下斜肌前置移位治疗伴有下斜肌亢进的分离性垂直偏斜

目的:观察下斜肌前置移位治疗伴有下斜肌亢进的分离性垂直偏斜(dissociated vertical deviation,DVD)。方法:下斜肌前置移位于下直肌附着点颞侧前2mm或下直肌附着点颞侧成一直线处,同时矫正水平斜视。结果:患者8例11眼中,术前6眼DVD程度是1+,术后DVD消失;术前3眼DVD程度是2+,术后2眼垂直斜视消失,1眼DVD程度为1+;术前2眼DVD程度是3+,术后1眼DVD程度为1+,1眼为2+。所有患者下斜肌均不亢进。结论:下斜肌前置移位是治疗伴有下斜肌亢进的DVD的有效方式,无明显副作用。     

Effect of graded anterior transposition of the inferior oblique muscle on versions and vertical deviation in primary position.

INTRODUCTION: There are various methods for weakening the inferior oblique muscle; here we describe the results of a graded anterior transposition. METHODS: Charts of 21 children (37 eyes) who underwent graded anterior transposition of the inferior oblique muscle were reviewed. Graded anterior transposition consisted of reinsertion of the inferior oblique muscle at various points along the temporal aspect of the inferior rectus muscle; the more severe the overaction, the more anterior the placement of the new insertion. In all cases the new inferior oblique insertion line was oriented parallel to the inferior rectus muscle axis. We analyzed the preoperative to postoperative change in inferior oblique overaction (versions) and vertical alignment in primary position. RESULTS: Postoperatively, 18 of 21 patients had normal versions, 2 patients had -1 underaction of 1 eye, and 1 patient had +1 overaction of both eyes. Eleven patients (15 eyes) had a preoperative vertical deviation in primary position of 4 PD or more. Three of these patients had unilateral congenital superior oblique palsy and a preoperative hypertropia of 20 PD. They underwent unilateral graded anterior transposition with a mean postoperative vertical change of 18 PD. Three patients had asymmetric primary inferior oblique overaction with true hypertropia, 1 patient had amblyopia and primary inferior oblique overaction, and 4 patients had dissociated vertical deviation associated with inferior oblique overaction. All patients had improvement after surgery, with no significant vertical deviation in primary position. CONCLUSIONS: Graded anterior transposition of the inferior oblique muscle is effective in normalizing versions and correcting vertical deviations in primary position.     

Unilateral inferior oblique anterior transposition for dissociated vertical deviation.

PURPOSE: This study analyzes the outcomes after unilateral inferior oblique anterior transposition (IOAT) for manifest dissociated vertical deviation (DVD). METHODS: A retrospective chart review was conducted for all patients who had unilateral or markedly asymmetric DVD, ipsilateral overaction of the inferior oblique muscle, lack of alternating fixation, and underwent unilateral IOAT surgery between March 1997 and March 2001. In each case, the bunched inferior oblique muscle was anteriorly transposed to the lateral edge of the insertion of the inferior rectus muscle. The primary outcome variable was change in DVD. Secondary outcome variables included inferior oblique muscle action, graded from -4 to +4, and vertical deviation in primary gaze. RESULTS: Ten consecutive patients met the inclusion criteria. Median age at the time of surgery was 14 years (range, 2 to 41 years.) Mean follow-up was 25 months (range, 6 to 60 months). Ipsilateral DVD in primary position decreased from a mean of 20.2 prism diopters (PD) (range, 14 to 33 PD) to 3.7 PD (range, 0 to 9 PD) (t test, P <.001). Nine (90%) of the patients had an excellent postoperative result (residual DVD of 0 to 4 PD) and one (10%) had a good result (5 to 9 PD). Inferior oblique overaction was eliminated in all patients. Mean inferior oblique muscle action decreased from +2.4 to -1.3. Three patients developed a transient or permanent 4 to 5 PD postoperative ipsilateral hypotropia in primary position. Dissociated vertical deviation in the fellow eye did not develop, or if present preoperatively, did not increase. CONCLUSIONS: Unilateral IOAT is an effective treatment for unilateral or markedly asymmetric DVD in patients with a strong, contralateral fixation preference. This surgery reduces inferior oblique overaction but may cause an ipsilateral hypotropia.     

