上斜肌麻痹的手术治疗

目的探讨上斜肌麻痹的手术治疗方式。方法采用减弱下斜肌、上或下直肌的减弱和加强手术,矫正斜视手术。结果经过斜视手术后,垂直眼位、水平眼位、代偿头位多数获得满意矫正。结论减弱上斜肌的直接对抗肌下斜肌手术是治疗上斜肌麻痹的主要手段。     

先天性单侧上斜肌麻痹的手术方式分析

目的：探讨先天性单侧上斜肌麻痹的手术治疗方法。

方法：本研究回顾分析对68例先天性单侧上斜肌麻痹患者,根据患眼的下斜肌功能亢进程度和原在位垂直斜度大小选择下斜肌切断并部分切除、下斜肌切断并前转位、下斜肌部分切除联合对侧眼下直肌或同侧眼直肌手术。伴有水平斜视者按水平斜视矫正原则一期或分期手术矫正。

结果：治愈58例,治愈率85.3%,好转7例,好转率10.3%,无效3例,无效率4.4%。

结论：根据下斜肌亢进程度、垂直斜视度及水平斜度选择不同手术方式,通过一期或分期手术,可有效获得较高治愈率。     

先天性上斜肌麻痹的手术方式选择

目的 对先天性上斜肌麻痹的手术方式选择进行探讨。方法 回顾性总结我科１９８９年８月￣１９９８年８月间收治的３４例单眼上斜肌麻痹和双眼上斜肌麻痹患者的手术效果,并对手术失败者进行原因分析。结果 ３４例上斜肌麻痹患者原在位生趣斜视矫正２７例,伴水平斜视及Ｖ型斜视者均获得矫正。结论 上斜肌麻痹的手术方式首选减拮抗肌下斜肌或同时弱拮抗肌下斜肌和配偶肌下直肌,儿童下斜肌减弱术应首选下斜肌后行徒术。     

先天性上斜肌麻痹的手术方式分析

目的:探讨先天性上斜肌麻痹的手术治疗方法。方法:对我院2004-10/2005-02收治的39例先天性上斜肌麻痹患者,根据患眼的下斜肌功能亢进程度和垂直斜度大小选择下斜肌后徙、下斜肌切断并部分切除、下斜肌前转位、或联合对侧眼上直肌、下直肌手术。结果:治愈28例(72%),好转10例(26%),无效1例(2%)。结论:先天性上斜肌麻痹的手术方式按减弱直接拮抗肌和配偶肌,加强麻痹肌和间接拮抗肌的原则进行,根据患者下斜肌功能亢进程度和垂直斜视度大小选择不同术式可获得良好的效果。     

先天性上斜肌麻痹的手术方式选择及疗效分析

目的 探讨不同手术方法治疗先天性上斜肌麻痹的临床效果.方法 回顾性分析102例先天性上斜肌麻痹手术的效果,并对不同术式进行比较.结果 102例进行手术121次,平均每例1.19次.102例中单眼患病76例,双眼26例.102例中合并DVD 23例.术前78例有代偿头位（76.47%）,术后代偿头位消失45例,好转30例,无效3例.术前同视机检查78例中,有双眼单视者38例,术后增加至51例.单纯下斜肌减弱术75例中,下斜肌断腱10例,有效率70%;下斜肌部分切除12例,有效率83.33%;下斜肌后徙33例,有效率87.88%;下斜肌转位20例,有效率90.00%.102例中治愈47例,好转44例,有效者共91例（89.22%）,无效11例（10.78%）.结论 先天性上斜肌麻痹临床表现复杂,手术方式不一,灵活选择不同的手术方式可收到较好效果.     

