【摘要】目的：评估传统与欠矫手术治疗部分调节性内斜视患者的效果。
方法：将25例具有部分调节性内斜视和正常AC/A的患者随机分为两组，其中13例患者接受传统手术治疗，其余12例患者接受欠矫手术治疗。传统手术是基于远距远视完全矫正所测量的偏差上，而欠矫手术比传统手术标准低20%。所有患者均进行对称性双眼内直肌后退术，术后随访6mo。
结果：术后6mo，传统组与欠矫组手术成功率分别为46%和91%（成功标准定义为通过近距和远距远视的完全矫正斜视≤8△）。传统组和欠矫组的手术过矫率分别为54%和9%，两组间差异有统计学意义（P<0.05）。没有残余内斜视。手术成功率或欠矫率与患者的年龄、术前等效球镜均值、术前眼偏斜量无相关性。
结论：对于具有正常AC/A的部分调节性内斜视患者，欠矫的双眼内直肌后退术成功率较高，过矫率较低。
【关键词】 部分调节性内斜视；调节性内斜视；过矫；欠矫
Correspondence to: Mohammad Taher Rajabi. Eye Research Center, Farabi Eye Hospital, South Kargar ST, Tehran, Iran. [email protected]
Abstract AIM: To evaluate the efficacy of standard and undercorrected surgical methods in patients with partially accommodative esotropia (PAET).METHODS: Twentyfive patients with PAET and normal accommodative convergence/accommodation (AC/A) were divided into two groups for alternate surgical plan including standard method (13 patients) and undercorrected method (12 patients) in a randomized fashion. Standard method is based on measured deviation through full hyperopic correction at distant target and was performed by Parks scheme. Undercorrected method criteria is 20% lower than standard. All patients underwent symmetrical bilateral medial rectus recessions (BMR), and all of them were followed for 6 months. RESULTS: Six months after operation, surgical success (defined as tropia ≤8Δ at distant and near fixation through full hyperopic correction) was 46% in standard group and 91% in undercorrected group. Overcorrection were observed 54% in standard group and 9% in undercorrected group (P<0.05). There was no residual esotropia. There was no correlation between surgical success rate or overcorrection rate and age, mean of preoperative spherical equivalent or preoperative eye deviation.CONCLUSION: Undercorrected BMR surgery has a lower overcorrection rate and higher surgical success rate than standard surgery in patients with PAET and normal AC/A.
KEYWODS: partially accommodative esotropia; accommodative esotropia; overcorrection; undercorrection
INTRODUCTION
An esotropia is partially accommodative when accommodative factors contribute to but do not account for the entire deviation. In these patients the hypermetropic spectacle correction improves the esodeviation but does not fully correct it[1].
Standard surgery for partially accommodative esotropia (PAET) is based on the maximum nonaccommodative component of the deviation measured through the full cycloplegic refraction. With this approach undercorrection was reported from 25% to 30% while overcorrection from 2% to 44%[26]. Because of high incidence of undercorrection, some advocated augmented or enhanced surgery[3,7,8].
Augmented surgery may be based on the average of the deviation measured with and without spectacles[3]. If consecutive exotropia develops following the surgery, proponents of augmented surgery reduce the hyperopic spectacle power to control the exodeviation[3,4].
Kushner[9] in a prospective study showed that surgical overcorrection in patients with PAET with greater than +2.5 diopters of hyperopia may not be reversible by postoperative reduction in the hyperopic correction. In addition, in other report high rate of consecutive exotropia (44%) was seen in PAET patients with normal AC/A ratio[2]. Finally some authors advocate conservative surgery in PAET.
In the present study we attempted to compare the efficacy of standard and undercorrected surgical methods in patients with PAET.
PATIENTS AND METHODS
In a randomized, prospective study between October 2002 and November 2005, 25 patients with PAET and normal AC/A were divided into two groups for alternate surgical plan including standard method (13 patients) and undercorrected method (12 patients). Inclusion criteria were esotropic patients with minimum spherical equivalent of +2.5 diopters of hyperopia, which their deviation reduced ≥10Δ through full hyperopic correction but not totally removed. Patients were required to wear the full cycloplegic glasses for at least three months prior to surgery.
Exclusion criteria were patients with high AC/A ratio (>5∶1 with gradient method), history of prior strabismus surgery, restrictive or paretic strabismus, intraocular or sensory pathway lesion, dissociated vertical or horizontal deviation, deep amblyopia and vertical deviation >5Δ.
For all patients symmetrical bilateral medial rectus recession (BMR) surgeries were done. In standard group, surgery was done for angle of esotropia measured through full hyperopic spectacles at far fixation (6 meters) based on Parks scheme. Decreased surgery was done by values 20% lower than above measurement.
The following data were recorded before operation, 1.5 months and 6 months after operation: visual acuity, angle of deviation (by prism alternative cover test), and cycloplegic refraction. Cycloplegic refractions were obtained at 30 minutes after instillation of 2 drops cyclopentolate (5g/L), given at interval of 5 minutes.
All surgeries were done by the same surgeon. Measurement of angle of strabismus was done by other ophthalmologist that did not know the group of patients, pre or postoperatively. Surgical success was defined as a tropia ≤8Δ at distance and near fixation through the cycloplegic refraction on accommodative target.
[1] [2] 下一页 |
