Magnetic resonance imaging of the extraocular muscles and corresponding cranial nerves in patients with special forms of strabismus

Background With the technical advances, magnetic resonance imaging （MRI） is now sensitive enough to detect subtle structural abnormalities of ocular motor nerves arising from the brainstem and orbits of living subjects. This study was designed to delineate the MRI characteristics in patients with special forms of strabismus. Methods A total of 29 patients with special forms of strabismus underwent orbital and intracalvafium MRI. Imaging of the ocular motor nerves in the brainstem was performed in 0.8 mm thickness image planes using the three-dimensional fast imaging employing steady-state acquisition （3D-FIESTA） sequence. Nerves to extraocular muscles （EOMs）, EOMs and their associated connective tissues were imaged with T1 weighting in tri-planar scans by dual-phased coils within 2.0 mm thick planes. Results Patients with congenital fibrosis of the extraocular muscles exhibited hypoplasia of the oculomotor （CN3）, abducens （CN6）, trochlear （CN4） nerves, and the EOMs; hypoplasia of CN6 in the brainstem and an extra branch of the inferior division of CN3 to the lateral rectus were the most common but not the only presentation of Duane＇s retraction syndrome. Hypoplasia of CN6, facial （CN7） and hypoglossal （CN12） nerves were revealed in patients with MSbius syndrome. In a rare case of bilateral synergistic convergence and divergence, an enlarged branch of CN3 to the medial rectus and a questionable branch of CN3 to the inferior rectus bilaterally were found. Conclusion MRI can reveal subtle structures of the ocular motor nerves and their corresponding EOMs. This can provide valuable information regarding pathogenesis in some special forms of strabismus.     

Duane眼球后退综合征28例临床分析

目的：探讨Duane眼球后退综合征（DRS）的临床特点和治疗方法。方法：回顾性分析28例DRS患者临床资料,20例内斜视患者行内直肌后徙术,5例外斜视患者行外直肌后徙术,3例Ⅲ型患者因原在位维持在正位,没有明显的代偿头位,未行手术治疗。结果：术后眼球后退、睑裂变小体征改善或消失。20例内斜视患者术后17例斜视度数≤10度,3例斜视度数〉10度,3例患者术后眼球后退、内转时睑裂变小体征仍严重且眼球内转时急速上、下转现象仍明显,行对侧直肌后固定缝线术后体征改善或消失。5例外斜视患者3例术后斜视度数≤10度,2例术后斜视度数均〉10度,1例外斜视者伴有下斜肌功能亢进,同时行下斜肌截腱术或转位术。随访3个月～1年,疗效稳定。结论：不同类型DRS的临床表现不同,其部分临床表现和眼外肌受累情况有时很难与先天性广泛纤维化区分,如上睑下垂、大度数斜视等,需进行更为深入细致的研究。     

35例上斜肌麻痹手术临床分析

分析先天性上斜肌麻痹所致的眼性斜颈３５例，术前测量第一眼位和头倾向患眼侧时的垂直偏斜度。此两者之和小于３５△时只作患眼下斜肌减弱术，大于３５△时作患眼下斜肌减弱术的同时作上直肌后徙术。术后斜颈消失，垂直偏斜小于５△者３０例（８６％），认为在眼性斜颈治疗中，患眼上直肌后徙术是效果可靠而可行的手术方法，其后徙量为１３～１４△／ｍｍ为宜。     

V型斜视合并下斜肌功能亢进的治疗

目的：探讨合并下斜肌亢进的V型斜视的治疗。方法：用对称的下斜肌减弱合并水平直肌的后徙，缩短术治疗。结果 29例V征消失，2例第一眼位仍有内斜视，1例出现垂直斜视。结论：对称性下斜肌减弱术是治疗合并有下斜肌功能亢进的V型斜视的有效术式。     

