Haluk Hüseyin GÜRSOY, Ayse İdil CAKMAK, Onur OZALP, Omur Can OZDEMİR, Ertugrul COLAK

Vertikal Kaymalarda Orta Dönem Şaşılık Cerrahisi Sonuçlarımız

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

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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