Unilateral inferior oblique muscle myectomy and recession in the treatment of inferior oblique muscle overaction: a longitudinal study
Unilateral inferior oblique muscle myectomy and recession in the treatment of inferior oblique muscle overaction: a longitudinal study
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DOI：
10.1038/sj.eye.6700488
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发表时间：
2003-11-01
期刊：
影响因子：
3.9
通讯作者：
Burke, J
中科院分区：
文献类型：
--
作者：
Shipman, T;Burke, J
背景下斜肌切除和后退治疗上斜肌功能不全(原位、直视和直视)的远期疗效未见文献报道。本研究的目的是在相同的双眼单眼视力的相似的患者群体中纵向比较这两种手术，这两种手术都由同一外科医生进行，至少随访12个月。方法24名患者随机接受单侧下斜肌切除术(在下直肌的颞缘)或因下斜肌过度反应合并长期存在的上斜肌功能减退而接受标准后退的患者24例，分别在手术前2周、4个月和12个月用相同的正视镜进行评估。结果23例患者符合研究标准，其中12例进行了肌切开术，11例进行了退行性手术。除一名患者外，其余患者均有明显的双眼单眼视觉。术前对侧视斜度平均为26.5棱镜屈光度(Delta)，在经济衰退组为20 Delta。术后12个月，脊髓切除组为1.75 Delta，经济衰退时为3 Delta。两种手术基本上都是自我分级，术前上斜度越大，手术效果越好。结论单次下斜肌弱化术在绝大多数患者中是有效的，即使在术前主位上斜度大于或等于15Delta的情况下也是如此。两组患者术后立即均有改善，在整个随访期内，许多患者表现为继续向斜视倾斜，但部分退行性患者的过度斜视复发。
Background The comparable long-term outcomes of inferior oblique muscle myectomy and recession for the treatment of superior oblique underaction ( in primary position and straight right and left gaze) have not been well documented in the literature. The purpose of this study was to compare longitudinally these two procedures in a similar, patient population with binocular single vision, when both operations were performed by the same surgeon, with a minimum follow-up period of 12 months.Methods A total of 24 patients who randomly underwent either a unilateral myectomy ( at the temporal border of the inferior rectus muscle) or a standard recession for inferior oblique muscle overaction associated with long-standing superior oblique underaction were evaluated preoperatively at 2 weeks, 4 months, and 12 months postoperatively by the same orthoptist.Results A total of 23 patients met the study criteria, ( 12 myectomies and 11 recessions). All but one patient had demonstrable binocular single vision. The average preoperative hyperdeviation in contralateral gaze was 26.5 prism dioptres (Delta) in the myectomies and 20 Delta in the recessions. This was reduced at 12 months postoperatively to 1.75 Delta in the myectomies and to 3 Delta in the recessions. Both procedures were largely self-grading, so that the larger the preoperative hyperdeviation, the greater the effect of surgery.Conclusions Single inferior oblique muscle-weakening procedures were effective in the vast majority of patients, even when the preoperative primary position hyperdeviation was 15 Delta or more. An improvement occurred in both groups immediately after surgery and in many throughout the follow-up period represented by a continuing drift towards orthotropia, but there was a recurrence of the hyperdeviation in some of the recession patients.