先天性眼球震颤的手术治疗

先天性眼球震颤病因不明。其临床特点是：眼球震颤是冲动型。有快慢相之分。病人有明显的代偿头位，面部转向与视线方向相反，有较稳定的中间带。常合并有水平斜视，且视力在代偿头位时常较第一眼位视力提高。手术治疗是目前该病的主要治疗方法。     

手术治疗先天性眼球震颤

4例先天性眼震,2例男性,2例女性。年龄11—17岁,平均年龄14岁。合并共同性外斜视2例。并先天性小角膜2例,鼻下方虹膜缺损2例,晶体混浊2例。4例代偿头位向左侧,眼球水平震颤,3例快相左侧,1例无快慢相之分(表1)。治疗:手术的目的是改善头位代偿,增进视力,减轻眼震,使中间带眼位移至中心眼位。术前检查:视力、头正位视力及中间带眼位视力、患者最佳视力头位;角膜缘试验,眼正位时与中间带眼位移动数(以mm计算)为眼球震颤数,此数为手术量的依据。     

调整PARKS法手术量治疗先天性眼球震颤

目的观察用调整Parks法手术量治疗伴有代偿头位的先天性眼球震颤(CN)的临床效果。方法调整Parks方法的手术量。当代偿头位为10°～15°、15°～25°、25°～30°和30°～35°时,则单眼手术量分别为7mm、11mm、13mm、15mm。结果1.与术前相比术后视力在第一眼位单眼或双眼同时注视最佳视力有显著提高;2代偿头位:代偿头位基本消除者(<10°)32例,明显改善者(代偿头位≥10°)9例,无变化者5例,同术前相比疗效显著。结论调整Parks法手术量可以用于治疗伴有各种大小代偿头位的CN患者。     

用增加PARKS法手术治疗先天性运动缺陷型眼球震颤

目的手术治疗先天性运动缺陷型眼球震颤的代偿头位，以期矫正眼位和头位倾斜，消除眼震和提高视力。方法用增加Parks（5、6、7、8mm）法手术治疗指征为代偿头位≥30°者；头位30°时手术量增加40％，头位45°时手术量增加60％。结果9例平均随访18月。头位、眼震强度和视力均明显改善；残余头位均＜15°，全部治愈；眼震强度由术前平均37．34减少到术后平均3．40；视力增加2行以上者占83．3％。结论用增加Parks5、6、7、8mm）法手术治疗代偿头位≥30°的先天性运动缺陷型眼球震颤有显著疗效。     

手术治疗伴有斜视的先天性冲动型眼球震颤

目的探讨先天性冲动型眼球震颤合并斜视的手术治疗方法及效果。方法回顾性分析行手术治疗的先天性冲动型眼球震颤伴有斜视11例,所有患者均根据中间带位置、代偿头位、斜视角度和注视眼的关系进行中间带的移位以及斜视的矫正。结果9例术后代偿头位完全改善,1例术后残留15°面转角,1例残留10°上斜视,所有患者原在位视力均提高两行以上。结论通过中间带移位及斜视度叠加矫正斜视,可以明显改善先天性冲动型眼球震颤的代偿头位及外观,并能提高第一眼位的双眼视力。     

先天性特发眼球震颤合并斜视手术治疗的研究

目的 探讨先天性特发眼球震颤(CIN)合并斜视手术设计方案及手术疗效.设计回顾性病例系列.研究对象66例先天性眼球震颤合并斜视患者,其中合并共同性内斜视22例,内斜视V征5例,共同性外斜视5例,外斜视A征4例,间歇性外斜视3例,麻痹性斜视11例,眼球后退综合征2例,垂直分离性斜视3例,Helveston综合征1例.方法 手术方式设计综合考虑患者的双眼视的状态、注视眼、视力是否平衡、麻痹性斜视的代偿头位和眼球震颤中间带的代偿头位,在改善代偿头位的基础上矫正斜视.主要指标代偿头位扭转角,第一眼位的双眼视力.结果 手术后随访3～12个月,平均6个月.术后头位消失占70.8%,明显改善占29.2%;在第一眼位术后视功能获得改善的患者占89.3%.结论 合并有斜视的先天性特发眼球震颤的手术治疗既要解决斜视问题也要解决代偿头位.合理的手术设计是获得较好结果的前提.(眼科,2009,18:55-58)     

