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內斜視手術術後連貫性外斜視之手術結果
Surgical Outcomes of Consecutive Exotropia
摘要
目的：評估對於內斜視手術術後之連貫性外斜視(consecutive exotropia)手術矯正的效果，並比較手術術式對於結果有無差異，以及術後眼位偏移的變化。 方法：針對在1996至2001年間，於本院接受內斜視手術術後之連貫性外斜視手術矯正的病人，所作的回溯性的研究。對於首次內斜視發生之年齡、接受內斜視手術之年紀、散瞳後之屈光狀態、有無弱視、發生外斜視之年齡、外斜視的角度及手術矯正的方法、術後的眼位變化及追蹤的時間長短，分析其相關性。 結果：本研究共納入46個病例，其中17人(37%)為男性，29人(63%)為女性。病人接受外斜視矯正手術時的平均年齡為20.4歲（標準差±11.5，範圍4-65）。外斜視術前平均偏斜角度為46.5稜鏡角度（標準差±18.0，範圍15~85）。術後第一天平均偏斜角度為2.3稜鏡角度（標準差±11.7，範圍－20~30）。術後第一週平均偏斜角度為4.9稜鏡角度（標準差±12.4，範圍－15~30），術後第六週平均偏斜角度為14.0稜鏡角度（標準差±14.7，範圍－20~60），追蹤時間長度平均為28.5月（標準差±39.4，範圍0.25~132.3），手術的成功率（術後眼位在十個稜鏡角度以內者）為63.0%。我們將手術前後的偏斜角度差距除以手術中內直肌復位或縮短和外直肌徙後的量定義為手術劑量與效果的關係(PD/mm)，經線性迴歸分析(simple linear regression)發現與外斜視手術術前偏斜的角度有關(p=0.0163)。以two independent sample Ttest分析，外斜視手術術前偏斜的角度＜57.5稜鏡角度者，其平均為2.72PD/mm，外斜視手術術前偏斜的角度＞=57.5稜鏡角度者，其平均為3.79PD/mm，兩平均值有統計上的顯著差異(p=0.0012)。利用Generalized estimating equation(GEE)來分析，發現術後六週的眼位比術後第一天平均高出7.1個稜鏡角度，有統計上的顯著意義(p=0.0067)。 結論：內斜視手術術後之連貫性外斜視可能發生於術後許多年後，因此，術後持續的追蹤是必要的。外斜視手術術前偏斜的角度與手術劑量與效果的關係成正相關。另外，外斜視矯正手術術後六週眼位比術後第一天平均高出7.1個稜鏡角度。這也再度印證了內斜視手術術後之連貫性外斜視矯正手術術後向外偏移的趨勢。
關鍵字
無資料並列摘要
Purpose: To evaluate the results of the surgical management of consecutive exotropia. Method: Retrospective study design. We reviewed the charts of the 46 patients who had operations for consecutive exotropia in our hospital from 1996 to 2001. Age of onset, age of primary operation, interval between primary and secondary operations, preoperative and postoperative angles of deviation, surgical methods, cycloplegic refraction status, and amblyopia were recorded respectively. Result: The mean age for consecutive exotropia correction was 20.4 years-old. Preoperative deviation angle was 46.5 prism diopters (PD). The post-op 1 day deviation angle was 2.3 PD, post-op 1 week deviation angle was 4.9PD, and post-op 6 weeks deviation angle was 14.0 PD. Mean follow-up time was 28.5 months. The success rate (final position between +10 and -10 PD) was 63.0%. The mean dose-effect relationship between the reduction in the angle of deviation and the sum of millimeters of the reoperation was strongly correlated with the amount of preoperative exodeviation. (p=0.0163 by simple linear regression) For those whose preoperative deviation angles were＜ 57.5PD and ＞=57.5PD, the mean dose-effect relationships were 2.72 and 3.79 PD/mm respectively. (p=0.0012 by two independent sample T tests) We also discovered an exotropic drift in the first 6 weeks. (7.1 PD, p=0.0067 by generalized estimating equation analysis) Conclusion: Patients receiving surgery for primary esotropia should be monitored regularly. Consecutive exotropia may occur many years after. The preoperative deviation angle was correlated with the dose-effect relationship. Also, there is an exotropic drift following consecutive exotropia surgery.