列眼睛方面上级肉毒杆菌毒素A（76.9% vs. 29.4%，P = 0.027）。已报告了几个成人斜视（III级证据）的大型病例系列，手术重新对准成功率为68%至85%。许多患者报告了手术治疗的功能受益。这些包括消除复视，发展双眼融合，扩大双眼视野，改善头部位置。少数患者会发生手术并发症，包括新发术后复视（1%-14%）或巩膜穿孔（0.8%-1.8%）。计划外再次手术（后续的斜视手术，预计不作为一个阶段性治疗的一部分）需要在高达21%的患者在大型病例系列共同性斜视，并在高达50%的患者甲状腺眼病。尽管缺乏来自随机对照试验的I级证据，现有的文献表明，手术治疗成人斜视是安全和有效的，以改善眼睛的对齐。在许多情况下，它可以改善视觉功能，主要基于III级证据。风险包括计划外再次手术、术后复视和巩膜穿孔。成人患者手术治疗的额外I级研究将有助于记录该治疗的有效性并证实其安全性。(C)2004年，美国眼科学会。
Objective: To describe the effectiveness and safety of surgical treatment of adult patients with strabismus, and to review the reported functional benefits and complications of strabismus surgery for adults.Methods: A literature search was conducted in September 2001. It was repeated and updated in April 2003, with retrieval of relevant citations. Panel members reviewed the articles and rated them according to their relevance to the topic and methodology.Results: The literature search identified 49 reports that describe the surgical treatment of strabismus in adult patients and meet predetermined review criteria. Of these reports, 2 were of randomized controlled trials, and 1 addressed the primary objective of this review. In this randomized study of adults with strabismus, direct comparison of surgical correction with botulinum toxin A chemodenervation indicated that surgical treatment was superior to botulinum toxin A in realigning the eyes (76.9% vs. 29.4%, P = 0.027). Several large case series of adults with strabismus (level III evidence) with successful surgical realignment rates of 68% to 85% have been reported. Functional benefits of surgical treatment are reported in many patients. These include elimination of diplopia, development of binocular fusion, expansion of binocular visual fields, and improvement of head position. Surgical complications, including new, postoperative diplopia (1%-14%) or scleral perforation (0.8%-1.8%), occur in a minority of patients. Unplanned reoperations (subsequent strabismus procedures that were not anticipated as part of a staged treatment) were needed in up to 21% of patients in large case series of comitant strabismus, and in up to 50% of patients with thyroid ophthalmopathy.Conclusions: Despite the paucity of level I evidence from randomized controlled trials, the existing literature suggests that surgical treatment of adults with strabismus is safe and effective in improving ocular alignment. In many cases it improves visual function, based largely on level III evidence. Risks include unplanned reoperation, postoperative diplopia, and scleral perforation. Additional level I studies of surgical treatment of adult patients would help to document the effectiveness and substantiate the safety of this treatment. (C) 2004 by the American Academy of Ophthalmology.