伴有下斜肌亢进的分离性垂直偏斜的手术疗效分析

目的分析下斜肌转位术对伴有下斜肌亢进的分离性垂直偏斜(dissociated vertical deviation,DVD)的矫正效果。方法回顾性分析我科行下斜肌转位术的24例(30眼)伴有下斜肌亢进的DVD患者的完整资料,并根据术前原在位垂直斜度将患者分为小度数、中等度数和大度数组,比较下斜肌转位术对各组近距离(33cm)和远距离(5m)原在位垂直斜度矫正效果。所有患者下斜肌固定于下直肌颞侧缘外的浅层巩膜,与下直肌附着点位于同一水平线上。合并水平斜视者同期手术矫正。结果近距离小度数DVD组、中等度数DVD组、大度数DVD组治愈率分别为100%、0、0;3组有效率分别为92.3%、7.7%、0;3组无效率分别为41.7%、25.0%、33.3%;远距离时各组治愈率分别为100%、0、0;3组有效率分别为92.9%、7.1%、0;3组无效率分别为25.0%、50.0%、25.0%;无论是近距离还是远距离,下斜肌转位术对小度数和中等度数DVD组的原在位垂直斜度矫正效果明显优于大度数DVD组,差异均有统计学意义(均为P<0.05),小度数和中等度数DVD组比较,差异无统计学意义(P>0.05)。结论下斜肌转位术对小度数DVD组(≤10△)和中等度数DVD组(11△～19△)近距离和远距离原在位垂直斜度的矫正效果明显优于大度数DVD组(≥20△)。     

下斜肌转位术对伴有下斜肌亢进DVD的矫正作用

目的 探讨下斜肌转位术对伴有下斜肌亢进的垂直分离性斜视(dissociated verticaldeviation,DVD)原在位垂直斜视的矫正作用.方法应用下斜肌转位术治疗34例(46只眼)伴有下斜肌亢进DVD患者的垂直斜视,18例合并水平斜视者同期手术矫正,手术前后测量原在位垂直斜视度及下斜肌亢进程度,并进行统计学比较.结果原在位垂直斜视度5m远距离平均矫正(13.57±9.74)PD(t=9.450,P<0.01),95%置信区间为(10.67,16.46)PD.33cm近距离平均矫正(13.28±9.98)PD(t=9.029,P<0.01),95%置信区间为(10.32,16.25)PD.下斜肌亢进程度从术前平均+2降至术后0(Wilcoxon符号秩检验,Z=5.957,P<0.01),差异均具有统计学意义.结论下斜肌转位术是治疗伴有下斜肌亢进DVD的有效手段.合并之下斜肌亢进同时得以消除.     

分离性垂直斜视手术治疗的临床观察

探讨分离性垂直斜视有效的手术治疗方法。 方法:回顾性分析38例61眼分离性垂直斜视患者行上直肌大量后徙,合并下斜肌亢进者同时行下斜肌后徙转位术的临床资料。观察术后效果。 结果:术后满意46眼,满意率75%,术后改善14眼,改善率23%,无效1眼。 结论:上直肌大量后徙术和下斜肌后徙转位术是治疗分离性垂直斜视的有效方法。合并有下斜肌亢进者,首选下斜肌后徙转位术,无下斜肌亢进者,首选上直肌后徙术。     

下斜肌前转位术治疗伴有下斜肌亢进的分离性垂直斜视患儿的疗效

目的：探究下斜肌前转位(anterior transposition of inferior oblique muscle)对伴有下斜肌亢进(inferior oblique overaction,IOOA)的分离性垂直斜视(dissociated vertical deviation,DVD)患儿的治疗效果及双眼不等量下斜肌转位术对伴有IOOA的双眼不对称DVD的疗效,为伴有下斜肌亢进的DVD患者提供更加有效的治疗方案。

方法：随机选取2014-01/2015-12在我院住院治疗的80例120眼伴有下斜肌亢进的DVD患者,均采用下斜肌前转位术对患者进行治疗。术后进行回访,回访时间为1～30mo,将患者手术前后远(5m)、近(33cm)距离原在位垂直斜度及IOOA程度进行比较,并对两者进行相关性分析; 对80例患者中采用双眼不等量下斜肌转位术进行治疗的20例30眼伴有IOOA的双眼不对称DVD患者手术前后远(5m)、近(33cm)距离原在位垂直斜度及IOOA程度进行比较,并观察所有患者下斜肌前转位术后抑制上转综合征(antielevation syndrome,AES)的发病情况。

