Abstract
The purposeto evaluate the effectiveness of dosing procedures for the degree of anterior transposition of the lower oblique muscle in the surgical treatment of its secondary hyperfunction of varying severity using modern methods of ophthalmological examination.Patients and methods. Between January 2013 and June 2017, 31 children (31 eyes) aged 3 to 17 years with vertical strabismus due to unilateral insufficiency of the superior oblique muscle were monitored. Depending on the magnitude of the vertical deviation in the adduction on the paretic eye measured in degrees by the Hirschberg method in the head rotation position, all patients were divided into two groups: group 1 — 12 children (12 eyes) (no more than 7° according to Hirschberg); group 2 — 19 patients (19 eyes) (more than 7° according to Hirschberg). Surgical treatment of hypertrophy was performed in all patients in both groups. Weakened the lower oblique muscle by its dosed front transposition. The degree of anterior transposition of the lower oblique muscle depended on the magnitude of the angle of vertical deviation.Results. The surgical intervention on the lower oblique muscle was performed in all patients in full. Hypertrophy in the primary position of the gaze in group 1 was completely eliminated in 11 eyes (91.7%), in group 2 — in 17 eyes (89.5%). The residual vertical angle, equal to 3 ° according to Hirschberg, in group 1 was detected in 1 eye (8.3%), in group 2 — in the 2 eyes (10.5%). Hypertrophy in adduction in group 1 was completely eliminated in 10 eyes (83.3%), in group 2 — in 17 eyes (89.5%). The residual vertical angle of 3° in Hirschberg’s group 1 was detected in 2 eyes (16.7%), in group 2 — in 2 eyes (10.5%).The conclusion. Application of the technology of dosed front transposition of the lower oblique muscle in the surgical treatment of its secondary hyperfunction will significantly improve the effectiveness and safety of treatment and reduce the risk of complications, shorten the duration of surgery and anesthesia in child. The developed method of dosing the degree of anterior transposition allows to perform this operation monolaterally, without fear of developing secondary hyperfunction of the lower oblique muscle in the pair eye.
Highlights
Выделяют два типа гиперфункции нижней косой мышцы
Hypertrophy in the primary position of the gaze in group 1 was completely eliminated in 11 eyes (91.7%), in group 2 — in 17 eyes (89.5%)
Hypertrophy in adduction in group 1 was completely eliminated in 10 eyes (83.3%), in group 2 — in 17 eyes (89.5%)
Summary
В период с января 2013 года по июнь 2017-го под наблюдением находился 31 ребенок (31 глаз) в возрасте от 3 до 17 лет с вертикальным косоглазием, обусловленным односторонней недостаточностью верхней косой мышцы. У всех пациентов в обеих группах гиперфункция нижней косой мышцы была вторичной (положительный тест Бильшовского — возникновение (увеличение) вертикальной девиации глаза при наклоне головы к плечу на стороне поражения) и носила монолатеральный характер. При этом в парных глазах циклоторзионного смещения выявлено не было, величина угла между горизонтальной прямой, проведенной из геометрического центра диска зрительного нерва и fovea в группе 1 была от 4 до 9° (в среднем 6,7 ± 1,27°), в группе 2 — от 6 до 9° (в среднем 7,07 ± 1,03°). В тех случаях, когда значение вертикального угла не превышало 7° по Гиршбергу, нижнюю косую мышцу подшивали к склере на 2 мм ниже уровня прикрепления нижней прямой мышцы и на 1 мм кнаружи от ее латерального края. При угле вертикальной девиации свыше 7° по Гиршбергу нижнюю косую мышцу подшивали к склере на одном уровне с местом прикрепления нижней прямой мышцы и на 1 мм кнаружи от ее латерального края. Results of treatment of vertical strabismus in secondary hyperfunction of the lower oblique muscle
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