Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre (PD)] were retrospectively reviewed. Two groups of patients were identified; Group I (21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A (BTA) injection into the recessed muscles and group II (30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group I (47.6%) and 20 patients in group II (66.7%) achieved esotropia/esophoria <5 PD or exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant (P=0.1) but there was a statistically significant higher rate of undercorrection in group I (P=0.03). On the other hand, 3 patients in group I (14.3%) and 5 patients in group II (16.7%) had improved stereopsis; this difference in the sensory outcome was not statistically significant (P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate (P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilateral medial rectus resection in the correction of large angle intermittent exotropia. The surgical success rate in BTA augmented surgery group is observed to be higher in patients with preoperative smaller angle of deviation and in patients with good stereoacuity.     

Active management of exotropia due to brainstem disease

Introduction: Patients with exotropia due to brainstem disease are generally managed by occlusion, although a small series has reported successful surgery. Methods: Patients presenting since 1987 with large-angle exotropia, limitation of adduction, and abducting nystagmus were identified from Botulinum Toxin Database and surgical records. Results: Nine patients (6 males, 3 females) presented from 21-64 years old (mean: 43 years) with mean deviation of 45 ? BI. Eight had diplopia (2 also had oscillopsia) and one had poor cosmesis. Seven underwent lateral rectus botulinum toxin injections (2 bilateral, 5 unilateral) with results from 8 ? BO to 20 ? BI (mean: 6 ? BI). Three became symptom-free and two had minimal diplopia. Two with oscillopsia had no symptomatic benefit from reduced deviations. Three patients required maintenance injections and two were discharged stable.There was no correlation between bilateral or unilateral injections and either continuing symptoms or further injection requirements. One patient undergoing bilateral injections had oscillopsia and did not have further treatment. Two patients chose surgery (bilateral lateral rectus recession, medial rectus resection). One, initially 68 ? BI, became esophoric and the other initially 50 ? BI, became 4 ? esotropic. Discussion : Buckley and Elston ( Eye 1997;11:377-380) reported three patients with pontine exotropia and recommended surgery. In our patients, except those with oscillopsia, either surgery or botulinum toxin injections improved symptoms. Conclusions: Patients with exotropia secondary to brainstem disease benefit from reduction of the deviation, by surgery or extraocular muscle botulinum toxin injections, unless oscillopsia is present.     

The Stabilization of Postoperative Exo-drift in Intermittent Exotropia after Surgical Treatment

Purpose

To investigate the long-term clinical course of intermittent exotropia after surgical treatment to determine whether and when postoperative exo-drift stabilizes, and the required postsurgery follow-up duration in cases of intermittent exotropia.

Methods

We retrospectively reviewed the medical records of patients diagnosed with intermittent exotropia who underwent surgical treatment between January 1992 and January 2006 at Yeungnam University Hospital and postoperatively performed regular follow-up examinations for up to 7 years. We also analyzed the difference in exo-drift stabilization, according to surgical procedure.

Results

A total of 101 patients were enrolled in the study. Thirty-one patients underwent lateral rectus recession and medial rectus resection (R&R) and 70 patients underwent bilateral lateral rectus recession (BLR). The postoperative angles of deviation increased significantly during the initial 36 months, but no subsequent significant changes were observed for up to 84 months. Follow-ups for 7 years revealed that more than 50% of the total amount of exo-drift was observed within the first postoperative year. In addition, the angles of deviation at 1 year correlated with those at 7 years postoperatively (Pearson correlation coefficient r = 0.517, p < 0.001). No significant exo-drift was observed after 36 months in patients who underwent BLR, whereas after 18 months in patients who underwent R&R.

Conclusions

The minimum postoperative follow-up required after surgical treatment to ensure stable results is 36 months. In particular, careful follow-up is necessary during the first postoperative year to detect rapid exo-drift. Patients who underwent BLR required a longer follow-up than those who underwent R&R to ensure stable postoperative alignment.     