结果：患者术前5m平均三棱镜度(prism diopters,PD)为19.5±0.15PD,术后平均PD为3.5±0.18PD,5m原在位平均矫正16±0.21PD; 术前33cm平均PD为18.6±0.20PD,术后平均PD为4.5±0.26PD,33cm原在位平均矫正14.1±0.16PD,差异具有统计学意义(P<0.05)。行下斜肌前转位术前下斜肌功能亢进+2和+3者各50眼,+1者20眼,术后有12眼仍表现为下斜肌功能亢进,但是亢进程度为+1。IOOA程度与原在位垂直斜度呈正相关,差异具有统计学意义(33cm：r=0.554,P<0.01; 5m：r=0.454,P<0.01)。20例30眼伴有IOOA的双眼不对称DVD患者原在位DVD垂直斜度差异具有统计学意义(P<0.05),IOOA程度明显降低。行下斜肌前转位术的患者术后18例24眼出现不同程度的AES,与行双眼不等量下斜肌转位术进行治疗的20例30眼伴有IOOA的双眼不对称DVD患者发生AES比较,差异具有统计学意义(P<0.05)。

结论：下斜肌前转位术对伴有下斜肌亢进的分离性垂直斜视患者具有很好的治疗效果,但是术后AES发生率较高,而行双眼不等量下斜肌转位术进行治疗的患者术后AES发生率能够保持在较低水平。     

下斜肌转位术治疗分离性垂直斜视

目的 探讨下斜肌转位术治疗分离性垂直斜视的临床效果。方法 选择25例DVD患者,17例伴下斜肌亢进,8例不伴下斜肌亢进。下斜肌亢进或不伴下斜肌亢进,但垂直斜视度≥10△均行下斜肌转位术。结果 (1)25例患者行下斜肌转位术后,22例术后残余垂直斜视度＜ 10△,1例术后残余垂直斜视度≥10△,2例术后残余垂直斜视度≥15△。(2)伴或不伴下斜肌亢进的DVD患者术前、术后斜视度比较有统计学差异。结论 下斜肌转位术是治疗伴或不伴下斜肌亢进分离性垂直斜视的有效方法,尤其适合垂直斜视度＞15△的患者。     

Modified Inferior Oblique Transposition Considering the Equator for Primary Inferior Oblique Overaction (IOOA) Associated with Dissociated Vertical Deviation (DVD)

Purpose: Inferior oblique anterior transposition (IOAT) should be done only in patients with inferior oblique overaction (IOOA) and dissociated vertical deviation (DVD) without fusional potential because the procedure can cause anti-elevation syndrome. This study reports the results of modified inferior oblique transposition onto the equator in 7 patients diagnosed with infantile exotropia or esotropia associated with IOOA and DVD.

Methods: We performed modified inferior oblique (IO) transposition onto or considering the equator on 7 patients who had infantile exotropia or esotropia associated with IOOA and DVD. Five patients had infantile exotropia, and the other two patients had infantile esotropia. Six patients had undergone bilateral rectus -- Bilateral Lateral Rectus (BLR) or Bilateral Medial Rectus (BMR) -- recession previously and one patient underwent BLR recession and IO transposition simultaneously. They had more than +1.5 IOOA with DVD in both eyes. IO was transposed vertically onto the equator in this study. The mean distance between the lateral border of the inferior rectus insertion and the equator was 5.6?mm (range: 4.5 to 6.5?mm). Three months after the operation, degree of IOOA and DVD in each eye was evaluated.

Results: IOOA and DVD were markedly reduced in all patients (+0.5 ～+1 for IOOA postoperatively). Mild contralateral IOOA was noted but the motility disturbance was successfully corrected in all cases postoperatively.

Conclusion: Bilateral IO transposition onto the equator could minimize antielevation and corrected IOOA and DVD successfully in patients with infantile exotropia or esotropia.     

Combined bilateral superior rectus muscle recession and inferior oblique muscle weakening for dissociated vertical deviation.