不同术式在儿童V型斜视治疗中的效果比较

目的：探讨不同术式对儿童V型斜视的治疗效果。方法：对15例V型内斜视在内直肌后徙＋外直肌缩短的同时行一侧或双侧下斜肌部分切除术;另外3例内直肌后徙同时向下移位5mm,外直肌缩短并向上移位5mm。对20例V型外斜视外直肌后徙且向上移位5mm,内直肌缩短同时向下移位5mm;另外8例在外直肌后徙＋内直肌缩短的同时行一侧或双侧下斜肌部分切除术。结果：四种方法均取得了比较满意的效果,术前、术后各项指标比较,均有显著性差异（P〈0.05）。结论：对儿童V型外斜视应根据病因选择不同的手术方式,以矫正眼位,最大程度地建立双眼单视功能。     

Magnetic resonance imaging of unilateral vertical retraction syndrome with atypical strabismus

We report two patients with unilateral vertical retraction syndrome. Magnetic resonance imaging (MRI) of the orbits of the two cases showed similar size and location of the orbital structure, but with dramatically different strabismus type. MRI sagittal reconstruction of the orbits suggested that abnormal muscle tissue arised from the inferior rectus, which might be associated with retraction and narrowing of the palpebral fissure and atypical strabismus as well.

     

Surgical treatment of acquired esotropia in patients with high myopia

Acquired esotropia with high myopia may be associated with superotemporal eyeball prolapse from the muscle cone and the subsequent shift of extraocular muscles limits the success of the traditional recession–resection surgery. In this study, we report two patients diagnosed with myopic strabismus fixus with esodeviation >90 prism diopter. Marked axial elongation of globes was present in both the patients. They received medial rectus muscle recession and hemi-Jensen procedure in both eyes. Postoperatively, they showed significant improvement in abduction, elevation, and ocular alignment. We found that the combination of medial rectus muscle recession and hemi-Jensen procedure was effective in treating patients with acquired large esotropia with high myopia.     

伴有不典型斜视的单侧垂直后退综合征的MRI表现

对两例单侧垂直后退综合征患者临床表现及核磁共振结果的分析,探讨其发病机制。MRI显示发自总腱环的与眼外肌等信号的条索样结构至于眼球后壁,两位患者眶内异常结构均附着于眼球的颞下方,表现出不同的斜视。连续斜冠状位核磁共振结果示两患者眼眶内异常结构起止点不尽相同,且具有可疑的异常神经支配,与患者上方注视时眼球后退、睑裂变小相关。     

垂直性斜视手术效果的临床分析

[目的]探讨不同术式对垂直性斜视的矫正效果。[方法]采用不同手术方式施垂直性斜视矫治,记录并比较手术效果。[结果]下斜肌断腱切除的手术量与手术效果具有相关性(r=0.42);下斜肌断腱切除术与肌腱切开术的手术效果无统计学差异;上下直肌后徙手术量与手术效果具有良好相关性。[结论]垂直性斜视的手术方式中,上斜肌断腱切除术及上下直肌后徙术是定量性术式。     

水平斜视合并垂直斜视手术方法研究

目的 :探讨水平斜视合并垂直斜视手术方法。方法 :在临床中对水平斜视合并垂直斜视的患者 ,随意分成两组 ,一组为对照组 ,即第一期手术矫正垂直斜度 ,7d后再做水平斜度矫正 ,分两次手术完成。另一组为观察组 ,通过水平肌肉止端移位能使眼球上、下移位的原则 ,在做水平斜视同时将水平肌肉止端移位 ,达到一次性手术不仅能解决水平斜视 ,同时也矫正垂直斜视度。结果 :两组手术后临床观察眼位 ,治疗效果无显著性差异 (P >0 0 5 )。结论 :水平斜度不超过 35度 ,合并垂直斜度不超过 5度的患者 ,可以通过一次性手术达到治愈效果。     

调整性直肌后徙斜视矫正术

目的　探讨调整性直肌后徙斜视矫正术的治疗效果。方法　共同性斜视患者 34例 ,常规眼部消毒、铺巾、局麻后暴露及分离直肌 ,根据直肌后徙量 ,将缝线垂直于肌肉缝合在巩膜浅层 ,调整直肌后徙量至眼位达理想位置 ,再将缝线缝合于肌止缘 ,缝合结膜。结果　全部患者经手术中调整直肌后徙量 ,均一次性矫正斜视眼位 ,随访 6个月无复发。结论　调整性直肌后徙斜视矫正术治疗斜视其操作简便 ,矫正位置比较理想     

Megnetic resonance imaging findings in sporadic Mobius syndrome

Background Although neuroradiological findings of M(o)bius syndrome have been reported as a result of brain and brainstem abnormalities,magnetic resonance imaging (MRI) now permits the direct imaging o...     

