Medial rectus recession is as effective as lateral rectus resection in divergence paralysis esotropia.
Medial rectus recession is as effective as lateral rectus resection in divergence paralysis esotropia.
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DOI：
10.1001/archophthalmol.2012.1389
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发表时间：
2012-10
影响因子：
--
通讯作者：
Demer, Joseph L.
中科院分区：
文献类型：
--
作者：
Chaudhuri, Zia;Demer, Joseph L.
提出内侧直肌（MR）切除与外侧直肌（LR）切除同样有效，后者迄今为止是发散性麻痹内斜视（DPE）的首选治疗方法。我们研究了17年的手术经验，比较了LR切除与成人DPE的MR衰退，DPE定义为症状性距离内斜视（ET）至少是近棱镜屈光度≤10的无症状内斜视（Δ）的两倍。24例DPE患者接受了手术治疗。双侧LR切除6例，单侧LR切除2例（L组），双侧MR退行13例，单侧MR退行3例，靶角为距离ET的两倍（M组）。L组8例患者中有1例，M组16例患者中有15例在表面麻醉下行术中可调节手术。L组术前中央凝视ET在远处为15.0 （7.7）Δ，在近处为4.1 （3.4）Δ，而M组在远处为10.4 （6.8）Δ，在近处为0.6 （1.7）Δ （P= 0.15，远处为0.003，近处）。术后随访8.5 ~ 40个月，两组患者均未出现复视或会聚不全症状。要矫正DPE的距离偏差，每棱镜屈光度需要两倍于通常推荐的ET和相同条件下LR切除的MR退行手术剂量。MR的后退提供DPE的双眼单视力，近距离无会聚不足，便于在表面麻醉下术中调整。
To propose medial rectus (MR) recession to be equally as effective as lateral rectus (LR) resection, which has heretofore been the preferred treatment for divergence paralysis esotropia (DPE). We examined a 17-year surgical experience comparing LR resection with MR recession in adults with DPE, defined as symptomatic distance esotropia (ET) at least double the asymptomatic ET of 10 or less prism diopters (Δ) at near. Twenty-four patients with DPE underwent surgery. Six patients underwent bilateral LR resection and 2 underwent unilateral LR resection (group L), while 13 underwent bilateral MR recession and 3 underwent unilateral MR recession, with the target angle double the distance ET (group M). One of 8 patients in group L and 15 of 16 patients in group M underwent intraoperative adjustable surgery under topical anesthesia. Mean (SD) preoperative central gaze ET measured 15.0 (7.7) Δ at distance and 4.1 (3.4) Δ at near in group L, but 10.4 (6.8) Δ at distance and 0.6 (1.7) Δ at near in group M (P=.15; distance, 0.003, near). Postoperatively, no patient in either group had symptomatic diplopia or convergence insufficiency in follow-up from 8.5 to 40 months. Twice the usual surgical dose of MR recession per prism diopter was required to achieve correction of the distance deviation in DPE as compared with that recommended for ET generally and also for LR resection in the same condition. Recession of the MR provides binocular single vision in DPE without convergence insufficiency at near, and it is convenient for intraoperative adjustment under topical anesthesia.
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