先天性上斜肌麻痹的手术治疗

目的探讨先天性上斜肌麻痹的各种手术方法与疗效及适应症。方法回顾性分析112例先天性上斜肌麻痹患者分别行患眼下斜肌断腱、下斜肌部分切除、下斜肌后徙转位、下斜肌后徙转位联合健眼下直肌后徙术的术后效果。结果术后平均随访22月（7～36月）,下斜肌断腱术22例,术后满意率86.36%,下斜肌部分切除术16例,术后满意率87.5%,两者治疗效果相当,无明显统计学差异;下斜肌后徙转位54例,术后满意率88.89%;下斜肌后徙转位联合健眼下直肌后徙术20例,术后满意率80%。结论先天性上斜肌麻痹患者应根据术前垂直斜视度的大小选用不同的手术治疗方法,且应该早期治疗。下斜肌断腱和下斜肌部分切除术治疗效果相当,适用于矫正垂直斜视度〈15~△者;下斜肌后徙转位适用于矫正垂直斜视度15~△～25~△者;下斜肌后徙转位联合健眼下直肌后徙术适用于矫正垂直斜视度〉25~△者。     

Overactive inferior oblique muscle

The most common type of overactive inferior oblique muscle is secondary to a delay in the development of superior oblique muscle function. Operative intervention is not indicated because as a child matures the overactivity of the inferior oblique muscle will gradually disappear. In those cases where surgery is performed, the desired effect of elimination of excess elevation is achieved indirectly. The theory that the inferior oblique muscle is not primarily an elevator is supported by this explanation involving an indirect surgical effect. An explanation of a common postoperative finding after unilateral recession of an inferior oblique muscle is presented.     

Comparison of anterior transposition and recession of the inferior oblique muscle in unilateral superior oblique paresis

PURPOSE: Both anterior transposition and graded recession have been shown to be effective procedures in weakening the inferior oblique muscle. Anterior transposition may work in part by converting the inferior oblique muscle from an elevator to a depressor of the globe. In theory, this would be useful in treating the inferior oblique overaction associated with superior oblique paresis. We compared inferior oblique recession and anterior transposition for the surgical correction of Knapp's class III unilateral superior oblique paresis. METHODS: Four patients underwent 14 mm recession, and five underwent anterior transposition of the inferior oblique muscle for the hypertropia in superior oblique paresis. Prism cover test measurements were made in all cardinal fields of gaze and were compared before and after operation between the two groups. RESULTS: The mean preoperative hyperdeviation in the primary position was 12 prism diopters in the recession group and 15 prism diopters in the anterior transposition group. The mean postoperative hyperdeviation was 1 prism diopter in the recession group and 3 prism diopters in the anterior transposition group. Postoperative results in the inferior oblique field of action demonstrated a mean 3 prism diopter hypertropia in the recession group and a 2 prism diopter hypotropia in the anterior transposition group. CONCLUSIONS: Anterior transposition and graded recession gave similar results in correcting the primary position hyperdeviation in Knapp's class III superior oblique paresis. Both procedures also markedly improved the hyperdeviation in the field of action of the inferior oblique muscle and superior oblique muscle. However, anterior transposition was more likely to result in postoperative hypodeviation in upgaze.     

Indications and results of the tenotomy of the superior oblique (author's transl)]

The tenotomy or tenectomy of an overactive superior oblique produces a similar effect as an elongation of the tendon. Its efficiency cannot be compared with the tenotomy or myotomy of an overactive inferior oblique or rectus muscle. No discernible underaction or complete paralysis of the superior oblique are to be feared, if the surgical indication and technique are correct. We prefer the tenotomizing of the overactive superior oblique to the recession of its insertion. Commonly, but still not always, the overaction of the superior obliques is associated with an A syndrome. Besides, the tenotomy and tenectomy of the superior oblique may be useful in true Brown's syndrome and as an additional procedure in cases of paralysis of the two elevators of one eye, During the past four years this operation was done 32 times on 24 patients. In none of these cases an insufficiency of the superior oblique was produced.     

