Epidemiology of strabismus surgery in a public hospital of the Brazilian Federal District

Abstract Purpose: to determine the prevalence of different types of strabismus submitted to a surgical procedure in a public hospital in the Brazilian Federal District. Methods: Retrospective cross-sectional review of medical records of patients who underwent strabismus surgery performed by the same surgeon from 2004 to 2014. Incomplete records were excluded from the study. Variables included sex, age, type of strabismus, type of surgery, and re-surgeries. Strabismus was classified into three main types (esotropia, exotropia, and pure vertical deviation), and their subtypes. The type of surgery was determined by the number of muscles operated on (up to two, or more than two), the involvement of oblique and vertical rectus muscles, and muscle displacement. Results: 563 patients were reviewed and 531 were included in the study. The average age was 12.7 years, and females accounted for 54.4% of total patients. Esotropia was the most frequent type of strabismus (74%), followed by exotropia (23.7%) and pure vertical deviation (2.3%). The most frequent subtype of esotropia was infantile (49.1%), with 16.1% of these surgeries performed before the age of 2. Constant exotropia was the most frequent subtype of exotropia (27.8%). The prevalence of esotropia decreased with age, whereas that of exotropia increased. 52.3% of surgeries involved more than two muscles. An association between different types of deviation was found in 58.9% of patients. In cases of paralytic strabismus, the sixth nerve was the most affected (46%). Re-surgeries accounted for 10.7% of total surgeries. Conclusion s: Esotropias were the most common types of strabismus, especially infantile esotropia. Most cases were associated with other types of deviation, and needed more complex surgeries, involving more than two muscles. This study expects to contribute to the planning of health measures that may effectively improve the assistance provided to the population.

摘要

研究目的：明确巴西联邦特区某公立医院收治的接受斜视（strabismus）手术患者的各类斜视患病率。

研究方法：对2004年至2014年间由同一位外科医生实施斜视手术的患者病历开展回顾性横断面审查，排除信息不完整的病历。纳入分析的变量包括性别、年龄、斜视类型、手术类型以及再次手术情况。斜视被划分为内斜视（esotropia）、外斜视（exotropia）与单纯垂直偏斜（pure vertical deviation）三大主类及其亚型。手术类型根据手术累及的肌肉数量（≤2条或＞2条）、斜肌（oblique muscles）与垂直直肌（vertical rectus muscles）的累及情况，以及肌肉移位操作进行判定。

研究结果：共审查563例患者的病历，最终纳入531例。受试者平均年龄为12.7岁，女性占总人数的54.4%。内斜视是最常见的斜视类型（74%），其次为外斜视（23.7%）与单纯垂直偏斜（2.3%）。内斜视最常见的亚型为婴儿型内斜视（49.1%），其中16.1%的手术在患者2岁前完成。恒定性外斜视是外斜视最常见的亚型（27.8%）。内斜视的患病率随年龄增长呈下降趋势，而外斜视的患病率则随年龄增长逐渐升高。52.3%的手术涉及超过2条眼肌。58.9%的患者存在不同类型眼肌偏斜的合并情况。在麻痹性斜视患者中，展神经（sixth nerve）受累最为常见（46%）。再次手术占总手术量的10.7%。

研究结论：内斜视是最常见的斜视类型，尤以婴儿型内斜视最为多见。多数病例合并其他类型的眼肌偏斜，需实施更为复杂的手术，涉及超过2条眼肌。本研究可为优化面向人群的医疗照护方案规划提供参考依据。