Divergence Excess Intermittent Exotropia: Long-Term Effect of Augmented Bilateral Lateral Rectus Recession

Purpose: To investigate the long-term (10 years) effects of augmented bilateral lateral rectus (aBLR) recession in patients affected by divergence excess intermittent exotropia (deIXT). Methods: Data of 58 patients affected by deIXT who underwent aBLR muscle recession were retrospectively analyzed. All patients were treated with 8.0 to 9.5 mm (mean 8.6 ± 0.5 mm) recession of BLR.Results: Our result showed a significant decreasing of both distance and near residual deviation during follow-up. The percentage of patients with successful surgical outcome (defined as a residual deviation ranging from 10pd intermittent exotropia to 5pd esotropia) increased during follow-up (from 51.7% to 81% at last follow-up). Stereopsis increased in 39.7% of patients at last follow-up. Moreover, there was a significant correlation between age at surgery and short/mid-term residual deviation. Conclusions: Our long-term results suggest that aBLR recession surgery is a very effective approach in patients affected by deIXT.     

两种术式治疗基本型间歇性外斜视的比较

目的 比较双眼外直肌后徙术与单眼一退一截术治疗基本型间歇性外斜视的手术疗效.方法 对行双眼外直肌后徙(A组)和单眼一退一截(B组)手术治疗的49例基本型间歇性外斜视病例进行了回顾性分析.A组26例,B组23例.采用三棱镜加交替遮盖法测定患者戴镜注视6m和33cm调节性视标的第一眼位斜视度,根据看远斜视度手术,所有手术均由同一医生完成.术后平均随访(13.8±9.4)月,疗效评价标准以眼位≤±8Δ为正位.结果 A组眼位正位率为53.8%,B组眼位正位率为82.6%,A、B两组眼位正位率的差异具有统计学意义(x2=4.59 P=0.032),B组眼位正位率高于A组.结论 基本型间歇性外斜视应首选单眼一退一截手术.     

Unilateral and bilateral lateral rectus recession in exotropia.

BACKGROUND AND OBJECTIVE: To evaluate the surgical results obtained by unilateral and bilateral lateral rectus recession for the correction of exotropia. PATIENTS AND METHODS: The charts of all patients with exotropia who were operated on at the Goldschleger Eye Institute at Sheba Medical Center during an 11-year period were retrospectively reviewed. Study participants all underwent a complete orthoptic and ocular examination. Twenty-five patients with moderate-angle exotropia underwent unilateral lateral rectus recession (group 1) and 38 patients with large-angle exotropia underwent bilateral lateral rectus recession (group 2). The angle of exotropia was measured by the prism and cover test. Moderate exotropia was defined as 25 prism diopters (PD) and large-angle exotropia as greater than 25 PD. RESULTS: The mean age at the time of the surgery was 10.0+/-5.2 years in group 1 and 8.5+/-8.0 years in group 2. The mean preoperative exotropia was 16.1+/-5.7 PD in group 1 and 29.6+/-14.4 PD in group 2. A mean postoperative exodeviation of 4.2+/-5.4 PD was found in group 1 and 5.8+/-13.6 PD in group 2. The success rate (deviation of < 10 PD) was 84% in group 1 and 74% in group 2. There was no incomitance in group 1. CONCLUSION: Unilateral lateral rectus recession is an effective surgical method for correcting moderate-angle exotropia with results similar to bilateral lateral rectus recession for larger exotropia angles.     