先天性单眼上斜肌麻痹不同手术方式疗效观察

目的:探讨不同手术方式治疗先天性单眼上斜肌麻痹的疗效以及术后双眼视觉功能的恢复重建情况。方法:回顾性病例研究。选择2016-05/2019-05郑州市第二人民医院斜视与小儿眼科收治的82例先天性上斜肌麻痹患儿作为研究对象,根据患者第一眼位垂直斜视度、患眼下斜肌功能亢进程度、单眼及双眼运动情况等术前检查结果,设计相应的手术方式。包括下斜肌断腱术(3例)、下斜肌部分切除术(63例)、下斜肌徙后术(6例)、健眼下直肌徒后术(4例)、下斜肌减弱+对侧/同侧直肌术(5例)、上斜肌折叠术(1例)。结果:和手术前比较,手术后同时知觉、融合功能、远立体视、近立体视、矫正视力、代偿头位均得到明显改善(P<0.05);有无代偿头位患儿手术后立体视无差异(P>0.05)。结论:根据先天性单眼上斜肌麻痹病情严重程度选择不同的手术方式,在改善患儿视力、代偿头位方面具有积极意义,有助于重建双眼视觉功能。     

Outcomes of surgical management in adults with unilateral superior oblique muscle palsy

PURPOSE: The purpose of this study was to determine the outcomes of surgical management in adult patients with unilateral superior oblique muscle palsy. MATERIAL AND METHODS: A retrospective review of 82 patients who underwent surgical correction at the Department of Strabismology, Cracow Eye Hospital over a 20 years period (1982-2003) was done. The patients were divided into 2 groups: congenital (group I) and acquired (group II) of superior oblique muscle palsy. Group I consisted of 43, group II of 39 patients. The mean age at surgery was 34 years in the congenital and 38 years in the acquired group. Preoperative and postoperative vertical deviation and excycloduction was measured in diagnostic positions of gaze using a major synoptoscope. RESULTS: There were a total of 97 operations: inferior oblique muscle recession was performed in 61 patients, superior oblique muscle tuck in 33, contralateral inferior rectus muscle recession in 1 patient, superior rectus muscle recession in 1 patient and inferior rectus muscle resection in 1 patient. 83% of patients underwent muscle surgery once, 16% were operated twice and 1 patient was operated three times. An average of 1.1 surgeries were performed per patient in the congenital group and 1.2 in the acquired group. In both groups, in all diagnostic positions of gaze, the mean preoperative vertical deviation in patients operated twice was found to be significantly greater than in patients operated once. There was no such relationship found for excyclotorsion. In both groups high and statistically significant correlation was found between the amount of vertical deviation and excyclotorsion before treatment and their reduction in the inferior oblique muscle recession group. For the superior oblique muscle tuck, such a relationship was found only in the acquired group. For both groups (congenital and acquired) recession of the inferior oblique muscle was found to be more effective than superior oblique muscle tuck in the reduction of vertical deviation and excyclotorsion for primary position, downward gaze and downward gaze in adduction. Only in upward gaze in adduction the superior oblique muscle tuck, proved to be more effective than inferior oblique muscle recession. Hypercorrection (vertical and torsional) was found only in the upper field of binocular gaze. Postoperative Brown's syndrome was found to be more frequent after a superior oblique muscle tuck than after recession of the inferior oblique muscle. The risk of postoperative Brown's syndrome after the superior oblique muscle tuck was particularly high in the congenital group. CONCLUSIONS: Recession of the inferior oblique muscle was found to be not only more effective but also safer than superior oblique muscle tuck.     

Inferior oblique muscle recession

Surgical recession of the inferior oblique muscle is simpler to perform if the inferior rectus muscle, rather than either the lateral rectus muscle or the inferior oblique muscle insertion, is used as a landmark. We measured 200 consecutive autopsy eyes to determine the distance from the commonly used 8-mm recession site determined by the Fink technique to the lateral border of the inferior rectus muscle insertion. It was easier to reach this point by measuring 4.0 mm posterior and 4.4 mm superior to the lateral insertion of the inferior rectus muscle, or 2.9 mm superior (on a line parallel to the corneoscleral limbus) and 5.1 mm posterior (on the line perpendicular to the corneoscleral limbus) to the lateral insertion of the inferior rectus muscle. We made anatomical studies to grade the amount of inferior oblique muscle recession and to evaluate the proper placement of the posterior border of the recessed inferior oblique muscle.     

