Marginal myotomy of the minimally overacting inferior oblique muscle in asymmetric bilateral superior oblique palsies.
Marginal myotomy of the minimally overacting inferior oblique muscle in asymmetric bilateral superior oblique palsies.
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DOI：
10.1067/mpa.2002.123656
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发表时间：
2002-08
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影响因子：
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通讯作者：
Mei Mellott;W. Scott;G. Ganser;R. Keech
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文献类型：
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作者：
Mei Mellott;W. Scott;G. Ganser;R. Keech
我们报告了10例不对称性双侧上级斜肌麻痹和不对称性下斜肌过度活动患者的手术结果。方法连续10例双侧上级上斜肌麻痹患者，均为原发位上斜视（5-28 PD），下斜肌功能亢进不等（小下斜肌亢进0 ~+2，大下斜肌亢进+2 ~+4）。同侧斜向上注视时，上斜视的再斜视。所有患者均接受了下斜肌大肌群的后退或肌切除术和下斜肌小肌群的边缘肌切开术。结果7例患者在初始位置时无垂直偏斜，2例患者有2 ~ 3 PD的残余上斜视，1例患者有8 PD的残余上斜视。8例患者术前存在异常头位，术后消除或明显改善。术后，除1例外，所有下斜肌功能亢进均为0至微量。平均随访时间为19个月（范围：1.5-68个月）。结论：对于双侧上级上斜肌麻痹伴不对称下斜肌过度活动的患者，轻度过度活动的下斜肌可通过边缘肌切开术，结合大过度活动的下斜肌的后退或肌切除术进行矫正。此手术可减少或消除原体位的上斜视，同时最大限度地减少残余下斜肌功能亢进的可能性。
PURPOSE We report the surgical results of marginal myotomy of a minimally overacting inferior oblique muscle in conjunction with traditional recession or myectomy of the greater overacting inferior oblique muscle in 10 patients with asymmetric bilateral superior oblique palsies and asymmetric inferior oblique overaction. METHODS Ten consecutive patients with bilateral superior oblique palsies had a hypertropia in primary position (5-28 PD) and unequal inferior oblique overaction (0 to +2 in the lesser overacting inferior oblique muscle, +2 to +4 in the greater overacting inferior oblique muscle). Reversal of the hypertropia was noted in ipsilateral oblique upgaze. All patients underwent a recession or myectomy of the greater overacting inferior oblique muscle and a marginal myotomy of the lesser overacting inferior oblique muscle. RESULTS Seven patients had no vertical deviation in primary position, 2 patients had a residual hypertropia of 2 to 3 PD, and 1 patient had a residual hypertropia of 8 PD. The abnormal head position present preoperatively in 8 patients was eliminated or greatly improved after surgery. Postoperatively all but 1 inferior oblique overaction was graded as 0 to trace. Mean follow-up time was 19 months (range, 1.5-68 months). CONCLUSIONS In bilateral superior oblique palsies with asymmetric inferior oblique overaction, a mildly overacting inferior oblique muscle can be corrected by marginal myotomy, combined with a recession or myectomy of the greater overacting inferior oblique muscle. This procedure can reduce or eliminate the hypertropia in primary position while minimizing the possibility of residual inferior oblique overaction.