Vertikal Kaymalarda Orta Dönem Şaşılık Cerrahisi Sonuçlarımız

Öz

Vertikal kayma nedeniyle cerrahi uyguladığımız olguların değerlendirilmesi. 2015 Ocak-2016 Haziran tarihleri arasında cerrahi uyguladığımız ve en az 1 yıl takip ettiğimiz olgular değerlendirildi. Cerrahi öncesi ve sonrası kayma açıları (PD) ve alt oblik (AO) fonksiyonları, görme keskinliği (GK), kırılma kusurları, etyolojileri ve uygulanan cerrahiler kaydedildi. Başarı, son muayenede 10 PD altında kayma açısı ve/veya alt oblik hiperfonksiyonunun (AOH) ≤+1 olması olarak tanımlandı.  172 olgunun 32’sinde vertikal kayma nedeniyle cerrahi uygulanmıştır. Primer AOH olguları (grup 1; n=19; 15 ezotropya, 4 egzotropya ile ilişkili) ile diğer etyolojilere (3 tip 3 Duane retraksiyon sendromu, 4 dördüncü sinir felci, 4 disosiye vertikal deviyasyon ve 2 çift elevatör felci) bağlı olan vertikal kaymalar (grup 2; n=13) karşılaştırıldı. Tüm primer AOH ve dördüncü sinir felci olgularında AO geriletmesi uygulandı. Duane sendromuda Y-split ve dış rektus geriletmesi, DVD’de üst rektus geriletme ve çift elevatör felcinde alt rektus geriletmesi uygulandı. Sağ gözde siferik ekivalan değeri (SE) (D) grup 1’de 1,5 (0,75-2,5); grup 2’de ise 0,5 (-0,625-0,875) idi (p=0,014). Sol gözde SE (D) grup 1’de 1,5 (0,75-2,5), grup 2’de ise 0,5 (0,125-1) idi (p=0,024). Grup 1’de AOH’u cerrahi ile 3,16±0,60’dan 0,89±0,81’e düşmüştür (p<0,01). Üç tip 3 Duane sendromunun hepsinde cerrahi sonrası yukarı atım belirgin olarak geriledi. Grup 1’de 16 (%84), grup 2’de 11 olguda (84%) cerrahi başarı elde edildi. Olguya göre uygun cerrahi tedavi ile farklı vertikal kaymalarda tatminkar başarı elde etmek mümkündür.

Anahtar Kelimeler

• vertkal kaymalar,inferior oblik kas cerrahisi,Duane retraksiyon sendromu,disosiye vertikal deviasyon

Our Midterm Outcomes of Strabismus Surgery in Vertical Deviations

Öz

The evaluation of cases operated for vertical deviation. Materials and Methods: Cases operated between January 2015 and June 2016 and followed-up for at least 1 year were evaluated. Pre and postoperative angle of deviations (PD), inferior oblique muscle (IO) functions, refractive errors, etiologies and surgeries performed were noted. Success was defined as alignment with 10 PD of orthophoria and/or inferior oblique overaction (IOOA) ≤+1 at the final examination. 32 out of 172 cases, surgery due to vertical deviation was performed. Primary IOOA cases (group 1; n=19; 15 was associated with esotropia, 4 with exotropia) were compared with cases (group 2; n=13) due to other etiologies [3 Duane retraction syndrome (DRS) type 3, 4 fourth nerve palsy, 4 dissociated vertical deviation (DVD), and double elevator palsy (DEP)]. IO recession was performed in all primary IOOA and fourth nerve palsy. Y-split and lateral rectus recession was performed in DRS, superior rectus recession in DVD, and inferior rectus recession in DEP. Right spherical equivalent (SE) (D) was 1.5 (0.75-2.5) in group 1 and 0.5 (-0.625-0.875) in group 2 (p=0.014). Left SE (D) was 1.5 (0.75-2.5) in group 1 and 0.5 (0.125-1) in group 2 (p=0.024). IOOA decreased from 3.16±0.60 to 0.89±0.81 postoperatively in group 1 cases (p<0.01). The upshoot regressed in 3 DRS type 3 cases postoperatively. Successful outcome was obtained in 16 cases in group 1 (84%) and 11 cases in group 2 (84%). Satisfactory outcome is possible by case-by-case approach in various vertical deviations. 