先天性上斜肌麻痹手术的临床观察

目的观察先天性上斜肌麻痹手术治疗的临床效果。方法26例(29眼)实施了手术治疗。其中15例(17眼)行下斜肌单纯切断术;合并分离性垂直偏斜3例(4眼)行下斜肌前转位术;垂直斜视度在20△以上者5例(5眼)行下斜肌切断加对侧眼下直肌后徙术;术前没有下斜肌亢进者3例(3眼),行单纯下直肌后徒术。合并内外水平斜视者同时行水平肌的缩短或后徙术。结果治愈22例(25眼),治愈率86.21%(25/29).有效3例(3眼)。其中2例(2眼)行单纯的下斜肌切断,术后残留垂直斜视度6△~10△;1例(1眼)合并DVD者,术中将下斜肌切断并前转位于下直肌旁,术后仍残留有10△的垂直斜视度。无效1例(1眼),合并间歇性外斜视,术前有40△的垂直斜度,术中将下斜肌前移位,同时行内外直肌的手术,术后仍有20△的垂直斜度。患者放弃治疗。结论选择合适的手术方式,早期实施手术,可取得良好的治疗效果。     

Marginal myotomy of the minimally overacting inferior oblique muscle in asymmetric bilateral superior oblique palsies.

PURPOSE: We report the surgical results of marginal myotomy of a minimally overacting inferior oblique muscle in conjunction with traditional recession or myectomy of the greater overacting inferior oblique muscle in 10 patients with asymmetric bilateral superior oblique palsies and asymmetric inferior oblique overaction. METHODS: Ten consecutive patients with bilateral superior oblique palsies had a hypertropia in primary position (5-28 PD) and unequal inferior oblique overaction (0 to +2 in the lesser overacting inferior oblique muscle, +2 to +4 in the greater overacting inferior oblique muscle). Reversal of the hypertropia was noted in ipsilateral oblique upgaze. All patients underwent a recession or myectomy of the greater overacting inferior oblique muscle and a marginal myotomy of the lesser overacting inferior oblique muscle. RESULTS: Seven patients had no vertical deviation in primary position, 2 patients had a residual hypertropia of 2 to 3 PD, and 1 patient had a residual hypertropia of 8 PD. The abnormal head position present preoperatively in 8 patients was eliminated or greatly improved after surgery. Postoperatively all but 1 inferior oblique overaction was graded as 0 to trace. Mean follow-up time was 19 months (range, 1.5-68 months). CONCLUSIONS: In bilateral superior oblique palsies with asymmetric inferior oblique overaction, a mildly overacting inferior oblique muscle can be corrected by marginal myotomy, combined with a recession or myectomy of the greater overacting inferior oblique muscle. This procedure can reduce or eliminate the hypertropia in primary position while minimizing the possibility of residual inferior oblique overaction.     

The effect of graded recession and anteriorization on unilateral superior oblique palsy

PURPOSE: We wanted to examine the effect of graded recession and anteriorization of the inferior oblique muscle on patients suffering from unilateral superior oblique palsy. METHODS: Inferior oblique muscle graded recession and anteriorization were performed on twenty-two patients (22 eyes) with unilateral superior oblique palsy. The recession and anteriorization were matched to the degree of inferior oblique overaction and hypertropia. The inferior oblique muscle was attached 4 mm posterior to the temporal border of the inferior rectus muscle in six eyes, 3 mm posterior in five eyes, 2 mm posterior in five eyes, 1 mm posterior in five eyes, and parallel to the temporal border in one eye. RESULTS: The average angle of vertical deviation prior to surgery was 11.3 +/- 3.9 prism diopters (PD). The total average correction in the angle of vertical deviation after surgery was 10.8 +/- 3.8 PD. In the parallel group, the average reduction was 14 PD. After surgery, normal inferior oblique muscle action was seen in eighteen of twenty-two eyes (81.8%). CONCLUSIONS: Graded recession and anteriorization of the inferior oblique muscle is thought to be an effective surgical method to treat unilateral superior oblique palsy of less than 15 PD.     

