New approach in strabismus surgery in high myopia
New approach in strabismus surgery in high myopia
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DOI：
10.1136/bjo.81.8.625
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发表时间：
1997-08-01
影响因子：
4.1
通讯作者：
Traupe, H
中科院分区：
文献类型：
--
作者：
Krzizok, TH;Kaufmann, H;Traupe, H
目的——根据高分辨率磁共振成像（MRT）的病理结果，制定适合内斜视和下斜视的高度近视患者眼肌手术的方法。 方法——35例单侧或双侧高度近视和斜视患者，即球轴平均长度为29.4毫米。使用西门子 Magnetom 1.5 特斯拉 MRI 扫描仪获得三个冠状、横向和旁矢状 MRI 图像平面。对15例经MRI发现并术中证实存在直肌眼外肌病理平面的患者，采用眼肌手术新技术重建生理肌平面。除了通过 MRI 测量对准和运动性之外，术后还要检查这一点。结果 - 新的 MRI 发现外直肌 (LR) 向颞尾象限脱位 3.4 毫米，需要新的手术技术。只有用硅胶环（“导轮”）或不可吸收的缝线将LR固定在赤道的生理经线上才是因果疗法。这会产生对齐并改善外展和抬高。结论 - 如果通过 MRI 检测到所描述的 LR 错位，则常见的高剂量内斜视隐窝切除手术甚至可能会加剧偏差。眼肌手术最重要的目的是使 LR 的病理路径正常化。脱位的LR生理功能的恢复是显着的。
Aims-To develop appropriate methods of eye muscle surgery in highly myopic patients with esotropia and hypotropia, with respect to the pathological findings in high resolution magnetic resonance imaging (MRT).Methods-35 patients with unilateral or bilateral high myopia and strabismus-that is, axial length of the globe averaged 29.4 mm. hluItiple coronal, transverse, and parasagittal MRI image planes were obtained using a Siemens Magnetom 1.5 tesla MRI scanner. In 15 patients with a pathological plane of recti extraocular muscles found by MRI and confirmed intraoperatively, a new technique of eye muscle surgery was performed to reestablish the physiological muscle plane. This was checked postoperatively in addition to the measurement of alignment and motility by MRI.Results-The new MRI finding of a dislocation of the lateral rectus (LR) into the temporocaudal quadrant by 3.4 mm requires new surgical techniques. Only fixing the LR in the physiological meridian at the equator with a silicone loop ('guide pulley') or a non-absorbable suture is a causal therapy. This yields alignment and improves abduction and elevation.Conclusions-If the described misalignment of the LR is detected by MRI, a common high dosage recess-resect procedure for esotropia may even aggravate the deviation. The most important aim of eye muscle surgery is to normalise the pathological path of the LR. The restoration of the physiological function of the dislocated LR is remarkable.