Anahtar Kelimeler

• vertical deviations,inferior oblique muscle surgery,Duane retraction syndrome,dissociated vertical deviation

Kaynakça

1. 1. Kemp PS. The best of the best: a review of select pediatric ophthalmology and strabismus case reports published in 2015. Digit J Ophthalmol. 2016;22(4):72-74.
2. 2. Kamlesh, Dadeya S, Kohli V, Fatima S. Primary inferior oblique overaction management by inferior oblique recession. Indian J Ophthalmol. 2002;50(2):97-101.
3. 3. Christoff A, Raab EL, Guyton DL, et al. DVD--a conceptual, clinical, and surgical overview. J AAPOS. 2014;18(4):378-84.
4. 4. Hatt SR, Wang X, Holmes JM. Interventions for dissociated vertical deviation. Cochrane Database Syst Rev. 2015;(11):CD010868.
5. 5. Farid MF. Y-split recession vs isolated recession of the lateral rectus muscle in the treatment of vertical shooting in exotropic Duane retraction syndrome. Eur J Ophthalmol. 2016;26(6):523-528.
6. 6. Koller HP, Olitsky SE, O'Hara M, Nelson LB. Diagnosis and Treatment of Fourth Nerve Palsy. J Pediatr Ophthalmol Strabismus. 2016;53(2):70-74.
7. 7. Erkan Turan K, Taylan Sekeroglu H, Koc I, Kilic M, Sanac AS. The frequency and causes of abnormal head position based on an ophthalmology clinic's findings: is it overlooked? Eur J Ophthalmol. 2017;27(4):491-494.
8. 8. Sanjari MS, Shahraki K, Nekoozadeh S, Tabatabaee SM, Shahraki K, Aghdam KA. Surgical treatments in inferior oblique muscle overaction. J Ophthalmic Vis Res. 2014;9(3):291-295.

9. 9. Bilgin B., Gursoy H, Niyaz L., Basmak H. Inferior oblique muscle surgery outcomes. Turkiye Klinikleri Journal of Ophthalmology. 2014;23(1), 7-11.
10. 10. Koç F, Ozal H, Firat E. Is it possible to differentiate early-onset accommodative esotropia from early-onset essential esotropia? Eye (Lond). 2003;17(6):707-710.
11. 11. Helveston EM, Mora JS, Lipsky SN, Plager DA, Ellis FD, Sprunger DT, et al. Surgical treatment of superior oblique palsy. Trans Am Ophthalmol Soc. 1996;94:315-328.
12. 12. Metz H. Double elevator palsy. Arch Ophthalmol. 1979;97:901-903.
13. 13. Jampel RS, Fells P. Monocular elevation paresis caused by a central nervous system lesion. Arch Ophthalmol. 1968;80:45-57.
14. 14. Scott WE, Jackson OB. Double elevator palsy: the significance of the inferior rectus restriction. Am Orthop J. 1977;27:5-10.
15. 15. Luo WT, Qiao T, Ye HY, Li SH, Chen QL. Clinical features and surgical treatment of double elevator palsy in young children. Int J Ophthalmol. 2018;11(8):1352-1357.
16. 16. Santiago AP, Rosenbaum AL. Disociated vertical deviation and head tilts. J AAPOS. 1998;2:5-11.
17. 17. Akar S, Sabancı S, Gokyigit B, et al. Outcomes of surgical treatment in dissociated vertical deviation cases. Turk J Ophthalmol. 2014;44(2):132-137.
18. 18. Velez FG, Velez G, Hendler K, Pineles SL. Isolated Y-splitting and recession of the lateral rectus muscle in patients with Exo-Duane syndrome. Strabismus. 2012;20(3):109e114.
19. 19. Bhate M, Sachdeva V, Kekunnaya R. A High Prevalence of Exotropia in Patients With Duane Retraction Syndrome in a Tertiary Eye Care Center in South India. J Pediatr Ophthalmol Strabismus. 2017;54(2):117-122.
20. 20. Altıntas AG, Arifoglu HB, Koklu SG. Modified Y spliting procedure for the treatment of Duane retraction syndrome. Turk J Ophthalmol. 2015;45(4):152-155.