Purpose: The aim of this study was to investigate the diagnostic value of preoperative sensory testing on postoperative diplopia and to evaluate the dose-effect relations of medial rectus muscle or unilateral recess/r...Purpose: The aim of this study was to investigate the diagnostic value of preoperative sensory testing on postoperative diplopia and to evaluate the dose-effect relations of medial rectus muscle or unilateral recess/resect advancement procedures and their constancy. Methods: A retrospective evaluation of 62 operative cases of consecutive exotropia performed from 2001 to 2003 was carried out. Diplopia after prismatic correction and after converging by minus glasses was tested. In 47 cases a unilateral recess/resect procedure and in 15 cases an advancement of the medial rectus muscle were performed. The postoperative resultswere controlled oneweek and three months after operation by measuring the angle of squint by a prism cover test looking in five metres and in 33 cm. Results: 22 patients (36% ) had neither diplopia after prismatic correction of angle of squint nor after operation. The other 40 patients (64% ) experienced diplopia,but were not troubled by it. In all patients the whole amount of angle of squint was operated. Immediately after operation,14 patients (23% ) experienced diplopia temporarily,which remained after 3months in 9 patients,but all of themwere not disturbed by it. In all patients the mean preoperative angle of-19 was corrected by a mean operative amount of 11 mm,the mean postoperative angles were + 1.5 after one week and-2.6 after three months with considerable variations of the results (standard deviations were about 5). In 15 cases with advancement of the medial rectus muscle the dose-effect relation was 2 per mm operative amount. After three months these patients become more divergent,the mean value was-6 ,the dose-effect relation was reduced to 1.4/mm. The unilateral recess/resect operations were more constant: these became more divergent of 2.5 only and their dose-effect relation remained more constant (after one week: 1.9° /mm,after 3 months: 1.7° /mm). Conclusions: The diagnostic value of preoperative prismatic correction of the deviation is very limited. Even if diplopia can be provoked,the chance of disturbing diplopia is very low. Nevertheless,some guidelines for pre-and postoperative care are necessary to prevent double vision. The postoperative outcome is favourable for the patient after one operation. In cases of relapsing divergence a second operation is easily possible.展开更多
文摘Purpose: The aim of this study was to investigate the diagnostic value of preoperative sensory testing on postoperative diplopia and to evaluate the dose-effect relations of medial rectus muscle or unilateral recess/resect advancement procedures and their constancy. Methods: A retrospective evaluation of 62 operative cases of consecutive exotropia performed from 2001 to 2003 was carried out. Diplopia after prismatic correction and after converging by minus glasses was tested. In 47 cases a unilateral recess/resect procedure and in 15 cases an advancement of the medial rectus muscle were performed. The postoperative resultswere controlled oneweek and three months after operation by measuring the angle of squint by a prism cover test looking in five metres and in 33 cm. Results: 22 patients (36% ) had neither diplopia after prismatic correction of angle of squint nor after operation. The other 40 patients (64% ) experienced diplopia,but were not troubled by it. In all patients the whole amount of angle of squint was operated. Immediately after operation,14 patients (23% ) experienced diplopia temporarily,which remained after 3months in 9 patients,but all of themwere not disturbed by it. In all patients the mean preoperative angle of-19 was corrected by a mean operative amount of 11 mm,the mean postoperative angles were + 1.5 after one week and-2.6 after three months with considerable variations of the results (standard deviations were about 5). In 15 cases with advancement of the medial rectus muscle the dose-effect relation was 2 per mm operative amount. After three months these patients become more divergent,the mean value was-6 ,the dose-effect relation was reduced to 1.4/mm. The unilateral recess/resect operations were more constant: these became more divergent of 2.5 only and their dose-effect relation remained more constant (after one week: 1.9° /mm,after 3 months: 1.7° /mm). Conclusions: The diagnostic value of preoperative prismatic correction of the deviation is very limited. Even if diplopia can be provoked,the chance of disturbing diplopia is very low. Nevertheless,some guidelines for pre-and postoperative care are necessary to prevent double vision. The postoperative outcome is favourable for the patient after one operation. In cases of relapsing divergence a second operation is easily possible.
