合并小度数垂直斜视的共同性外斜视眼外直肌MRI研究

MRI study of rectus extraocular muscles in concomitant exotropia with small angle vertical deviation

目的观察共同性外斜视合并小度数垂直斜视患者眼外4条直肌Pulley位置、肌肉体积及水平直肌上、下两部分肌肉体积比值的特点。方法横断面研究。收集2018年1月至2019年12月在天津市眼科医院确诊为共同性外斜视患者,其中第一眼位不合并垂直斜视的患者为A组,第一眼位合并小角度垂直斜视(<5三棱镜度)的患者为B组;健康志愿者为C组。采用MRI冠状位扫描观察各组眼外4条直肌Pulley位置及体积的差异,同时计算比较水平直肌上、下两部分肌肉比值的差异。采用单因素方差分析及Kruskal-Wallis检验进行统计学分析。结果收集A组患者19例(38只眼),男性10例,女性9例,平均年龄30岁;B组患者10例(20只眼),男性4例,女性6例,平均年龄27岁;C组健康志愿者20名(40只眼),3个组间年龄和性别分布匹配(均P>0.05)。3个组间眼外4条直肌Pulley位置差异均无统计学意义(均P>0.05)。A组内直肌肌肉体积为(358.6±44.9)mm^(3),B组内直肌肌肉体积为(334.7±35.6)mm^(3),C组内直肌肌肉体积为(437.5±49.3)mm^(3),A组、B组内直肌肌肉体积均小于C组,差异均有统计学意义(t=6.405,6.025;均P<0.01);除内直肌外,其他直肌肌肉体积在3个组间差异均无统计学意义(均P>0.05)。3个组内直肌及外直肌上、下两部分肌肉体积比值差异均无统计学意义(均P>0.05);与A组和C组比,B组患者体积比值更分散。结论共同性外斜视合并小度数垂直斜视患者眼外4条直肌Pulley位置变化不明显,内直肌体积明显减小,水平直肌上、下两部分肌肉体积比值分布较分散可能与小度数垂直斜视有关。(中华眼科杂志,2021,57:223-227)

Objective To observe the changes of four pulley locations of extraocular rectus muscles and rectus muscle volumes,as well as superior and inferior part ratio of horizontal rectus muscles,in concomitant exotropia with small-angle vertical deviation in primary gaze.Methods Cross-sectional study.Data was collected from January 2018 to December 2019 in Tianjin Eye Hospital.The pulley position changes and volumes of four extraocular rectus muscles in the coronal position of patients who had concomitant exotropia without vertical deviation(group A)or with small-angle vertical deviation in primary gaze(<5 prism diopter;group B)and normal controls(group C)were observed using MRI,and the changes of the volume ratio of the superior and inferior parts of the horizontal rectus muscle were calculated.One way analysis of variance and Kruskal-Wallis test were used for statistical analysis.Results There were 19 patients(38 eyes;10 males,9 females)aged(30±7)years in group A,ten patients(20 eyes;4 males,6 females)aged(27±6)years in group B,and 20 healthy volunteers(40 eyes)in group C.Age and gender distribution were matched among the three groups(all P>0.05).Among the three groups,the pulley locations of the four extraocular rectus muscles were not significantly different(all P>0.05).The medial rectus muscle volume in groups A[(358.6±44.9)mm^(3);t=6.405,P<0.01]and B[(334.7±35.6)mm^(3);t=6.025,P<0.01]was significantly smaller than group C[(437.5±49.3)mm^(3)].There was no statistically significant difference in the superior and inferior muscle volume ratio of the lateral rectus in three groups(all P>0.05),while the ratio in group B was more dispersive.Conclusions The pulley location changes of four extraocular rectus muscles of patients with concomitant exotropia and small-angle vertical deviation in primary gaze are not significant,but the medial rectus volume in patients who had concomitant exotropia with vertical deviation or not is significantly smaller.The dispersive superior and inferior muscle volume ratio of the horizontal rectus muscles may be related to the small angle of vertical deviation in clinical examinations.(Chin J Ophthalmol,2021,57:223-227)