上斜肌麻痹患者垂直斜视的手术治疗
Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
References to other published versions of this review
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Methods | Study design: parallel‐group randomized controlled trial Number randomized: 24 total participants, 12 in the unilateral inferior oblique myectomy group and 12 in the unilateral inferior oblique recession group Exclusions after randomization: none reported Losses to follow‐up: 1 participant who underwent recession failed to complete 1‐year follow‐up Number analyzed: 23 total participants, 12 in the unilateral inferior oblique myectomy group and 11 in the unilateral inferior oblique recession group Unit of analysis: individual (1 study eye per participant) How were missing data handled? 1 participant missing 1‐year follow‐up excluded from analysis Power calculation: none reported | |
| Participants | Country: UK Mean age: 30.8 years (range 12 to 77 years) in the myectomy group, 28.5 years (range 13.7 to 69 years) in the recession group Gender: not reported Inclusion criteria: symptom‐producing and/or socially noticeable unilateral overacting inferior oblique muscle Exclusion criteria: previous or simultaneous extraocular muscle surgery, strabismus surgery or prisms during follow‐up period, inability to co‐operate with testing, visual acuity of 20/60 or worse in either eye, failure to attend any postoperative visit Equivalence of baseline characteristics: preoperative median hypertropia in primary gaze was 15 PD and 10 PD in the myectomy and recession groups, respectively. Preoperative median hypertropia in contralateral gaze was 26.5 PD and 20 PD in the myectomy and recession groups, respectively. There was no statistically significant difference in hypertropia in contralateral gaze, inferior oblique overaction, or superior oblique underaction preoperatively between groups. Other participant details: all participants had decompensated longstanding unilateral superior oblique underaction, although this was not an inclusion criterion | |
| Interventions | Intervention 1: unilateral inferior oblique myectomy at the temporal border of the inferior rectus muscle Intervention 2: unilateral inferior oblique 10‐millimeter recession (3 mm posterior and 2.5 mm lateral to the temporal pole of the inferior rectus muscle insertion) Length of follow‐up: 12 months | |
| Outcomes | Main outcomes: average postoperative reduction of vertical deviation in ipsilateral, primary, and contralateral gaze positions; median postoperative hypertropia in ipsilateral, primary, and contralateral gaze positions; average change of vertical deviation in ipsilateral, primary, and contralateral gaze positions between 2 weeks and 12 months postoperatively; median postoperative reduction in inferior oblique muscle overaction; median postoperative improvement in superior oblique function Adverse events: none reported Intervals at which outcomes assessed: 2 weeks, 4 and 12 months postoperatively | |
| Notes | Publication type: journal article Trial registration: not reported Study period: not reported Funding source: not reported Disclosures of interest: not reported Subgroup analyses: participants with preoperative primary position hypertropias of 15 PD or more, participants with preoperative hypertropias of 10 PD of more in ipsilateral gaze Contact with trial investigators: none | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method of randomization not reported. |
| Allocation concealment (selection bias) | Unclear risk | Method of allocation concealment not reported. |
| Masking of participants and personnel (performance bias) | Unclear risk | Surgeons could not be masked. Masking of participants not reported. |
| Masking of outcome assessment (detection bias) | Unclear risk | Measurements were performed by an orthoptist; masking of the orthoptist not reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | 1 participant in the recession group withdrew from the study. The characteristics of this participant were not reported, other than indicating that this participant was "asymptomatic in the early postoperative period." |
| Selective reporting (reporting bias) | Unclear risk | The protocol was not available, so prespecified outcomes are unknown. |
| Other bias | Low risk | None identified. |
| Methods | Study design: parallel‐group randomized controlled trial Number randomized: 22 total participants, 11 in the disinsertion of inferior oblique group and 11 in the anterior transposition of inferior oblique group Exclusions after randomization: none reported Losses to follow‐up: none Number analyzed: 22 total participants, 11 in the disinsertion of inferior oblique group and 11 in the anterior transposition of inferior oblique group Unit of analysis: individual (1 study eye per participant) How were missing data handled? no missing data were reported Power calculation: none reported | |
| Participants | Country: Turkey Mean age: 20.6 years in the disinsertion group, 18.5 years in the anterior transposition group Gender: 6 men and 5 women in the disinsertion group, 7 men and 4 women in the anterior transposition group Inclusion criteria: unilateral superior oblique palsy diagnosed by hypertropia in the primary position, greater hypertropia in contralateral gaze, a positive Bielschowsky head‐tilt test with increase of hypertropia on ipsilateral head tilt, underaction of ipsilateral superior oblique muscle, overaction of ipsilateral inferior oblique muscle Exclusion criteria: any previous extraocular muscle surgery, primary position hypertropia less than 8 PD Equivalence of baseline characteristics: no statistically significant difference between groups in age, gender, etiology (congenital vs acquired), percentage with preoperative diplopia or head tilt, or prism diopters of hypertropia in primary gaze or adduction | |
| Interventions | Intervention 1: disinsertion of inferior oblique muscle Intervention 2: anterior transposition of inferior oblique muscle (2 mm anterior to temporal border of inferior rectus insertion) Length of follow‐up: at least 6 months (up to 40 months) | |
| Outcomes | Main outcomes: reduction of hypertropia in primary position and adduction Secondary outcomes: proportion of participants with preoperative diplopia with postoperative resolution of diplopia, proportion of participants with preoperative head tilt with postoperative resolution of head tilt, proportion of participants requiring a second surgery Adverse events: primary position hypotropia, clinically significant (causing diplopia or secondary upshoot of the contralateral eye in adduction) or insignificant elevation deficiency Intervals at which outcomes assessed: last follow‐up (mean 18.8 months, range 6 to 40 months) | |