Treatment of convergence insufficiency type intermittent exotropia with bupivacaine injection to the medial rectus combined with lateral rectus recession

PurposeTo evaluate the outcomes of combined bupivacaine HCL (BPX) injection in the medial rectus (MR) muscle with recession of the lateral rectus muscle in the treatment of convergence insufficiency–type intermittent exotropia (CI-IXT).MethodsThe medical records of patients who underwent combined injection-recession treatment from January 2019 to January 2020 for CI-IXT were reviewed retrospectively along with a group of age-matched controls with IXT without CI who underwent only unilateral LR recession during the same period. The following data were extracted from the record: age at surgery, average follow-up period, angle of deviation at distance and near and the difference between them before and after surgical procedure, correction of near and distance deviations, and recession dosage. Successful outcome was defined as a distance deviation in primary gaze between ≤10^Δ of exophoria/tropia and ≤5^Δ of esophoria/tropia.ResultsA total of 10 patients and 20 controls were included. Average follow-up was 13.9 ± 3.67 months in the BPX group and 15.9 ± 3.61 months in the control group (P = 0.17). Postoperative distance deviation measured 8.30^Δ ± 5.88^Δ in the BPX group and 14.67^Δ ± 9.83^Δ in the control group (P = 0.80). Distance-near differences were significantly reduced in the CI-IXT group receiving BPX, by a mean of 6.60^Δ, from a preoperative mean of 10.50^Δ ± 3.65^Δ to 3.90^Δ ± 3.26^Δ (P < 0.01).ConclusionsBPX injection combined with unilateral lateral rectus recession yields outcomes comparable to bilateral lateral rectus recession for distance deviations, and results in reduction of the distance-near difference in the angle of exotropia.     

The effect of unilateral medial rectus muscle resection in patients with recurrent exotropia

PURPOSE: To investigate the effect of unilateral medial rectus muscle resection for recurrent exotropia after bilateral lateral rectus muscle recession for intermittent exotropia METHODS: A retrospective analysis was made of thirtypatients who underwent unilateral medial rectus resection for recurrent exotropia. All had prior bilateral lateral rectus recession for intermittent exotropia. Data were collected for age, the preoperative deviation, the postoperative deviation at 2 weeks, 3 months, 6 months and the last visit, and the amount of medial rectus resection performed. RESULTS: The average preoperative deviation was 27.0+/-3.6 PD. After unilateral medial rectus resection, average deviation at distance was 2.8 PD at postoperative 2 weeks, 4.5 PD at 3 months, 5.1 PD at 6 months and 5.8 PD at last visit. The average deviation corrected per millimeter of medial rectus resection was 3.53+/-0.17 PD/mm. CONCLUSIONS: Considering that deviation angles of recurrent exotropia is smaller than those of primary surgery and the possibility of saving the other medial rectus muscle, unilateral rectus muscle resection could be effective surgical method for recurrent exotropia.     

Surgical outcomes of symmetric and asymmetric surgery for intermittent exotropia with postoperative large early overcorrection

Purpose

To compare surgical outcomes between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus resection (RR) for intermittent exotropia with overcorrection of 20 prism diopter (PD) or more on postoperative day 1.

Methods

A retrospective chart review identified 319 patients who underwent either BLR or RR for primary surgical treatment of intermittent exotropia between July 2008 and June 2011. The patients with basic type intermittent exotropia and overcorrection of 20 PD or more, at either near or distance, on postoperative day 1 and had more than 6 months of follow-up were included. Patients with simultaneous vertical and/or oblique muscle surgery and those with paralytic or restrictive strabismus were excluded. The pre- and post-operative deviation, visual acuity, and near stereoacuity were analyzed.

Results

Twenty-four patients were included. The mean postoperative day 1 alignment was 21.5 ± 6.2 PD esotropia at distance, and 13.8 ± 8.0 PD at near. Fourteen patients underwent BLR and 10 underwent RR. Three patients were wearing the base out prism below 15 PD at the last follow-up. The mean duration from the surgery to esotropia below 10 PD was 2.9 ± 1.1 weeks and 8.0 ± 7.1 weeks in the BLR and RR groups, respectively (p = 0.030). All three recurrent patients underwent RR. None of the patients completely lost stereoacuity, postoperatively.

