垂直斜视引起的假性上睑下垂患者眼肌影像学特征及处理

Imaging of extraocular muscles and treatment in pseudoptosis with vertical deviation

目的 探讨垂直斜视引起的假性上睑下垂患者的眼外肌影像学特点及临床处理.方法 回顾性病例研究.2007年8月至2009年10月间收治的假性上睑下垂伴垂直斜视患者12例,对其行眼眶CT检查,根据CT表现及临床检查结果设计不同手术方式,观察手术前后的上睑下垂和垂直斜视变化.结果 术前CT检查,75%（8/12）患者的眼外肌发生明显变化,表现为受累眼上直肌-提上睑肌群最大截面积为（15.11±7.11）mm^2,明显小于对侧眼[（24.93±6.43）mm^2,P＜0.01].全部患者经个性化斜视矫正手术,垂直斜视均得到治愈;斜视术后上睑下垂治愈10例,好转2例.结论 上直肌-提上睑肌群萎缩性改变是垂直斜视引起的假性上睑下垂的影像学特征之一;伴有假性上睑下垂的垂直斜视需要设计个性化的手术方案;眼外肌CT检查可为临床分析垂直斜视引起的假性上睑下垂提供有价值的信息.

Objective To investigate pseudoptosis with a vertical deviation of the extraocular muscles and to evaluate different outcomes based on imaging and clinical findings. Methods This was a retrospective study that included 12 patients who were treated between August 2007 and October 2009. Preoperative ophthalmologic examination and orbital CT scan were performed. The choice of surgical procedure was based on the results of the clinical evaluation and CT imaging.Results Of the patients, 75%（8/12） showed significant changes in their extraocular muscles. In patients＇ coronal images, the maximum cross-sectional area of the superior rectus-levator complex in the affected eyes became thinner than that of the contralateral eyes [（15.11±7.11）mm2 vs （24.93±6.43）mm2, P〈0.01]. The vertical misalignment was completely corrected in all patients. Pseudoptosis totally disappeared in 10 patients and partially improved in 2 patients. Conclusion Either congenital hypoplasia or paresis of the superior rectus-levator complex in the affected eye may be the main cause of pseudoptosis with vertical deviation. Surgical procedures for pseudoptosis with vertical deviation must be individualized according to the clinical evaluation and imaging. CT imaging of the extraocular muscles may provide clinically valuable information for choosing the appropriate surgical procedure.