| Notes | Publication type: journal article Trial registration: not reported Study period: not reported Funding source: not reported Disclosures of interest: not reported Subgroup analyses: none Contact with trial investigators: none | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method of randomization not reported. |
| Allocation concealment (selection bias) | Unclear risk | Method of allocation concealment not reported. |
| Masking of participants and personnel (performance bias) | Unclear risk | Masking of participants not reported. |
| Masking of outcome assessment (detection bias) | High risk | The surgeons performed preoperative and postoperative assessments and were not masked. |
| Incomplete outcome data (attrition bias) | Unclear risk | No report of incomplete data, but outcomes were assessed at inconsistent time points postoperatively based on follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | The protocol was not available, so prespecified outcomes are unknown. |
| Other bias | Low risk | None identified. |
PD: prism diopters
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Comparison of 2 different surgical techniques, but the study was retrospective rather than a prospective randomized trial | |
| Comparison of 2 different surgical techniques, but the authors did not specify whether this was a retrospective or prospective study, and also did not describe how participants were assigned to the 2 different surgical groups | |
| Comparison of 2 different surgical techniques, but this was a retrospective review rather than a prospective randomized trial |
Study flow diagram.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
| Inferior oblique myectomy compared with inferior oblique recession for vertical strabismus in superior oblique palsy | ||||
| Patient or population: people with symptom‐producing and/or socially noticeable unilateral overacting inferior oblique muscle; all participants had longstanding unilateral superior oblique underaction Settings: eye hospital Intervention: inferior oblique myectomy Comparison: inferior oblique recession | ||||
| Outcomes | Relative effect | No. of participants | Quality of the evidence | Comments |
| Proportion of participants with postoperative surgical success (hypertropia less than 3 PD in primary gaze) | N/A | 23 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. However, median hypertropia in primary gaze at 12 months was 3 PD in the myectomy group and 1 PD in the recession group. The average reduction in hypertropia in primary position was 14 PD in the myectomy group and 8 PD in the recession group (P = 0.042). |
| Proportion of participants with anomalous head position preoperatively with residual head tilt postoperatively | N/A | 23 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. |
| Proportion of participants with postoperative hypertropia less than 3 PD in down gaze | N/A | 23 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. |
| Proportion of participants with postoperative hypertropia less than 3 PD in contralateral gaze | N/A | 23 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. |
| Proportion of participants who received additional strabismus surgery | N/A | 23 (1 study) | N/A | None of the participants in either group required a second strabismus surgery during the follow‐up interval. |
| Proportion of participants with reversal of vertical deviation postoperatively | N/A | 23 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. |
| Proportion of participants with postoperative orbital cellulitis | N/A | 23 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. |
| GRADE Working Group grades of evidence CI: confidence interval; N/A: not applicable; PD: prism diopters | ||||
| Inferior oblique disinsertion compared with inferior oblique anterior transposition for vertical strabismus in superior oblique palsy | ||||
| Patient or population: people with unilateral superior oblique palsy Settings: eye hospital Intervention: inferior oblique disinsertion Comparison: inferior oblique anterior transposition | ||||
| Outcomes | Relative effect | No. of participants | Quality of the evidence | Comments |
| Proportion of participants with postoperative surgical success (hypertropia less than 3 PD in primary gaze) | N/A | 22 (1 study) | Moderate | This outcome measure was not reported in the study included in this comparison. However, the mean reduction of hypertropia in primary position was 13.3 (SD 1.9) PD in the disinsertion group and 18.5 (SD 3.9) PD in the anterior transposition group (mean difference ‐5.20 PD, 95% CI ‐7.76 to ‐2.64). This difference favors inferior oblique anterior transposition. |
| Proportion of participants with anomalous head position preoperatively with residual head tilt postoperatively | RR 7.00 (0.40 to 121.39) | 22 (1 study) | Very low | This outcome favors inferior oblique anterior transposition. |
| Proportion of participants with postoperative hypertropia less than 3 PD in down gaze | N/A | 22 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. |
| Proportion of participants with postoperative hypertropia less than 3 PD in contralateral gaze | N/A | 22 (1 study) | Moderate | The mean reduction of hypertropia in adduction was 20.6 (SD 6.2) PD in the disinsertion group and 27.7 (SD 9.6) PD in the anterior transposition group (mean difference ‐7.10 PD, 95% CI ‐13.85 to ‐0.35). Anterior transposition resulted in a greater decrease in hypertropia in contralateral gaze, but it was unclear whether this difference favored the anterior transposition group, since the authors did not report the number of participants overcorrected in contralateral gaze. |
| Proportion of participants who received additional strabismus surgery | RR 7.00 (0.40 to 121.39) | 22 (1 study) | Very low | This outcome favors inferior oblique anterior transposition. |
| Proportion of participants with reversal of vertical deviation postoperatively | N/A | 22 (1 study) | N/A | None of the participants in either group developed postoperative reversal of vertical deviation. |
| Proportion of participants with postoperative orbital cellulitis | N/A | 22 (1 study) | N/A | This outcome measure was not reported in the study included in this comparison. |
| GRADE Working Group grades of evidence CI: confidence interval; N/A: not applicable; PD: prism diopters; RR: risk ratio; SD: standard deviation | ||||