Conclusions

In basic type intermittent exotropia with overcorrection of 20 PD or more on postoperative day 1, the overcorrection resolved faster and recurrence rates were lower in BLR group than in the RR group. Consecutive esotropia over 15 PD did not occur in both groups.     

Ⅱ型 Duane 眼球后退综合征临床特征和手术疗效分析

目的：探讨Ⅱ型 Duane 眼球后退综合征（DRS）的临床特征和手术治疗方法及效果。方法6例Ⅱ型 DRS病人,外斜视-30△--110△,均有代偿头位、眼球后退,其中1例内转时有上转和下转现象。2例患者行患眼外直肌后徙术;2例行双眼外直肌后徙术;2例行双眼外直肌后徙术,健眼内直肌缩短术。结果6例患者术后眼位均有明显改善。5例术后眼位正位,1例术后欠矫,6例患者术后代偿头位和内转时上转和下转现象消失或有明显改善。结论患眼外直肌后徙可以有效地治疗Ⅱ型 DRS,如斜视度数大,可同时行健眼外直肌后徙加内直肌缩短术。     

Large-angle exotropia corrected by intraoperative botulinum toxin A and monocular recession resection surgery.

PURPOSE: Surgical correction of large-angle exotropia, greater than 70 PD, traditionally requires operating on three or four horizontal muscles. However, in secondary exotropia from monocular visual loss, it is advisable to operate only on the eye with poor vision. We used intraoperative botulinum toxin as an adjunct to the monocular recession-resection procedure for large-angle sensory exotropia, therefore operating only on the visually impaired eye. METHODS: Three patients underwent monocular recession (10 mm) and resection (10 mm) along with intraoperative botulinum toxin A injection of 10 units into the recessed muscle. All had desired cosmetic repair of long-standing large-angle exotropia (range 100 to 110 PD) with amblyopia and vision worse than 20/200 in the deviated eye. RESULTS: Within 4 days after operation all patients demonstrated maximal paresis of the lateral rectus muscle. This lasted 8 to 12 weeks and resulted in stable orthotropia at 2.5 years in case 1 and stable 8 PD exotropia at 4 years in case 2. The third case demonstrated a stable 18 PD exotropia by 7 months with a satisfactory cosmetic result. CONCLUSION: This technique provides an alternative for the surgical correction of large-angle exotropia by operating only on two horizontal muscles. In sensory exotropia it also avoids subjecting a normal eye to an operative risk.     

两种不同术式治疗基本型间歇性外斜视的疗效比较

目的:探讨单眼一退一截术(unilateral recess-resection,R&R)和双眼外直肌后徙术(bilateral lateral rectus recession,BLR-rec)治疗基本型间歇性外斜视的疗效差异.方法:回顾性分析2013-01/2015-01在我院治疗的基本型间歇性外斜视患者89例,其中49例行单眼退截手术,40例行双眼外直肌后徙术.观察两组患者术后1d,1、6mo,1、2a时立体视功能及斜视度.结果:两组患者术后1d,1、6mo,1、2a手术成功率、斜视度比较,差异均无统计学意义(P>0.05),但手术成功率随着时间推移均不断降低.术后1d~2a,R&R组外斜漂移量为12.10±5.74PD,BLR-rec组外斜漂移量为7.78±4.21PD,差异有统计学意义(P=0.021).R&R组较BLR-rec组更易引起外斜回退.两组患者近立体视均显著提高,两组组间近立体视提高情况比较差异无统计学意义(x2=4.530,P=0.210).结论:BLR-rec术远期稳定性优于R&R术.     

Efficacy of Botulinum Toxin in the treatment of Intermittent Exotropia

Background: Multiple surgical interventions are burden to patients with intermittent exotropia (IXT) due to a high recurrence rate. This study was designed to evaluate the efficacy of botulinum toxin injection in the treatment of intermittent exotropia (IXT).