先天性水平冲动型眼球震颤的手术治疗

目的探讨先天性水平冲动型眼球震颤的手术方法及效果。方法回顾性分析经手术治疗的先天性水平冲动型眼球震颤8例患者临床资料,所有患者均根据中间带位置,代偿头位进行中间带移位。结果 6例代偿头位消失,1例术后残留10°扭转角,1例术后残留15°扭转角。所有患者原在位视力均提高。结论通过中间带移位,可以明显改善先天性水平冲动型眼球震颤的代偿头位及外观,并能提高第一眼位的双眼视力。     

先天性特发性眼球震颤合并水平斜视的手术治疗

目的:探讨先天性特发性眼球震颤合并水平斜视的手术治疗方法。方法:对27例合并水平斜视的先天性特发性眼球震颤患者,采用主导眼中间带移位术联合斜视眼斜视矫正术。结果:在27例患者中,所有患者主导眼第1眼位视力均提高2行以上,22例代偿头位消失,明显改善5例,术后25例患者眼位映光基本正位(±5°以内),2例患者眼位映光在±5°～±10°,部分患者双眼视功能较术前有所好转。结论:对合并水平斜视的先天性特发性眼球震颤行主导眼中间带移位术联合斜视眼斜视矫正术,不仅能改善原在位视力,矫正代偿头位和斜视,还有利于双眼视的建立。     

先天性冲动型眼球震颤合并共转性斜视的手术治疗

目的 探讨先天性冲动型眼球震颤合并共转性斜视的手术治疗效果。方法 对我院1995～2001年收治的118例水平性共转性斜视，其中10例合并先天性冲动型眼球震颤患者的手术方式和疗效作回顾分析。设计手术时，先将眼球震颤和斜视的手术矫正量分开计算，然后将手术量相加。结果 10例中9例术后正位，1位患者残留外斜视。9例患者术后第一眼位眼震明显减轻，代偿头位消失或明显改善，第一眼位最佳矫正视力均提高，视力增进1～5行。结论 先天性眼球震颤合并共转性斜视，既考虑眼震情况、静止眼位、代偿头位方向及度数，又考虑斜视性质、度数，注视眼眼别，两者可一并手术。     

先天性水平冲动型眼球震颤的手术治疗

目的讨论先天性水平冲动型眼球震颤的手术设计和效果。方法采用Parks法手术治疗先天性水平冲动型眼球震颤24例,观察术后疗效。结果绝大多数患者原在位眼震基本消失,21例代偿头位基本消失,原在位视力提高1～4行。结论Parks法适合于矫正代偿头位>15°的先天性水平性冲动型眼球震颤。     

Amblyopic nystagmus patients and how safe they are in traffic

Summary Background: By law, applicants for driver's licenses not only have to have sufficient vision, but also have to use this sight reliably. The nystagmus patient takes advantage of ocularly induced head turns and other forms of compensation. In the approved test procedures he is deprived of such compensations. Materials and methods: The eye movements of a nystagmus patient were recorded oculographically. He was allowed to use compensatory mechanisms of body posture and movement for stabilization of vision. Results: The nystagmus patient can achieve better visual performance when he is allowed to utilize complex segmental body movements for stabilization of vision. Conclusions: It is proposed that test procedures for visual performance in traffic be altered as follows: nystagmus and abnormal head postures are admittable if sufficient binocular vision is achieved. The test may use illustrations of traffic situations containing relevant details such as traffic signs. These are to be understood by the test person on triplicate presentation.      

Head nodding is compensatory in spasmus nutans.

BACKGROUND: Spasmus nutans is defined as asymmetric nystagmus with associated head nodding in childhood. It is not clear whether head nodding is a compensatory mechanism to control the nystagmus or an involuntary movement of pathologic origin. METHODS: The authors analyzed the relation between head and eye movements by simultaneous eye and head movement recordings of 35 patients with spasmus nutans. RESULTS: In 21 of these patients, the fine, fast, dissociated nystagmus changed during head nodding to larger and slower symmetric eye movements with both eyes oscillating at the same amplitude in phase and 180 degrees out of phase to the head movements, corresponding to a normal compensatory vestibulo-ocular reflex. CONCLUSION: These findings indicate that head nodding is compensatory in spasmus nutans.     

