Disosiye horizontal deviasyon: 13 olguda klinik bulgular ve cerrahi tedavi sonuçları
Küçük Resim Yok
Tarih
2003
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Disosiye Horizontal Deviasyon (DHD) abduktor komponentin belirgin olduğu disosiye bir şaşılık türüdür. DHD 'nin iki karekteristik özelliği, asimetrik horizontal kayma ve değişken kayma açısı mevcudiyetidir. Bu çalışmada DHD1H olguların klinik özellikleri ve ameliyat sonrası sonuçları değerlendirilmiştir. Gereç ve Yöntem: Çalışmaya alman 13 hastanın 4'ü erkek, 9'u kadındı. Hastaların ortalama yaşı 9.6±5.6 (4-21) idi. DHD tanısı alternan örtme-açma ve prizma örtme testi ile konuldu. Tüm hastalara cerrahi tedavi uygulandı. Ekzodeviasyonu belirgin olan olgulara 8 mm lateral rektus kası geriletmesi, ezodeviasyonu belirgin olan olgulara ise 6 mm lateral rektus kası geriletmesi yapıldı. Beraberinde disosiye vertikal deviasyon (DVD) veya alt oblik kas hiperfonksiyonu mevcut olan olgularda bu patolojiler de aynı cerrahi seansta düzeltildi. Bulgular: DHD; 10 olguda (%77) ekzodeviasyon, 3 olguda (%23) ezodeviasyon şeklindeydi. Yedi olguda (%54) tek gözde, 6 olguda (%46) her iki gözde tutulum mevcuttu. Belirgin DHD 'si mevcut gözlerde en yüksek kayma açısı ortalama değer olarak 36.5±2.4 (25-55) prizm diyoptri (PD) olarak ölçüldü. Ameliyat öncesi iki göz arası horizontal kayma açısı farkı ortalama değer olarak 30.0±10.2 (15-55) PD iken, ameliyat sonrası ise bu fark tüm hastalarımızda 10 PD altında saptandı. Sonuç: DHD 'nin klinik özellikleri oldukça karışıktır. İki göz arasındaki kayma açısı sabit olmayıp, her iki gözde değişik zamanlarda farklı kaymalar gözlenir. DHD'nin ekzodeviasyon ile birlikte olduğu gözlerde aynı taraf lateral rektus kasına 8 mm geriletme, ezodeviasyon ile birlikte olduğu gözlerde aynı taraf lateral rektus kasma 6 mm geriletme yapılması cerrahi tedavi seçimi olabilir.
Purpose: The dissociated strabismus in which an abductor component is prominent is known as dissociated horizontal deviation (DHD). Asymmetric horizontal deviation and variable angle deviation are the two characteristic elements of DHD. We studied the clinical features and postoperative results of DHD cases. Material and Methods: Thirteen patients, 4 males and 9 females were included in this study. The mean age was 9.6±5.6 (range 4 to 21) years old. The patients were diagnosed as DHD by alternating cover-uncover and prism cover tests. All patients underwent surgery. DHD cases manifesting with exodeviation underwent 8 mm lateral rectus recession. DHD cases manifested with esodeviation underwent 6 mm lateral rectus recession. If dissociated vertical deviation (DVD) or inferior oblique muscle overaction were present they were treated at the same operation. Results: DHD was present as exodeviation in 10 cases (77%) and as esodeviation in 3 cases (23%). It was unilateral in 7 cases (54%) and bilateral in 6 cases (46%). The mean value of maximal deviations measured in prominent DHD eyes was 36.5±2.4 (range 25 to 55) prism diopters. The mean horizontal deviation difference between the two eyes was 30.0±10.2 (range 15 to 55) prism diopters preoperatively. All .of our cases were completely within the limits of 10 prism diopters after surgical treatment.Conclusion: Clinical picture of DHD is very confusing. The deviation between eyes is not constant and at different times different deviations can be observed in both eyes. Eight mm ipsilateral lateral rectus recession may be the choice of treatment when DHD is associasted with exodeviation and 6 mm ipsilateral lateral rectus recession when associasted with esodeviation.
Purpose: The dissociated strabismus in which an abductor component is prominent is known as dissociated horizontal deviation (DHD). Asymmetric horizontal deviation and variable angle deviation are the two characteristic elements of DHD. We studied the clinical features and postoperative results of DHD cases. Material and Methods: Thirteen patients, 4 males and 9 females were included in this study. The mean age was 9.6±5.6 (range 4 to 21) years old. The patients were diagnosed as DHD by alternating cover-uncover and prism cover tests. All patients underwent surgery. DHD cases manifesting with exodeviation underwent 8 mm lateral rectus recession. DHD cases manifested with esodeviation underwent 6 mm lateral rectus recession. If dissociated vertical deviation (DVD) or inferior oblique muscle overaction were present they were treated at the same operation. Results: DHD was present as exodeviation in 10 cases (77%) and as esodeviation in 3 cases (23%). It was unilateral in 7 cases (54%) and bilateral in 6 cases (46%). The mean value of maximal deviations measured in prominent DHD eyes was 36.5±2.4 (range 25 to 55) prism diopters. The mean horizontal deviation difference between the two eyes was 30.0±10.2 (range 15 to 55) prism diopters preoperatively. All .of our cases were completely within the limits of 10 prism diopters after surgical treatment.Conclusion: Clinical picture of DHD is very confusing. The deviation between eyes is not constant and at different times different deviations can be observed in both eyes. Eight mm ipsilateral lateral rectus recession may be the choice of treatment when DHD is associasted with exodeviation and 6 mm ipsilateral lateral rectus recession when associasted with esodeviation.
Açıklama
Anahtar Kelimeler
Disosiye Horizontal Deviasyon (DHD), Asimetrik Horizontal Kayma, Değişken Kayma Açısı
Kaynak
MN Oftalmoloji
WoS Q Değeri
Scopus Q Değeri
Cilt
10
Sayı
4