İnfantil Ezotropya ve Tedavisi
Özet
İnfantil ezotropya, nörolojik açıdan normal çocuklarda yaşamın ilk 6 ayında başlayan, genellikle kırma kusurlarıyla ilişkili olmayan geniş açılı bir içe kaymadır. Etyolojisi tam bilinmemekle birlikte, alt oblik kas hiperfonksiyonu ve disosiye vertikal deviasyon (DVD) gibi motor anormalliklerle birlikte görülebilir. Tedavinin temel amacı görsel eksenleri hizalayarak binoküler görmeyi sağlamaktır. En yaygın yaklaşım cerrahi müdahale olup, bilateral medial rektus geriletmesi ve lateral rektus rezeksiyonu gibi teknikler uygulanmaktadır. Literatürde, stereopsis gelişimi için cerrahinin 2 yaşından önce yapılmasının sonuçları iyileştirdiği savunulsa da ideal zamanlama ve en etkili prosedür üzerinde tam bir uzlaşı yoktur. Alternatif bir yöntem olan botulinum toksini (A) enjeksiyonu, kas cerrahisine göre daha az invaziv bir seçenek sunar. Toksin, asetilkolin salınımını inhibe ederek kas felci oluşturur ve gözlerin hizalanmasına yardımcı olur. Ancak, çocuklarda sedasyon gerektirmesi, pitoz gibi komplikasyon riskleri ve kalıcı başarı için çoğunlukla tekrarlayan enjeksiyonlara ihtiyaç duyulması nedeniyle kullanımı tartışmalıdır. Sonuç olarak, infantil ezotropyada erken tedavinin önemi genel kabul görse de en iyi cerrahi yaklaşımı ve botulinum toksininin tam rolünü belirlemek için prospektif, randomize ve çok merkezli çalışmalara ihtiyaç duyulmaktadır.
Infantile esotropia is a large-angle inward deviation that begins before 6 months of age in neurologically normal children and is generally not associated with refractive errors. Although its etiology remains unknown, it is frequently accompanied by motor abnormalities such as inferior oblique muscle hyperfunction and dissociated vertical deviation (DVD). The primary goal of treatment is to align the visual axes to promote the development of binocular vision, with surgical intervention remaining the mainstay of therapy through techniques like bilateral medial rectal recession and lateral rectal resection. Although literature suggests that performing surgery before the age of 2 improves stereopsis outcomes, there is still no consensus on the ideal timing or the most effective surgical procedure. Botulinum toxin A injection serves as a less invasive alternative to muscle surgery by inhibiting acetylcholine release to induce temporary muscle paralysis, allowing sensory mechanisms to support alignment. However, its use in children is controversial due to the need for sedation, risks of complications like ptosis, and the frequent necessity for multiple injections to maintain alignment. Consequently, while early intervention is widely favored, prospective, randomized, multicenter controlled trials are still required to define the optimal surgical approach and the exact role of botulinum toxin.
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