知觉性外斜视伴患眼下转肌功能不全(单眼跷跷板样运动)

Sensory exotropia with depression muscles dysfunction in deviated eye(deviated eye seesaw movement)

目的报告一类知觉性外斜视伴有下转肌功能不全的临床特征。设计回顾性病例系列。研究对象8例知觉性外斜视伴有患眼上斜肌亢进及下直肌力弱者。方法对8例患者的临床特点进行回顾性分析总结。主要指标知觉性外斜视伴有患眼下转肌功能不全的临床特征,包括发病年龄、视力、眼位、眼球运动检查等。结果本类型斜视有发病年龄早的特点。健眼视力良好,患眼视力≤0.1,不能注视。第一眼位表现患眼大角度外斜视,或外上、外下斜视。第二眼位患眼内转时下斜视,外转时上斜视。大部分伴有A征。双眼水平运动时患眼内转时下转,表现上斜肌亢进,外转时上转,表现下直肌力弱的单眼跷跷板样运动,双眼左下转、右下转时患眼下直肌力弱,上斜肌亢进更显著。患眼多伴有内旋斜视。治疗以矫正水平斜视为主,对伴有的垂直斜视可酌情矫正。结论知觉性外斜视伴有患眼下转肌功能不全,与一般的知觉性外斜视临床表现有所不同,应单独提出认识。

Objective To report clinical characteristics of sensory exotropia with depression muscle dysfunction in deviated eye. Design Retrospective case series. Participants 8 cases with sensory exotropia together with superior oblique overaction and inferior rectus underaction in deviated eye. Methods To analyse clinical characteristics of sensory exotropia with depression muscle dysfunction in deviated eye. Main Outcome Measures Clinical characteristics of sensory exotropia with depression muscles dysfunction in deviated eye, including age, visual acuity, fixation, and deviation of the eye. Resultls This kind of strabismus showed a characteristic of yonger onset. The vision was ≤ 0.1 in deviated eye and could not fixation. It was maximal horizontal exotropia deviation in deviated eye and sometimes with elevation or depression at primary position. It was depression when deviated eye moved to adduction and it was eleva- tion when deviated eye moved to abduction at secendary position. It was together with A-patterns mostly. Binocular horizontal movement could induce overaction of superior oblique and underaction of inferior rectus at deviated eye. It showed marked seesaw movement at deviated eye due to inferior rectus underaction. Incyclotropia was existed mostly at the deviated eye. The point of the treatment was to correct the horizontal deviation. The vertical deviation should be corrected when it was needed. Conclusion Sensory exotropia with depression muscles dysfunction shows remarkable differential clinical characteristics from generic sensory exotropia, so it should be understood discriminatingly. （Ophthalmol CHN, 2011, 20： 199-202）