分开麻痹的临床特点及疗效评价

Characteristics and therapeutic effect evaluation of divergence paralysis

目的通过对分开麻痹临床特点的分析,提高对该病的认识并评价非手术和手术治疗的临床效果。方法回顾性研究。连续收集2014年9月至2016年1月在天津市眼科医院确诊并接受治疗的11例分开麻痹患者完整的临床资料,包括一般资料、神经科会诊以及治疗前后眼位、眼球运动、斜视度、双眼视觉状态、AC/A、复视像检查,通过随访进行疗效评价。所有患者随访3~18个月,平均6.9个月。结果研究中1例患者有Miller-Fisher综合征病史,3例有高血压病史,1例有安眠类药物摄入史。11例患者均表现为看远同侧复视,急性起病,神经科会诊及头颅MRI、CT正常,均伴有屈光不正。治疗前斜视度数5 m:+25△^+55△,33 cm:+8△^+40△;双眼外转落后1~3 mm;AC/A为2.0~4.0,平均2.9。10例行手术治疗,1例屈光矫正基础上加配三棱镜,其中外直肌手术缩短量为4.0~7.5 mm、内直肌后徙量为4.0 mm。末次随访时复视均消失,斜视度数5 m:-4△^+12△,33 cm:-8△^+8△;双眼外转落后0~2 mm;AC/A为1.3~4.0,平均2.6。结论分开麻痹具有视远内斜视度数大、同侧复视的临床特点,外直肌加强手术对改善复视及内斜视具有较好的疗效。

Objective To investigate the clinical features of divergence paralysis improve the diagnostic and therapeutic ability,and evaluate the effect of surgical and non-surgical treatment.Methods It was a retrospective case series study.11 cases with complete data,diagnosed and treated as divergence paralysis in Tianjin Eye Hospital from September 2014 to January 2016,were summarized.The observation items included general date,neurologica consultation,comprehensive eye examination,and the eye position and movement,deviation degree,binocular vision,AC / A,diplopia examination of pre-treatment and post-treatment.The patients were followed up from 3 months to 1.5 years,averaged 6.9 months.Results In our study,1 patient was MillerFisher syndrome,3 cases had a history of hypertension,and 1 case had the history of intaking sleeping pills for about 3 months.The rest of the patients denied the nervous system disease,cardiovascular disease and other medical history.All patients complained about uncrossed diplopia only at distance.All of the 11 patients had a sudden onset of their symptoms.Each patient was examined by same neurologist,meanwhile MRI or CT were performed.All the results showed normal.All patients had refractive error.The angle of esotropia for distance of 5 meters was from ＋25~Δ to ＋ 55~Δ and wasfrom ＋8 to ＋40~△ for near（33 cm） before treatment while changed into-4~Δ ~ ＋ 12~Δ for distance（5 m） and to-8~Δ ~ ＋8~Δ for near（33 cm） after treatment.The ratio of AC / A ranged from 1.3 to 4.0,with an average of 2.6.Conclusion The clinical characteristics of divergence paralysis are a greater angle of esotropia and ipsilateral diplopia.Lateral rectus resection and non-surgical treatment have better effects on the improvement of diplopia and esotropia.