Long-term outcome of medial rectus recession and pulley posterior fixation in esotropia with high AC/A ratio.
Long-term outcome of medial rectus recession and pulley posterior fixation in esotropia with high AC/A ratio.
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DOI：
10.3109/09273972.2012.711795
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发表时间：
2012-09
期刊：
影响因子：
0.9
通讯作者：
Demer JL
中科院分区：
文献类型：
--
作者：
Wabulembo G;Demer JL
内直肌（MR）后徙联合滑轮后固定（PF）可用于治疗具有高矫正性会聚与调节（AC/A）比的外斜视（ET），短期内与MR后徙联合巩膜PF一样有效。本研究提供了一种新的检查MR后徙联合滑轮PF（PPF）的长期结果。在21名儿童中，我们进行了双侧MR后退和滑轮PF，以使ET在近距离大于远距离（高AC/A）。平均随访时间为3.5 ± 2.5（标准差[SD]）年。就诊时平均年龄为2.7 ± 1.8岁，手术时平均年龄为4.3 ± 1.6岁。弱视14例（67%）。术前远距离和近距离ET平均值分别为19.6Δ ± 10.5Δ和36.9Δ ± 18.9Δ。平均近距离（N-D）视差为16.4Δ ± 12.3Δ。MR后退平均为4.4 ± 0.9 mm。术后早期平均ET远侧为1.3 ± 3.3Δ，近侧为2.8Δ ± 5.2Δ。平均术后晚期ET分别为0.1Δ ± 5.8Δ和1.0Δ ± 6.2Δ。在最终术后检查时，平均N-D视差降至0.9Δ ± 3.6Δ。MR衰退与PPF具有很高的长期有效性，即使在弱视和自闭症患者中。由于不需要后巩膜穿刺，因此最大限度地减少了与巩膜PF相关的穿孔风险。MR退缩与PPF是一种安全且高效的高AC/A比值ET长期治疗方法。长期结果可能超过替代程序。
Medial rectus (MR) recession with pulley posterior fixation (PF) can be used to treatesotropia (ET) with a high accommodative convergence to accommodation (AC/A) ratio as effectively in the short term as MR recession with scleral PF. This study provides a novel examination of the long-term results of MR recession with pulley PF (PPF). In 21 children we performed bilateral MR recession and pulley PF for ET greater at near than distance (high AC/A). Mean follow-up was 3.5 ± 2.5 (standard deviation [SD]) years. Mean age at presentation was 2.7 ± 1.8 and at surgery 4.3 ± 1.6 years. Fourteen (67%) children had amblyopia. Distance and near pre-operative ET averaged 19.6Δ ± 10.5Δ and 36.9Δ ± 18.9Δ, respectively. Mean near-distance (N-D) disparity was 16.4Δ ± 12.3Δ. The MR recession averaged 4.4 ± 0.9 mm. Early mean postoperative ET was 1.3 ± 3.3Δ at distance and 2.8Δ ± 5.2Δ at near. Mean late postoperative ET was 0.1Δ ± 5.8Δ and 1.0Δ ± 6.2Δ at distance and near, respectively. At the final postoperative examination, mean N-D disparity was reduced to 0.9Δ ± 3.6Δ. MR recession with PPF has a high long-term effectiveness, even in patients with amblyopia and autism. Since no posterior scleral suturing is required, it minimizes the perforation risk associated with scleral PF. MR recession with PPF is a safe and highly effective long-term treatment for ET with high AC/A ratio. Long-term results may surpass those of alternate procedures.