分离性垂直偏斜18例报告

目的探讨分离性垂直偏斜（dissociatedverticaldeviation，DVD）的临床特点和治疗方法。方法回顾分析18例DVD病例。结果临床特点（1）交替遮盖被遮眼向上偏斜，与一般斜视的神经支配法则相矛盾；（2）常合并隐性眼震；（3）多合并水平斜视；（4）双眼视功能不佳；（5）常合并下转肌或上转肌亢进或麻痹；（6）合并Helveston综合征（Helveston综合征指DVD和A型外斜及上斜肌过强三者同时存在的综合征）；（7）视力往往良好，但也有合并视力减退。治疗方法首选上直肌后徙加后固定缝线。若合并下斜肌亢进，则作下斜肌转位术。18例病人出院时均为正位，随诊时间术后1个月～2年，18例病人中15例在第一眼位无明显上斜现象。仅在遮盖一眼时出现轻度上斜。一例术后一年第一眼位5°上斜，较术前斜度明显减少。结论当DVD病人上斜明显影响外观时应行手术治疗。

Dissociated verticaldeviation

Objective:To evaluate the clinical features and treatment of dissociated vertical deviation (DVD).Method 18 cases of DVD were reviewed restrospectively.Results Clinical features:(1)the covered eye deviated upward in alterative cover test, contradictory to the nerve-controlling deviations;(2)DVD are frequently accompanied by latant nystagmus;(3)DVD patients may have other types of squint at the same time;(4)poor binocular visual function;(5)supraverge or infraverge muscle hyper activated or paralysed;(6)Helveston syndrome may be present at the same time;(7)Visions of both eyes usually are good,but may be poor in one eye or in both eyes.Treatment:Recession of superior rectus combined with posterior fixation suture is prefered as the initial procedure,and this may be combined with transplantation of inferior oblique if the latter muscle is over-activating.Postoperatively,15 cases show mild hypertropia at l month to 2 year postoperatively while 1 case shows marked hypertropia.Conclusion When hypertropia of DVD is so prominent that becomes a significant cosmetic handicap,surgery is recommended.