Serhat İMAMOĞLU, GÖKHAN PEKEL, Birsen GÖKYİĞİT, Evren PEKEL, Serpil AKAR, NİHAT SAYIN, Ahmet DEMİROK

Çocuklarda Görülen Tip 1 Duane Sendromunda Güçlendirilmiş Vertikal Rektus Kas Transpozisyonu

Amaç: Tip 1 Duane sendromlu çocuklarda güçlendirilmiş tam ve kısmi rektus kas transpozisyonunun etkinliğinin değerlendirilmesidir. Materyal- Metot: Tip 1 Duane sendromlu, lateral fiksasyon yöntemiyle güçlendirilmiş vertikal rektus kas transpozisyonu yapılan 25 hastanın 27 gözünün retrospektif incelemesinde, kısmi (12 göz) ve tam (15 göz) rektus kas transpozisyonunun fonksiyonel sonuçları karşılaştırıldı. On iki gözde primer pozisyonda şaşılık yok iken 15 gözde ezotropi mevcut idi. İstatistiksel analiz için SPSS 15.0 yazılım programı kullanıldı. Preoperatif ve postoperatif kaymaları kıyaslamada T-testi kullanıldı. Bulgular: Ekim 2004-Temmuz 2010 tarihleri arasında opere edilen 25 hastanın (9 erkek, 16 kız; 9,9±4,7 yaş) 27 gözü çalışmaya alındı. Yirmi üç hasta tek taraflı ve 2 hasta bilateral tip 1 Duane sendromu idi. Ezotropik tip 1 Duane sendromlu hastalarda preoperatif uzakta kayma açısı 22,6±10,1 prizma dioptri (PD), postoperatif 7,0±10,0 PD (p=0,000) ve preoperatif yakında kayma açısı 21,8±9,6 PD ve postoperatif 6,0±7,9 PD (p=0,000) idi. Güçlendirilmiş transpozisyon sonrasında 22 gözde (% 81) abdüksiyon yeteneği belirgin bir şekilde artmış olarak saptandı. Sonuçlar: Kısmi ve tam rektus kas transpozisyonuna lateral fiksasyon sütürlerinin eklenmesi, tip 1 Duane sendromlu çocuklarda addüksiyon yeteneği bozulmadan, prosedürün tonik abdüksiyon kuvvetini iyileştirmiştir. Güçlendirilmiş tam rektus kası transpozisyonu ve güçlendirilmiş kısmi rektus kası transpozisyonunun fonksiyonel sonuçları benzer olarak bulunmuştur.

Augmented Vertical Rectus Muscle Transposition in Children with Type 1 Duane Syndromet

Objective: Our aim was to evaluate the efficacy of augmented full and partial rectus muscle transposition in children with type 1 Duane syndrome. Methods: A retrospective review of vertical rectus muscle transposition augmented with lateral fixation procedures in 27 eyes of 25 children with type 1 Duane syndrome was performed and the functional results of partial (12 eyes) and full (15 eyes) rectus muscle transposition were compared. Fifteen eyes had also esotropia while 12 eyes did not have strabismus in primary position. SPSS 15.0 software for Windows® was used to summarize baseline characteristics and outcomes and to compare preoperative and postoperative deviation (paired T-test). Results: Twenty-seven eyes of 25 children (9 male and 16 female) with a mean age of 9.9 (SD:4.7) years were operated between October 2004 and July 2010. Twenty-three children had unilateral and two children had bilateral type 1 Duane syndrome. In esotropic type 1 Duane syndrome patients, the preoperative angle of deviation at distance was 22.6 ± 10.1 prism diopters (PD) compared with 7.0 ± 10.0 PD postoperatively (p=0.000) and the preoperative angle of deviation at near was 21.8 ± 9.6 PD compared with 6.0 ± 7.9 PD postoperatively (p=0.000). After augmented transpositions, abduction ability was markedly increased in 22 eyes (81 %). Conclusion: The addition of lateral fixation sutures to partial and full rectus muscle transpositions improves the tonic abducting force of the procedure for children with type 1 Duane syndrome without compromising adduction. The functional results of full rectus muscle augmented transposition and partial rectus muscle augmented transposition are similar to each other.

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