AIM: To investigate the clinical features and surgical outcomes of congenital dysplasia involving both inferior recti(IR) and medial recti(MR) muscles.METHODS: A retrospective review was conducted including cases of s...AIM: To investigate the clinical features and surgical outcomes of congenital dysplasia involving both inferior recti(IR) and medial recti(MR) muscles.METHODS: A retrospective review was conducted including cases of simultaneous congenital dysplasia of IR and MR that were diagnosed and surgically treated at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China, from July 2009 to November 2019. Ocular motility, ocular alignment at distance(6 m) and near(33 cm) by prism alternating cover test and stereoacuity were assessed in all patients before and after surgery. RESULTS: A total of five patients(four males and one female;three with right eye and two with left eye congenital dysplasia) were included in this review. The patients ranged in age from 10 to 42 y(21±13.4 y). The main clinical findings were hypertropia and exotropia of the affected eye, along with motility limitations in adduction and depression. Lateral rectus(LR) recession/transposition combined with IR resection was performed in one case. Two scheduled surgeries were performed in four cases, with one involving superior rectus recession and IR resection and the others LR recession and MR resection. Mean±SD pre-surgical exotropia of 51.0±31.11 prism diopter(PD) and hypertropia of 29.20±7.12 PD in the primary position were decreased to 3.6±12.90 and 3.2±10.09 PD, respectively, at two years after surgery, with a success rate of 60% and an undercorrection rate of 40%. CONCLUSION: The main clinical features associated with simultaneous MR/IR congenital dysplasia are hypertropia and exotropia of the affected eye along with motility limitations in adduction and depression. Scheduled two-stage surgeries achieved a success rate of 60%.展开更多
AIM： To describe the clinical features of congenital double elevator palsy（CDEP） and to evaluate various surgical outcomes between the standard Knapp and augmented Knapp procedures, based on improvements in primary...AIM： To describe the clinical features of congenital double elevator palsy（CDEP） and to evaluate various surgical outcomes between the standard Knapp and augmented Knapp procedures, based on improvements in primary eye position and ocular motility.METHODS： Twenty-two patients with CDEP at Shanghai Children＇s Hospital were enrolled from July 2014 to January 2018. The forced duction test（FDT） was negative in 21 patients, aged 8 mo to 12 y（mean 5.4 y）. Patients were divided into two treatment groups： 16 patients underwent the standard Knapp procedure（group A）, with or without horizontal squint procedure; and 5 patients underwent the augmented Knapp procedure（Foster procedure; group B）. One patient underwent inferior rectus recession in the affected eye and superior rectus recession in the sound eye because of a positive FDT. The pre-and postoperative vertical deviations in the primary position and ocular motility were compared in the two groups.RESULTS： Twenty-one eyes of the 22 patients（95%） were aligned within 10 prism diopters（PD）, and all patients（100%） reached ≥25% elevation improvement after surgery. The average corrected vertical deviation in group B was statistically better than that of group A. For group A, the vertical deviation in the primary position decreased from 24.75Δ±8.35Δ to 4.56Δ±8.07Δ after surgery, for an improvement of 23.06Δ±6.51Δ（P〈0.05）. In group B, the decrease was from 35.00Δ±5.00Δ（range 30Δ-40Δ） to 1.00Δ±2.24Δ, for an improvement of 34.00Δ±4.18Δ（P〈0.05）. There were significant differences between the pre-and postoperative elevation in each group（group A, P〈0.05; group B, P〈0.05）. The average scale of improved elevation in group B（1.80±0.45） was not significantly better than that of group A（1.69±0.87; Z=-0.732, P=0.548）. The average follow-up periods lasted 21 mo in group A and 18 mo in group B.CONCLUSION： For vertical deviations 〈30Δ, the standard Knapp procedure can be chosen. For deviations greater than 30Δ-40Δ, the Foster procedure should be chosen. Because of our early interference, the inferior rectus（IR） muscle did not show mechanical restriction. Monocular elevation deficiency（MED） should be diagnosed early so that complications will be reduced and the procedure will be easier for the surgeon.展开更多
