Vertikal Kaymalarda Orta Dönem Şaşılık Cerrahisi Sonuçlarımız

Year 2020, Volume: 42 Issue: 3, 277 - 281, 27.05.2020

Haluk Hüseyin Gürsoy , Ayse İdil Cakmak Onur Ozalp Omur Can Ozdemir Ertugrul Colak

https://doi.org/10.20515/otd.528287

Abstract

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.

Keywords

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

Our Midterm Outcomes of Strabismus Surgery in Vertical Deviations

Abstract

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. 

Keywords

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

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