PURPOSE: Dissociated vertical deviation (DVD) is a common disorder that is often difficult to treat satisfactorily with extraocular muscle surgery. Weakening both elevators in a single eye is uncommonly performed because of possible severe upgaze deficiency or chin-up head posture postoperatively. METHODS: A retrospective review of medical records was performed that yielded 14 patients who had undergone bilateral superior rectus muscle recessions (mean 8.1 mm, range 5-10 mm) and bilateral inferior oblique muscle recession, myectomy, or anterior transposition in the treatment of DVD. Three additional patients with asymmetric inferior oblique muscle overaction or true hypertropia in primary gaze position were identified who had bilateral superior rectus muscle recessions combined with unilateral inferior oblique muscle weakening. RESULTS: Mild-to-moderate elevation deficiencies were common postoperatively but never exceeded -2 up-gaze limitation (scale 0 to -4) except in the immediate postoperative period and were not associated with persistent chin-up head posturing. Cosmetically objectionable upper eyelid retraction occurred in one patient after re-recession of a superior rectus muscle but before inferior oblique muscle surgery. Only three patients undergoing four vertical muscle surgeries had residual DVD >10 PD in primary gaze position, and none exhibited manifest dissociated strabismus warranting further treatment. CONCLUSION: Bilateral superior rectus muscle recession of up to 10 mm combined with inferior oblique muscle weakening appears to be a safe surgical approach in the management of patients with large angle or recurrent DVD. Our data further suggest that simultaneous four vertical muscle surgery may be preferred in some patients to weakening the superior rectus or inferior oblique muscles alone.     

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.     

下斜肌减弱术治疗下斜肌亢进的临床分析

目的探讨下斜肌减弱手术不同方式治疗下斜肌亢进和V征的临床效果。方法下斜肌亢进122例160眼,包括原发下斜肌亢进20例37眼及继发下斜肌亢进102例123眼,采用不同手术方式,对其手术效果进行比较。结果122例中术前82例有代偿头位(67.21%)者,术后82例中代偿头位消失50例,好转28例,无效4例。下斜肌减弱术的手术方式:断腱术6眼;部分切除24眼;后徙80眼;前转位50眼。术前下斜肌亢进程度 1,21眼; 2,91眼; 3,42眼; 4,6眼;术后残留下斜肌 1,3眼;其余均得到矫正。术前V型斜视48例,术后V征消失38例,好转10例。单纯下斜肌减弱矫正原在位垂直斜度≤15△。结论下斜肌部分切除、后徙及前转位术矫正下斜肌亢进及V征同样安全有效。     

Efficacy of inferior oblique anterior transposition placement grading for dissociated vertical deviation.

OBJECTIVE: To determine if graded anterior placement of a transposed inferior oblique muscle is beneficial for treating variable amounts of dissociated vertical deviation (DVD). DESIGN: Retrospective, consecutive, comparative case series. PARTICIPANTS: Patients who underwent inferior oblique muscle anterior transposition (IOAT) for DVD at one institution between 1991 and 1999. METHODS: Chart review. All patients had IOAT procedures of graded placement at 1, 2, or 3 mm anterior to the inferior rectus muscle insertion or standard placement at the level of the inferior rectus muscle insertion. MAIN OUTCOME MEASURES: The effect of graded and standard placement was assessed by measuring the difference between preoperative and postoperative DVD and was defined as DVD correction. The success of surgery was judged by the residual DVD at long-term follow-up of 6 months or more. Excellent, fair, and poor outcomes were defined as residual DVD of 0 to 5 prism diopters (PD), 6 to 12 PD, and 13 or more PD, respectively. RESULTS: Fifty-five patients (106 eyes) underwent IOAT for DVD. The comparison of DVD correction for the standard versus graded group yielded significance at long-term follow-up (P = 0.001). This result became nonsignificant after adjusting for preoperative DVD (P = 0.178). The power to detect a 5-PD difference between graded and standard placement was 90%. The surgical success was similar for patients receiving graded and standard IOAT. Patients with 0 to 15 PD of preoperative DVD fared better than those with more than 15 PD of preoperative DVD. CONCLUSIONS: This study does not demonstrate increased correction of DVD with graded IOAT versus standard IOAT. We do not recommend placement of the inferior oblique muscle anterior to the inferior rectus muscle insertion. Inferior oblique muscle anterior transposition for DVD was clinically more effective for smaller amounts of DVD.     

分离性垂直斜视手术探讨

目的探讨分离性垂直斜视(Dissociated vertical deviation,DVD)的有效手术方法。方法对40例58眼DVD根据双眼视力状况,双眼上斜程度及合并其他类型斜视进行综合分析,设计手术。双眼DVD不伴有下斜肌功能亢进者,若双眼视力良好,且上斜程度相等者做双眼上直肌等量后徙术;双眼上斜程度不等者做双眼上直肌不等量后徙或先做上斜明显眼手术。若单眼弱视明显先做弱视眼手术。单眼DVD,仅做单眼手术。伴有下斜肌功能亢进者做下斜肌缩短4-5mm后徙转位术。DVD合并水平斜视者,尽可能一期完成。否则,先矫正水平斜视,6个月后行DVD矫正术。上直肌后徙按1mm矫正3Δ计算,最大后徙量为8mm。结果40例58眼DVD,50眼满意(85．21％), 8眼好转(13．79％)。结论对不伴有下斜肌功能亢进的DVD行上直肌超常量后徙术疗效满意;伴有下斜肌功能亢进的DVD行下斜肌缩短4-5mm后徙转位术疗效满意。     