文摘AIM: To investigate the clinical features and surgical outcomes of congenital dysplasia involving both inferior recti(IR) and medial recti(MR) muscles.METHODS: A retrospective review was conducted including cases of simultaneous congenital dysplasia of IR and MR that were diagnosed and surgically treated at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China, from July 2009 to November 2019. Ocular motility, ocular alignment at distance(6 m) and near(33 cm) by prism alternating cover test and stereoacuity were assessed in all patients before and after surgery. RESULTS: A total of five patients(four males and one female;three with right eye and two with left eye congenital dysplasia) were included in this review. The patients ranged in age from 10 to 42 y(21±13.4 y). The main clinical findings were hypertropia and exotropia of the affected eye, along with motility limitations in adduction and depression. Lateral rectus(LR) recession/transposition combined with IR resection was performed in one case. Two scheduled surgeries were performed in four cases, with one involving superior rectus recession and IR resection and the others LR recession and MR resection. Mean±SD pre-surgical exotropia of 51.0±31.11 prism diopter(PD) and hypertropia of 29.20±7.12 PD in the primary position were decreased to 3.6±12.90 and 3.2±10.09 PD, respectively, at two years after surgery, with a success rate of 60% and an undercorrection rate of 40%. CONCLUSION: The main clinical features associated with simultaneous MR/IR congenital dysplasia are hypertropia and exotropia of the affected eye along with motility limitations in adduction and depression. Scheduled two-stage surgeries achieved a success rate of 60%.
文摘AIM： To describe the clinical features of congenital double elevator palsy（CDEP） and to evaluate various surgical outcomes between the standard Knapp and augmented Knapp procedures, based on improvements in primary eye position and ocular motility.METHODS： Twenty-two patients with CDEP at Shanghai Children＇s Hospital were enrolled from July 2014 to January 2018. The forced duction test（FDT） was negative in 21 patients, aged 8 mo to 12 y（mean 5.4 y）. Patients were divided into two treatment groups： 16 patients underwent the standard Knapp procedure（group A）, with or without horizontal squint procedure; and 5 patients underwent the augmented Knapp procedure（Foster procedure; group B）. One patient underwent inferior rectus recession in the affected eye and superior rectus recession in the sound eye because of a positive FDT. The pre-and postoperative vertical deviations in the primary position and ocular motility were compared in the two groups.RESULTS： Twenty-one eyes of the 22 patients（95%） were aligned within 10 prism diopters（PD）, and all patients（100%） reached ≥25% elevation improvement after surgery. The average corrected vertical deviation in group B was statistically better than that of group A. For group A, the vertical deviation in the primary position decreased from 24.75Δ±8.35Δ to 4.56Δ±8.07Δ after surgery, for an improvement of 23.06Δ±6.51Δ（P〈0.05）. In group B, the decrease was from 35.00Δ±5.00Δ（range 30Δ-40Δ） to 1.00Δ±2.24Δ, for an improvement of 34.00Δ±4.18Δ（P〈0.05）. There were significant differences between the pre-and postoperative elevation in each group（group A, P〈0.05; group B, P〈0.05）. The average scale of improved elevation in group B（1.80±0.45） was not significantly better than that of group A（1.69±0.87; Z=-0.732, P=0.548）. The average follow-up periods lasted 21 mo in group A and 18 mo in group B.CONCLUSION： For vertical deviations 〈30Δ, the standard Knapp procedure can be chosen. For deviations greater than 30Δ-40Δ, the Foster procedure should be chosen. Because of our early interference, the inferior rectus（IR） muscle did not show mechanical restriction. Monocular elevation deficiency（MED） should be diagnosed early so that complications will be reduced and the procedure will be easier for the surgeon.