先天性上斜肌麻痹其下斜肌病变程度的观察

目的:测量先天性上斜肌麻痹患者其下斜肌异常的程度。方法:采用临床横断面研究,自身配对对照设计。选取30例合并单眼上斜肌麻痹的外斜视(间歇性外斜视、恒定性外斜视)患者做双眼外直肌后退和下斜肌减弱等相应的垂直肌手术时,观察患者麻痹眼和非麻痹眼的下斜肌,测量下斜肌的紧张度。下斜肌的紧张度是以斜视钩垂直于巩膜勾出下斜肌,肌肉离开巩膜的最大距离表示。结果:麻痹眼的下斜肌粗细不等,但都比健眼下斜肌坚韧、紧绷。麻痹眼的下斜肌平均紧张度为6.33±1.35mm,非麻痹眼的下斜肌平均紧张度为7.76±0.81mm,两者的差异具有统计学意义(P<0.01)。结论:上斜肌麻痹时患眼的下斜肌紧张度较高、弹性较差。     

Apparent contralateral inferior oblique muscle overaction after unilateral inferior oblique muscle weakening procedures.

BACKGROUND: Unilateral inferior oblique muscle weakening surgical procedures often lead to the appearance of inferior oblique muscle overaction in the contralateral eye. The purpose of this study was to determine how different types of unilateral inferior oblique muscle procedures affect the apparent function of the inferior oblique muscle in the contralateral eye. METHODS: A computer search was performed to locate all patients on the pediatric ophthalmology service at the Wilmer Ophthalmological Institute who underwent a unilateral inferior oblique muscle weakening procedure from 1980 to 1994. Only patients with a diagnosis of primary inferior oblique muscle overaction were included in the study. RESULTS: Fourteen patients met the inclusion criteria. One patient had undergone an anterior transposition of the inferior oblique muscle, seven patients had undergone a 10 mm recession of the inferior oblique muscle, and six patients had undergone a myectomy of the inferior oblique muscle. Before the operation,there was no difference in the inferior oblique muscle function of the contralateral eye among the three groups. However, after the operation apparent inferior oblique muscle overaction developed more frequently and to a greater degree in the contralateral eye among patients in the anterior transposition and 10 mm recession groups than among patients in the myectomy group. CONCLUSION: Either anterior transposition or 10 mm recession of the inferior oblique muscle may limit elevation in abduction in the eye on which inferior oblique muscle surgery was performed. The limitation of elevation in abduction may create apparent inferior oblique muscle overaction in the contralateral eye.     

上直肌后徙联合下斜肌后徙转位治疗分离性垂直斜视

目的观察上直肌后徙联合下斜肌后徙转位术治疗分离性垂直斜视的效果。方法回顾性分析上直肌后徙术联合下斜肌后徙转位术的30例（50眼）分离性垂直斜视的手术效果。结果近期治疗效果满意率为83．33％,远期治疗效果满意率为75．00％。结论上直肌后徙联合下斜肌后徙转位术是治疗分离性垂直斜视的一种有效方法。     

The surgical results of correcting strabismus with inferior oblique hyperfunction

PURPOSE: To evaluate the surgical results of correcting strabismus with inferior oblique hyperfunction. MATERIAL AND METHODS: A retrospective chart review of 40 patients, who underwent surgery from 1999-2001 was performed. 7 patients had isolated inferior oblique hyperfunction, 5 with hypertropia, 23 patients had esotropia with inferior oblique hyperfunction and 5 patients had exotropia with inferior oblique hyperfunction. The recession of inferior oblique muscle was undergone in cases with inferior oblique hyperfunction, sometimes in hypertropia with anteposito. The recession-resection of rectus muscles with myotomy-tenotomy of inferior oblique muscle or his recession usually were performed in cases with coexisting esotropia or exotropia. RESULTS: In all cases eyes were acceptably aligned. The recession of inferior oblique muscle is the most effective method of operation in high oblique hyperfunction.