直肌后徙联合后部巩膜缝线悬吊固定术治疗甲状腺相关眼病限制性斜视

目的：探讨甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)致限制性斜视患者行直肌后徙联合后 部巩膜缝线悬吊固定术后的斜视度、复视图及双眼视觉功能的变化。方法：选择2010年7月至2013年6月于中南大学 湘雅医院眼科诊治的因TAO导致限制性斜视行手术治疗的患者18例(19只眼),8例(8只眼)为限制性下斜视,行下直肌 徙后术;5例(5只眼)为限制性上斜视,行上直肌徙后术;2例(2只眼)为限制性内上斜视,分次行上直肌徙后及内直 肌徙后术;3例(4只眼)为限制性内斜视,行内直肌徙后术。其中2例(下斜视1例,内斜视1例)为眼眶减压术后患者, 二期行眼外肌徙后术。所有患者均行直肌后徙联合后部巩膜缝线悬吊固定术。手术前和手术后均进行斜视度、复视 图及立体视觉检查,并进行对照比较。结果：18例患者均随访6个月以上。手术前斜视度为20Δ~80Δ,术后斜视度为 2Δ~10Δ;术前16例患者第一眼位有复视,术后14例患者第一眼位及下转15°方位复视消失,2例患者第一眼位复视消 失,下方视野残留复视症状;术前具立体视觉患者2例,术后具立体视觉患者增至14例,各项指标术后与术前比较, 差异均具有统计学意义(均P<0.05)。结论：TAO导致限制性斜视患者行直肌后徙联合后部巩膜缝线悬吊固定术可有效 改善斜视度,消除复视,有助于提高患者的生活质量。     

连续性外斜视23例临床分析

目的 探讨内斜视术后继发外斜视的相关因素及手术方式.方法 对2004年6月至2009年10月在邢台市眼科住院的23例内斜视术后继发外斜视的患者施行手术治疗并观察疗效.结果 内直肌后徙量超过角膜缘后11.5 mm常造成术后眼球运动受限,与常规量内直肌后徙(距角膜缘＜11.5 mm)引起的眼球受限例数比较经χ2检验P＜0.05.结论 (1)内直肌后徙量超过角膜缘后11.5 mm常造成术后眼球运动受限,从而导致继发性外斜视;(2)外直肌后徙联合后徙的内直肌前徙和/或缩短是治疗继发性外斜视的有效方式;(3)术中5～10 PD小度数过矫可提高远期的术后正位率.     

斜视手术对角膜内皮形态影响的评价与分析

目的评价斜视手术后角膜内皮细胞的变化.方法将38例斜视患者分为单条水平直肌手术组和水平直肌截退术两组,采用非接触角膜内皮镜观察斜视手术前后角膜内皮细胞的形态及密度的变化,比较手术方式对角膜内皮细胞形态的影响.结果斜视手术前后角膜内皮细胞密度无显著性差异（P〉0.05）,单条水平直肌手术和水平直肌截退术对角膜内皮细胞形态的影响有显著差异（P〈0.05）.结论斜视手术对角膜内皮产生了轻微、暂时的营养不良;角膜内皮细胞检查可作为一种观察指标对眼前节缺血进行预测.     

TREATMENT OF A-V SYNDROME

Analysis of the surgical results of 27 patients with A-V syndrome came to the following conclu ;sions: a. If the V-exotropia was 30 prism diopter (p.d.) or less without obvious misalignment in down gaze, a bilateral 8 mm recession with 5 mm elevation of lateral rectus insertions would usually be sufficient to correct the misalignment or at least to eliminate ir in primary position and down gaze. b. If the V-esotropia or V-exotropia was more than 30 p.d. with some deviation in down gaze, surgery on three horizontal muscles was necessary. c. When V- exotropia was accompanied by overacting inferior oblique, weakening of the latter at the same setting would further reduce the deviation in upward gaze. In the 27 patients, the vertical displacement of hori zontal muscle insertions did not cause any substantial torsional disturbances.     

