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Klin Monbl Augenheilkd 2015; 232(4): 446-451
DOI: 10.1055/s-0035-1545812
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Horizontale Dreimuskelchirurgie bei frühkindlichem Innenschielen und dekompensiertem Mikrostrabismus

Three Horizontal Muscle Surgery for Infantile Esotropia and Decompensated Microtropia
V. Sturm
1   Cantonal Hospital of St. Gallen, Department of Ophthalmology, St. Gallen, Switzerland (Chair: PD Dr. Christophe Valmaggia)
2   University Hospital Zurich, Department of Ophthalmology, Zurich, Switzerland (Chair: Prof. Klara Landau)
,
M. N. Menke
3   Cantonal Hospital of Aarau, Department of Ophthalmology, Aarau, Switzerland (Chair: Prof. Hanspeter E. Killer)
,
G. P. Jaggi
2   University Hospital Zurich, Department of Ophthalmology, Zurich, Switzerland (Chair: Prof. Klara Landau)
4   Augenarzt Obwalden, Sarnen, Switzerland
,
P. Wandernoth
1   Cantonal Hospital of St. Gallen, Department of Ophthalmology, St. Gallen, Switzerland (Chair: PD Dr. Christophe Valmaggia)
,
A. Kunz
1   Cantonal Hospital of St. Gallen, Department of Ophthalmology, St. Gallen, Switzerland (Chair: PD Dr. Christophe Valmaggia)
› Author Affiliations
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Publication History

Publication Date:
22 April 2015 (online)

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Zusammenfassung

Hintergrund: Das chirurgische Management großer Schielwinkel bei frühkindlichem Innenschielen und dekompensiertem Mikrostrabismus wird kontrovers gehandhabt. Es scheint ein gewisser Bias gegenüber Operationen an mehr als 2 horizontalen Augenmuskeln aus Angst vor einer Überkorrektur vorzuliegen. Hauptziel dieser Studie war die motorische und sensorische Beurteilung der horizontalen Dreimuskelchirurgie sowie die Etablierung einer chirurgischen Dosis-Wirkungs-Beziehung. Patienten und Methoden: Retrospektive Kohorten-Studie von 27 Patienten (16 weiblich, 11 männlich; mittleres Alter 7,9 [J], zwischen 1 und 27 [J]), mit frühkindlicher Esotropie und dekompensiertem Mikrostrabismus, bei denen zwischen 2005 und 2013 eine Dreimuskelchirurgie (beidseitige Rücklagerung des M. rectus medialis und einseitige Faltung des M. rectus lateralis) zur Korrektur des Schielwinkels durchgeführt wurde. Ergebnisse: Der Schielwinkel betrug präoperativ 30,2 [°] (21,9 bis 48,0). Postoperativ zeigte sich eine signifikante Reduktion auf 2,6 [°] (− 16,7 bis 16,7), nach sechs Monaten auf 5,5 [°] (− 14,1 bis 21,9). Eine Dosis-Wirkungsbeziehung von 1,63°/mm ließ sich für die kombinierte Dreimuskelchirurgie ermitteln. Schlussfolgerung: Die horizontale Dreimuskelchirurgie ist zur Korrektur großer Schielwinkel bei frühkindlicher Esotropie und dekompensiertem Mikrostrabismus gut geeignet. Konsekutive Exotropien stellen eine Rarität dar.

Abstract

Background: Surgical management of large-angle infantile esotropia and decompensated microtropia has been controversially debated. There seems to be a relative bias against surgery on more than two horizontal muscles to avoid overcorrections. In our study we report on the sensory and motor outcomes after three horizontal muscle surgery. Furthermore we aim to suggest a table to guide surgery amounts. Patients and Methods: This study was a retrospective interventional cohort of 27 patients (16 female, 11 male; mean age 7.9 [years], ranging from 1 to 27 [years]) with infantile esotropia and decompensated microtropia who underwent three horizontal muscle surgery (bilateral medial rectus muscle recession and lateral rectus muscle plication) between 2005 and 2013. Results: Preoperative deviation in primary position measured 30.2 [°] (mean; range 21.9 to 48.0). Postoperatively esotropia was significantly reduced to 2.6 [°] (mean; range − 16.7 to 16.7). After six months deviation measured 5.5 [°] (mean, range − 14.1 to 21.9). An effect of 1.63°/mm was calculated for the combined three muscle surgery. Conclusions: For the correction of large-angle infantile esotropia and decompensated microtropia three horizontal muscle surgery is associated with a high success rate. Only a very low rate of consecutive exotropia does occur.

Schlüsselwörter

frühkindliches Innenschielen - dekompensierter Mikrostrabismus - Strabismus - horizontale Dreimuskelchirurgie

Key words

infantile esotropia - decompensated microtropia - strabismus - three horizontal muscle surgery
 

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