Method: A total of 21 patients with IXT, who had a far deviation of less than 40 prism diopters (PD), were enrolled. All cases were followed for at least 6 months with non-surgical management and had decremented fusional control (increasing 3 or more scores in Newcastle Control Score [NCS]). Botulinum toxin was injected (10 units Dysport) to both lateral rectus muscles. Fusional control, sensory and motor status were evaluated at 1 day, 1 week, and 1, 3, and 6 months after injection to compare with the pre-injection values.

Results: Fusional control (based on NCS) showed a significant improvement during 6-month follow-up. Mean NCS was 4.4?±?0.8 SD before botulinum toxin injection and 1.4?±?0.4 SD after 6 months (p?Conclusion: Botulinum toxin injection to lateral rectus muscles seems to be a promising procedure in the management of fusional control, far and near deviations in patients with intermittent exotropia in short time.     

Large bilateral lateral rectus recession in large angle divergence excess exotropia

PURPOSE: Classic teaching suggests that surgery for intermittent exotropia should be based on distance/near differences. True divergence excess exotropia should be treated with symmetric lateral rectus recession. The aim of this study was to investigate the effect of large bilateral lateral rectus (LR) recession in large-angle intermittent exotropia. METHODS: Thirty-three consecutive patients with large-angle divergence excess exotropia ranging from 50 to 65 (mean 56.7 +/- 6.3) prism diopters were treated with 8.0 to 9.5 mm (mean 8.8 +/- 0.7 mm) recession of both LR muscles. RESULTS: Successful alignment was achieved in 25 cases (76%) while residual exotropia was seen in eight patients (24%) within the limit of 15 prism diopters. Mean follow-up time was 28.5 +/- 8.4 (range 13 to 38) months. Abduction deficit due to this procedure was not seen in any case. CONCLUSIONS: We conclude that large bilateral LR recession is an appropriate surgical method for large-angle divergence excess exotropia.     

单眼外直肌后徙术治疗儿童间歇性外斜视的疗效

目的探讨单眼外直肌后徙术对中、小度数儿童间歇性外斜视的疗效。方法回顾性系列病例研究。2009年4月至2010年3月期间行单眼外直肌后徙术治疗、斜视度为15^△-35^△的间歇性外斜视儿童69例。采用三棱镜加交替遮盖法测定患儿注视6m和33cm的斜视度,根据看远斜视度定量行7-10mm单眼外直肌后徙术。随访时间≥6个月。手术前后采用Worth四点灯检查中心和周边融合,采用Titmus立体视图测定立体视锐度。疗效评价标准以眼位-8^△-0^△为正位;第一眼位与侧向注视的斜视度相差≥10^△为非共同性阳性。采用X^2检验对数据进行分析。结果术后1-3d和≥6个月随访正位率分别为81％和62％,欠矫率分别为12％和36％。斜视度为30^△、35^△（外直肌后徙9．5-10mm）者欠矫率较高。术前与术后远期随访比较,具有正常中心融合和周边融合者比例的差异有统计学意义（X^2=21．9,P〈0．01;X^2=14．0,P〈0．01）,术后明显高于术前;具有正常立体视功能者比例的差异有统计学意义（X^2=15．0,P〈0．01）,术后明显高于术前。术后远期随访未见眼位非共同性阳性者。结论单眼外直肌后徙术治疗斜视度为15^△-25^△的儿童间歇性外斜视安全、有效。     

The surgical management of consecutive exotropia.