眼上直肌、外直肌肌腹联合术矫正16例高度近视限制性斜视的临床效果分析

目的 评估上直肌、外直肌肌腹联合术治疗高度近视限制性内、下斜视的临床效果。方法 回顾性分析16例27只高度近视限制性斜视眼患者的病例资料,所有患者患眼采用上直肌、外直肌肌腹联合术。随访时间3～12月,比较手术前、后患者的斜视度及眼球运动度。结果 所有患者术前患眼均有不同程度的上转和外转受限,术前平均内斜视度为（92.50±18.17）△,平均下斜视度为（21.88±5.74）△,眼球外转受限程度为-3.19±0.62,眼球上转受限程度为-2.85±0.82;术后患者眼球外转（外转受限程度为-1.15±0.52）、上转（上转受限程度为-0.78±0.51）均有明显提高,与术前比较,差异有统计学意义（ P<0.01）,内斜视度〔平均为（9.19±4.39）△〕及下斜视度〔平均为（2.38±3.10）△〕明显减小,与术前比较,差异有统计学意义（ P<0.01）,除术前斜视度较大的个别患者外,总体效果较为满意（包括获得较为满意的外观）。结论 上直肌、外直肌肌腹联合术能矫正高度近视引起的限制性内下斜视,获得较为满意的外观。     

分离性垂直偏斜手术治疗探讨

目的 :探索治疗分离性垂直偏斜 (DVD)的最佳手术方式。方法 :对 10 3例 192眼DVD患者应用上直肌后退术 ,上直肌后退联合后固定缝线术 ,下斜肌转位术及上直肌后退联合下斜肌转位术进行随机分组治疗。结果 :后退组近期效果良好者 6 7.39% ,远期 5 8.82 % ,P <0 .0 0 5。后退 后固定组近期效果良好者 82 .6 9% ,远期 80 .5 6 % ,P>0 .5。下斜肌转位组近期效果良好者 6 5 % ,远期 5 6 .6 7% ,P >0 .0 0 1。后退 下斜肌转位组近期效果良好者 83.72 % ,远期 81.2 5 % ,P >0 .1。结论 :单独上直肌后退和下斜肌转位术治疗DVD效果不佳 ,后退 后固定缝线组及后退 下斜肌转位组效果可靠 ,后者尤其适用于合并下斜肌亢进患者     

Outcome of early surgery in infantile esotropia: Our experience in tertiary care hospital

BackgroundInfantile esotropia is a convergent strabismus presenting before 6 months of age and is the most common strabismus disorder presenting in the ophthalmology OPD. The dilemma of whether to go for early surgery and how early has been a matter of research for the last 50 years. We describe our results of surgery in infantile esotropia at variable age groups, as well as with different reoperation rates and compare with the results in western literature.MethodsA prospective study was carried out through a review of 113 cases operated for infantile esotropia between February 2013 and August 2014. The variables studied were: age at surgery, type of fixation, refractive error, associated nystagmus, inferior oblique overaction or dissociated vertical deviation (DVD), type of surgery performed and pre- and postoperative deviation angles.ResultsThere were 67 male and 46 female cases of infantile esotropia. The age group of patients varied from 6 months to 12 years. Latent nystagmus was seen in 22 cases, inferior oblique overaction in 49 cases and DVD (mild) in 14 cases. Bimedial rectus recession was done in 78 cases and recession–resection in non-dominant eye in remaining 35 cases. The postoperative residual deviation was <10 PD in 102 cases, between 10 and 16 PD in 5 cases and more than 16 PD in 6 cases. Only 6 cases (5.3%) required reoperation for correction of residual deviation.ConclusionThe authors recommend surgery before 12 months in all cases of infantile esotropia. The reoperation rates in the current study were considerably low.     

内直肌超常规量后徙矫正大角度内斜视

本文报告26例(27眼)大角度(≥50)内斜视在一眼作内直肌超常规量后徙,一次手术矫正率88.89％。眼球内转及辐辏无明显障碍。提示此类内直肌后徒极量可由5mm放宽至7mm。