儿童先天性眼球震颤行Parks中间带移位术前后的立体视觉

目的探讨先天性眼球震颤儿童行Parks中间带移位术前后的立体视觉。方法采用颜氏随机点同视机图片与立体视图本,对21例先天性眼球震颤儿童,做手术前正前方与中间带方位的、远与近距离立体视定性和定量测定。实行Parks中间带移位术后,再同样做远与近立体视锐度测定,进行分级对比分析。结果所有病例术后正前方基本不震颤或明显减轻,视力提高2～5行。代偿头位基本消除或改善。立体视从无到有,视锐度从800“至60“逐级提高,由周边体视转变为黄斑体视、以至中心凹体视。结论先天性眼球震颤儿童立体视觉术前可有部分发育,中间带方向好于非中间带方向,经Parks中间带移位术后,不仅解决了眼球震颤、代偿头位、视力问题,而且能使远近立体视均得到不同程度的提高。     

肉毒杆菌毒素A治疗先天性眼球震颤22例

目的:观察肉毒杆菌毒素A(BTA)治疗先天性眼球震颤(CN)的效果。方法:先天性眼球震颤患者22例,男17例,女5例。用眼震图(ENG)检查BTA注射相应眼外肌前与注射后1wk,1,3,6mo的近、远距离眼震,视力,3级视功能情况,各组进行统计学处理,并比较统计学差异。结果:各组注药前后视力改变无统计学差异(P>0.05)。注药后1mo与注药前相比,远近距离原眼位的各眼震参数降低均有明显统计学差异(P<0.05);注药后3,6mo与注药前相比近、远距离原眼位振幅降低有明显统计学差异(P<0.05);最小震强位置注药后1wk,1,3,6mo与注药前相比虽无明显差异,但从频数分布图中可见最小震强出现的位置有向原眼位集中的趋势。注药后3,6mo3级视功能与注药前相比仅融合范围扩大有显著差异(P<0.05)。结论:该方法治疗先天性眼球震颤可使近、远距离原眼位眼震有所减轻,视力、代偿头位及3级视功能有所改善。注药后1mo疗效最显著,6mo后疗效下降。该方法治疗先天性眼球震颤有明显效果。     

Unexplained head tilt following surgical treatment of congenital esotropia: a postural manifestation of dissociated vertical divergence

BACKGROUND: Strabismus surgery for congenital esotropia can be complicated by the development of a postoperative head tilt. PURPOSE: To determine the pathophysiology of acquired head tilting following horizontal realignment of the eyes in children with congenital esotropia. MATERIALS AND METHODS: Retrospective analysis of nine children with congenital esotropia who developed unexplained head tilts following horizontal realignment of the eyes. RESULTS: Shortly after strabismus surgery, each child developed a head tilt in association with asymmetrical dissociated vertical divergence (DVD). Five children maintained a head tilt toward the side of the fixing eye (group 1), which did not serve to control the DVD. Four children maintained a head tilt toward the side of the hyperdeviating eye, which served to control the DVD (group 2). Children in group 2 had earlier horizontal muscle surgery and developed better stereopsis than those in group 1, suggesting that the higher degree of single binocular vision and stereopsis in these children may have led to a compensatory torticollis to control an asymmetrical DVD. CONCLUSIONS: The onset of an unexpected head tilt after congenital esotropia surgery is usually a postural manifestation of asymmetrical DVD. In this setting, a head tilt toward the side of the fixing eye corresponds with a postural manifestation of the underlying central vestibular imbalance that produces DVD, while a head tilt toward the side of the hyperdeviating eye serves to counteract the hyperdeviation and stabilise binocular vision.     