PURPOSE: To review the results and techniques of surgical treatment of consecutive exotropia. METHODS: We performed a retrospective chart review of all patients who underwent surgery for consecutive exotropia in a pediatric ophthalmology practice between 1992 and 2001. Patients were excluded if follow-up lasted < 6 weeks or if exotropia was caused by other ocular disorders such as previous trauma or congenital cataracts. RESULTS: Fifty-nine patients were identified. The procedure performed in the majority of cases was unilateral lateral rectus recession and medial rectus advancement to the original insertion. Seven patients underwent bilateral lateral rectus recession, and 6 underwent lateral rectus recession combined with medial rectus resection. The mean interval between original surgery and surgery for consecutive exotropia was 14.1 years (range 4 months to 47.5 years). The mean preoperative distance exodeviation was 31.7 prism diopters (PD). Satisfactory alignment (ie, within 10 PD of orthophoria) was achieved in 36 patients (61%) at week 1 and 42 patients (71%) at final follow-up. Mean follow up was 16.0 months. Thirty-nine patients (66%) demonstrated an exodrift after surgery (mean 7.6 PD). CONCLUSION: Consecutive exotropia may occur many years, even decades, after esotropia surgery. Lateral rectus recession with advancement of the previously recessed medial rectus is an effective treatment. An exotropic drift occurs after consecutive exotropia surgery, usually within the first 6 weeks. A suitable ocular alignment immediately after surgery for consecutive exotropia is a small-angle esotropia of 5 to 10 PD.     

LACTOSE control scoring helps predict surgical outcomes for childhood intermittent exotropia

ObjectiveTo determine whether preoperative Look And Cover, then Ten seconds of Observation Scale for Exotropia (LACTOSE) control scores can predict surgical outcomes in children with intermittent exotropia.DesignRetrospective interventional case series from a university-based tertiary eye care centre.ParticipantsA total of 350 patients with basic-type intermittent exotropia who underwent bilateral lateral rectus recession between 3 and 10 years of age from January 2014 to December 2017.MethodsAll patients were preoperatively assessed for their degree of control at both distance and near according to LACTOSE scoring system. Demographic, clinical, and oculomotor data before and after surgery were collected and analyzed with regard to the degree of control. Surgical success was defined as an alignment between 10 prism diopters (PD) of exodeviation and 5 PD of esodeviation at both distance and near.ResultsYounger age, lower visual acuity, worse stereoacuity, and larger angle of deviation were associated with higher (i.e., worse) LACTOSE control scores. Of the 350 patients having surgery, 169 (48.3%) were followed for more than 12 months postoperatively. Surgical success was achieved in 132 (78.1%) patients at 12 months after surgery. The only significant predictor of surgical success was preoperative LACTOSE score. There was a significant inverse relationship between LACTOSE scores and surgical success rates for both distance and near scores (p = 0.004 and 0.023, respectively).ConclusionsHigher distance and near LACTOSE scores representing worse control of deviation were associated with higher rates of surgical failure in children with intermittent exotropia. This finding indicates that surgical outcome of intermittent exotropia can be predicted by preoperative LACTOSE scores.     