三种下斜肌转位术治疗分离性垂直斜视疗效观察

目的观察三种下斜肌转位术治疗分离性垂直斜视的手术疗效,探讨治疗DVD的最佳手术方法。方法伴有下斜肌功能亢进的DVD患者75例,根据手术方式分为3组:单纯下斜肌转位术组、下斜肌截除联合转位术组、下斜肌截除联合前徙并转位术组。观察3组术后1个月、3个月及6个月的眼位、下斜肌运动、代偿头位及并发症情况。结果 3组患者术后下斜肌亢进均消失;代偿头位均不同程度改善;单纯下斜肌转位术组和下斜肌截除联合转位术组术后效果良好者23例(92%)、下斜肌截除联合前徙并转位术组术后效果良好者24例(96%),3组间疗效无明显差异,P<0.05。单纯下斜肌转位术无明显的睑裂变化及上转受限,而联合截除术式有少部分患者出现睑裂变小和眼球上转受限。结论单纯下斜肌转位术可矫正15△~25△的垂直斜视,且术后眼球上转受限和睑裂变化也不明显,是伴有下斜肌功能亢进DVD的首选方法。     

Myectomy versus anterior transposition for inferior oblique overaction

BACKGROUND: Inferior oblique overaction can be either secondary (as a sequela of ipsilateral superior oblique palsy) or primary (commonly associated with horizontal strabismus). Superior oblique underaction often coexists with both primary and secondary inferior oblique overaction. This retrospective case series compares the efficacy of inferior oblique myectomy versus anterior transposition in improving inferior oblique overaction and superior oblique underaction in eyes with either primary or secondary inferior oblique overaction. METHODS: One hundred twenty eyes of 81 patients were included in this retrospective case series, of which 20 had anterior transposition of the inferior oblique and 100 eyes underwent myectomy. Inferior oblique myectomy was compared with inferior oblique anterior transposition in improving inferior oblique overaction and superior oblique underaction in each diagnostic subgroup. Postoperative outcome was qualitatively and quantitatively assessed. Fisher's exact test was used to compare the outcomes. The quantitative improvement of function in terms of inferior oblique overaction and superior oblique underaction was analyzed by regression analysis. RESULTS: When postoperative inferior oblique overaction was considered, there was no statistically significant difference between myectomy and anterior transposition in both primary and secondary inferior oblique overaction. Myectomy was superior to anterior transposition in improving superior oblique underaction in both primary inferior oblique overaction (OR = 0.14; 95% CI, 0.015-1.45; p = 0.056) and secondary inferior oblique overaction (OR = 0; 95% CI, 0-0.027; p < 0.001). The quantitative improvement of function showed a significant difference between procedures for superior oblique underaction (t-test; p = 0.005; 95% CI, 0.25-1.3) but not inferior oblique overaction (t-test; p = 0.8; 95% CI, -0.67-0.54). CONCLUSIONS: This study demonstrates both inferior oblique myectomy and inferior oblique anterior transposition to be effective in correcting primary and secondary inferior oblique overaction. Myectomy is more effective in improving superior oblique underaction associated with both primary and secondary inferior oblique overaction. On this basis, we feel that inferior oblique myectomy has some advantage over anterior transposition in treating combined inferior oblique overaction and superior oblique underaction and can be considered the procedure of choice.     

Nasal myectomy of the inferior oblique muscles for recurrent elevation in adduction.