Understanding ocular torticollis in children

Ocular abnormal head posture (AHP) or torticollis is a frequent sign in pediatric pathology The incidence is 5.6% in ophthalmological practice and 3.19% in pediatric ophthalmological practice. The abnormal head posture is adopted to improve visual acuity maintain binocular single vision, center residual visual field with the body or for cosmetic reasons. Face turn is the most frequent abnormal head posture in pediatric ophthalmology. The more common diseases causing face turn are Duane syndrome, congenital fibrosis of extraocular muscles, nystagmus, refractive errors, visual field defects. The most frequent ocular causes of head tilt in children are congenital nystagmus, superior oblique paresis, dissociated vertical deviation, Brown syndrome, refractive errors. Chin-up or chin-down abnormal head postures are most commonly caused by "A" and "V"-pattern strabismus, palpebral ptosis, nystagmus, refractive errors. Torticollis is not a diagnosis, but it is a sign of an underlying disease. There are ocular diseases which diagnosis is straightforward for general practitioner, pediatricians or pediatric surgeons (horizontal nystagmus, lateral rectus paralysis, ptosis, esotropia), but others less obvious (superior oblique paralysis, Duane syndrome, A and V-pattern strabismus, torsional nystagmus) because of the compensatory head posture, and these last disorders are predisposed to confusion with congenital AHP Interdisciplinary collaboration between ophthalmologist, pediatrician, pediatric surgeon, ENT specialist and neurologist is mandatory in establishing the etiology of AHP Every child with AHP must be examined by an ophthalmologist.     

Eye and head movements in patients with achromatopsia

The diagnosis of patients with rod monochromatism (RM) and blue-cone monochromatism (BCM) may be difficult. The relative direction and symmetry of nystagmus of the two eyes, as well as the existence or nature of rhythmic head movements, are not known. We analyzed simultaneous eye and head movement recordings of 16 patients with RM and three patients with BCM. Longitudinal examinations were performed in seven patients. Younger patients had pendular, intermittent or continuous oblique nystagmus with both eyes oscillating in phase or out of phase with equal amplitudes. Older patients had continuous symmetrical oblique jerk nystamus with decreasing velocities in the slow phase. In two children, we demonstrated evolution from pendular to predominantly jerk nystagmus. Rhythmic head movements were detected in all children. Patients with RM and BCM exhibit a distinct entity of nystagmus and can be differentiated from patients with congenital or latent nystagmus. However, eye and head movements can mimic spasmus nutans.     

手术治疗先天性眼球震颤合并斜视

目的 探讨先天性眼球震颤合并斜视的手术方法和效果.方法 回顾性分析先天性眼球震颤合并斜视手术24例.手术的设计根据中间带位置、代偿头位、斜视角度和主导眼的关系进行综合考虑,代偿头位矫正在主导眼上施行,斜视矫正在非主导眼上施行.结果 手术后随访3 ～12个月,平均（6.38±2.18）月.20例（83.33％）术后代偿头位消失,3例（12.50％）代偿头位明显改善,残留原方向15°以内头位扭转角,1例（4.17％）过矫.18例（75.00％）术后眼位达到正位,5例（20.83％）达到轻度欠矫或过矫,1例（4.17％）明显欠矫.所有病例原在位眼震减轻或消失,原在位双眼同时视视力均较术前提高2行或2行以上.术前术后双眼同时视视力及头位扭转角变化差异均有统计学意义（z=-5.83,-3.37,P ＜0.01）.结论 合并有斜视的先天性眼球震颤,手术既要矫正斜视又要解决代偿头位,合理的手术设计可以取得良好的治疗效果.     

The relationship between head and eye movement in congenital nystagmus with head shaking: objective recordings of a single case.

Head shaking and congenital nystagmus were recorded in a patient presented with visual tasks. When she was at rest the nystagmus took a 6 cycles per second saw-tooth wave-form. When she was attentive the nystagmus beat at a 2 to 2.6 cycles per second with a saddle-shaped deformation which permitted foveation. The head shaking occurred occasionally when the patient was attentive and was phase-locked to the nystagmus with resemblances in wave form and direction. Deceleration of the head shaking to zero velocity and peak displacement (to the left) coincided with the onset of the saddle of the nystagmus and hence assisted foveation; all other parts of the head-shaking cycle were detrimental to vision. It is proposed that the head shaking has a common pathological origin with the nystagmus and that, just as an isolated congenital nystagmus wave form becomes altered with attention to permit periods of foveal fixation, the pattern of combined head and eye nodding in this patient provided similar peroids of fixation.