外直肌超长量后徙术治疗大角度外斜视的疗效评价

背景 临床上矫正超过50Δ的大角度外斜视时往往需对3条或4条水平直肌进行手术,以避免因外直肌超长量后徙(＞7 mm)引起的眼球外转受限.但研究表明,超长量外直肌后徙可有效矫正大角度外斜视,且术后并不出现眼球明显外转受限.这个结果仍有待临床上进行验证. 目的 观察双眼外直肌超长量后徙或合并非主导眼内直肌缩短对大角度外斜视的矫正效果. 方法 采用系列病例观察法对2013年5月至2014年10月在天津市眼科医院行双眼外直肌超常量后徙术或合并非主导眼内直肌缩短术的间歇性或恒定性大角度外斜视患者51例的治疗效果进行分析,其中29例为间歇性外斜视,22例为恒定性外斜视.所有患者均接受术前及术后眼前节、眼底、眼球运动和双眼视功能检查,采用三棱镜加遮盖法测量斜视角大小.依据病史、眼球运动、知觉状态和斜视角度数对患者行个体化手术治疗,术中结合可调整缝线技术,行双眼外直肌超长量后徙术或合并非主导眼内直肌缩短术.术后随访时间均超过6个月,比较术眼术前和术后眼位变化、眼球运动情况以及双眼知觉功能.结果 行双眼外直肌超长量后徙术者33例,双眼外直肌超长量后徙术合并非主导眼内直肌缩短术者18例.术前患者视远(5 m)斜视度为-52Δ～-120Δ,平均(-70.57±16.46)Δ;视近(33 cm)斜视度为-55Δ～-130Δ,平均(-75.65±16.14)Δ.左眼外直肌后徙8～15 mm,平均(11.17±1.67)mm,右眼外直肌后徙9～15 mm,平均(11.28±1.62) rnm,非主导眼内直肌缩短3～6 mm.末次随访时患者视远斜视度为+4Δ ～-14Δ,平均(-3.45±4.20)Δ;视近斜视度为+4Δ～-14Δ,平均(-5.49±3.96)Δ,其中41例术后眼球正位,占80.4％,10例欠矫,未发现过矫者.32例患者术后立体视较术前改善,其中术前无立体视的27例中18例术后获得不同程度的立体视.无一例患者出现眼球运动障碍.结论 双眼外直肌超长量后徙术或合并非主导眼内直肌缩短术可有效治疗大角度外斜视,可减少需要手术的眼外肌数目,术后未发现眼球运动障碍.     

继发性外斜视手术方式及术后眼位变化

目的研究内斜视术后继发外斜视的手术方式及术后眼位的变化。方法手术治疗43例内斜视术后继发外斜视的病人,探讨其手术方式并观察术后1周、6周、6个月和1年的眼位变化情况。结果单眼内直肌前徙7例,单眼内直肌缩短4例,单眼内直肌前徙＋单眼外直肌后徙20例,双眼外直肌后徙5例,单眼外直肌后徙3例;4例外斜视度数≥50△行3条肌肉的手术。术后1年35例眼位正位（81.3%）,其中单眼内直肌前徙或缩短11例术后8例（72.7%）正位,外直肌后徙8例（5例为双眼,3例为单眼）术后6例（75%）正位,单眼内直肌前徙＋单眼外直肌后徙20例术后18例（90%）正位;1周～6周斜视度数变化-5.2△±0.4△,6周～6个月变化-1.2△±0.4△,1周～1年变化-6.4△±2.1△。1周～6周有25例患者（58.1%）有外斜视漂移,变化-8.0△±1.4△,其中术中过矫组的10例继发外斜视患者,术后6周内均出现了外斜视漂移,平均为-8.3±2.0△。结论外直肌后徙联合后徙的内直肌前徙是治疗继发性外斜视的有效方式。术中5△～10△小度数过矫可提高远期的术后正位率。     

'Largest angle to target' in surgery for intermittent exotropia

PURPOSE: To evaluate the safety of the approach based on the notion that the surgical dose for intermittent exotropia should be based on the largest angle ever measured. DESIGN: Prospective case series of 33 patients. METHODS: A total of 33 patients with intermittent exotropia, in whom angles of misalignment at distance or near showed a difference of 15 prism diopters (PD) or more among visits, were included. All the patients were treated by bilateral lateral rectus recession by the same surgeon (JMH), and all were followed up for a minimum of 6 months postoperatively. Short- and long-term surgical results after the initial procedure for intermittent exotropia were analysed. RESULTS: The short-term average result at a postoperative 1 week was 9.3 PD esotropia at distance (range 30 esotropia-16 exotropia). The long-term average results postoperative 6 or 9 months were 4.8 PD exotropia at distance (range 12 esotropia-30 exotropia). At the last follow-up, no overcorrection over 2 PD esophoria at distance was found, and 9 PD of intermittent esotropia and esophoria at near was observed in two patients, respectively. CONCLUSIONS: The strategy of surgical dose for intermittent exotropia based on the largest angle ever measured did not result in overcorrections and is believed to be safe.