| ObjectiveTo investigate the express and developmental characteristics of lateral incomitance(LI)and its associated symptoms after different unilateral horizontal rectus surgeries(Rc,Rc&Rs and Rs)over time in exotropia,offer reference about surgical design and postoperative results evaluation to clinicians.MethodsA retrospective study,from Feb.2015 to Aug.2016,all exotropic patients after unilateral horizontal rectus surgeries were operated by one surgeon in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.According to surgical procedures,patients were divided into 3 groups,the unilateral lateral rectus recession group(group Rc),the unilateral medial rectus resection group(group Rs)and the unilateral rectus recession-resection group(group Rc&Rs).Eye alignment,ocular movement,binocular vision,adapted head posture and strabismus degree were recorded at 1 day before surgeries and 1 week,3-6 months and final follow-up after surgeries respectively.Strabismus degree measurements were obtained at distance(6 M)and near(33cm)fixation in primary position and lateral gaze fixation using prism and alternative cover test(PACT),lateral gaze measurements were obtained 30° from primary position,the LI was defined as difference of >5PD between primary position and lateral gaze fixation.SPSS 19.0 software was used for the statistical analysis.ResultsA total of 99 exotropic patients who met Inclusion criteria were brought into our study,male:female=53:46,age at surgery was from 5 to 52 years(10.1±7.9 y),the final follow-up visit was9-18 months(11.5±2.4m).The preoperative overall incidence of LI was 31.3%(31/99),the early postoperative incidence was 36.4%(36/99),there was no significant difference compared with preoperative incidence of LI(p=0.743).The incidence of LI at postoperative intermediate-term and final follow-up were43.4%(43/99)and 26.3%(26/99)respectively(p=0.011).Subgroup analysis of postoperative incidence of LI: the incidence of LI in group Rc was 34.7%(17/49),53.1%(26/49)and 32.7%(16/49)respectively(1 w vs final,p=0.831),group Rs was 37.5%(6/16),50.0%(8/16)and31.3%(5/16)respectively(1 w vs final,p=0.710),group Rc&Rs was 38.2%(13/34),26.5%(9/34)and 14.7%(5/34)respectively(1 w vs final,p=0.028).It was apt to express LI and ocular movement incomitance when surgical dosage was Rc?7mm,Rs?6.5mm and Rc+Rs>10mm in this study.35(35.4%)patients at postoperative early term had abduction deficiency of horizontal rectus surgeries eye,which mainly expressed in group Rc&Rs(21 patients),it disappeared after 3-6 months in group Rc and Rs,and lasted till final follow-up in group Rc&Rs,but the incidence and degree significantly decreased compared with earlier time.19(19.2%)patients at postoperative early term had diplopia,most diplopia could relieve at 3-6 months.Adapted head posture only occurred in group Rc and Rc&Rs in this study,it could take place at both early and intermediate term after operation,and alleviate with the decrease of LI and recovery of ocular movement function.ConclusionThe overall incidence of LI before and after unilateral horizontal rectus surgeries in exotropia had no significant difference.The developmental characteristics of incidence of LI after different unilateral horizontal rectus surgeries were distinct,the incidence at final follow-up decreased significantly compared with early term after Rc&Rs,and it had no obvious difference after Rc and Rs.It was apt to express LI and ocular movement incomitance when surgical dosage exceed some levels.the ocular movement incomitance,diplopia and adapted head posture can relieve or disappear over time after unilateral horizontal rectus surgeries. |
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