PURPOSE: Recurrence of inferior oblique overaction (IOOA) after recession or anterior transposition of the inferior oblique (IO) muscles is a common problem. We have been treating such cases by nasal myectomy of the IO, where a segment of approximately 5 mm is removed from the nasal portion, leaving the temporal portion of the IO with its insertion and its ancillary origin, the neurofibrovascular junction, intact. Here we report long-term findings on this procedure. METHODS: Records were analyzed on 72 eyes belonging to 40 patients with recurrent IOOA of grade +1 or more, who received nasal myectomy of the inferior oblique (NMIO) in one (8 cases) or both (32 cases) eyes, and who had a minimum of 3 months follow-up. RESULTS: At follow-up (range 3.6 months to 12 years; median 26 months), 27 patients (68%) showed no IO overaction, whereas 11 (28%) showed improvement of at least one grade point and 2 (5%) showed no improvement. Of the patients with residual IO overaction, three received additional surgery: in two of these patients IO overaction was subsequently eliminated while no additional follow-up was available for the third patient. The effects of NMIO on dissociated vertical deviation were variable. CONCLUSION: In 95% of these patients nasal myectomy of the IO resulted in reduction and in many cases elimination of IO overaction. An advantage of this procedure is that the temporal portion of the muscle, with its ancillary origin and insertion, is preserved.     

A prospective evaluation of anterior transposition of the inferior oblique muscle, with and without resection, in the treatment of dissociated vertical deviation

BACKGROUND: Anterior transposition of the inferior oblique muscle (ATIO) has become a popular surgical treatment for dissociated vertical deviation (DVD), particularly in patients with coexisting inferior oblique muscle overaction (IOOA). We wanted to assess whether adding a resection improves the outcome compared with standard anteriorization. METHODS: We undertook a prospective, randomized evaluation of ATIO, with and without a 7-mm resection, in patients with DVD of at least 5 PD in one eye. We included 51 eyes of 30 patients, 26 eyes treated with the standard ATIO and 25 treated with a 7-mm resection added. We recorded the size of the preoperative and final DVD, grade of the preoperative and final IOOA, rates of reoperation, and complications. Mean follow-up was 15.4 months in the standard group and 25.0 months in the resection group, with a minimum of 4 months for all cases. RESULTS: The median preoperative and postoperative DVD was 12 PD and 4 PD in the standard group, respectively. This compared with 14 PD and 4 PD, respectively, in the resection group, representing no statistically significant difference in outcome. The presence or absence of IOOA did not influence the result of ATIO for either group. No significant complications of surgery occurred in either group. CONCLUSIONS: ATIO is an effective treatment for DVD and can be used to treat DVD in patients with or without IOOA, with few adverse effects. Our study revealed no advantage to adding a 7-mm resection to the standard procedure.     

Helveston综合征的手术治疗

目的：探讨 Helveston 综合征的手术治疗方法。
　　方法：回顾分析我院手术治疗且资料完整的15例30眼Helveston 综合征病例,根据患者上斜肌亢进及分离性垂直偏斜(dissociated vertical deviation,DVD)程度的不同选择不同的手术方式。
　　结果：患者8例16眼行双眼上斜肌鞘内断腱术,术后随访1~3a,A 征均消失,其中3例6眼 DVD 消失,5例10眼DVD 减轻,均未再次行 DVD 矫正手术;患者4例8眼行双眼上直肌后徙联合双眼外直肌后徙并垂直移位术,术后随访1~3a,眼位正位,A 征消失,1例2眼 DVD 消失,3例6眼 DVD 减轻,未再行二次手术;患者3例6眼行双眼水平直肌后徙联合垂直移位术,术后随访6mo,眼位正位,A 征消失,DVD 减轻,未再次行二次手术。
　　结论：Helveston 综合征可根据患者上斜肌亢进及 DVD 程度的不同选择不同的手术方式。     

Unilateral anterior transposition of the inferior oblique muscle for correction of hypertropia in primary position.

PURPOSE: To evaluate the correction of hypertropia in primary position with unilateral inferior oblique (IO) anterior transposition (IOAT). METHODS: Ten patients with idiopathic (nonparalytic, restrictive, or dissociated vertical deviation) hypertropia with marked IO overaction, who underwent unilateral IOAT, were prospectively evaluated to observe the correction of the hypertropia in primary position. No previous ocular muscle surgery had been performed. Four patients had esotropia and two had exotropia. In addition to the proposed surgery, horizontal procedures were performed to correct horizontal deviation, but no vertical transposition of horizontal muscles was done. Four patients had hypertropia and IO overaction, without horizontal strabismus, and IOAT was the only procedure performed. The IO muscle was reinserted 1 mm laterally to the lateral extremity of the inferior rectus muscle insertion using only one suture. The statistical analysis was performed by Wilcoxon rank sum test. RESULTS: The mean absolute correction in primary position was 18.1 prism diopters (PD) (range, 4 to 33), directly proportional to the size of the hypertropia before surgery. Nine of the 10 patients had a residual vertical deviation of 相似文献