眼球震颤的外科治疗。

Atilla H, Erkam N, Işikçelik Y

Department of Ophthalmology, School of Medicine, Ankara University, Turkey.

Eye (Lond). 1999;13 ( Pt 1):11-5. doi: 10.1038/eye.1999.3.

PURPOSE

To evaluate the effect of symmetric recession surgery on all four horizontal rectus muscles in the treatment of patients with congenital motor nystagmus and sensory nystagmus secondary to albinism, dyschromatopsia and degenerative myopia.

METHODS

Prospectively, four patients with a diagnosis of congenital motor nystagmus and eight patients with sensory nystagmus were operated on. The amount of recession was determined according to the ocular alignment of the patients. Electronystagmographic recordings were conducted in every patient pre-operatively and post-operatively, as well as an ophthalmological examination.

RESULTS

Mean age of the patients at the time of the first visit was 6.7 +/- 4.2 years (range 9 months to 14 years) and mean age at the time of operation was 8.3 +/- 2.7 years (range 6-14 years). In 8 cases an equal amount of weakening of the four horizontal recti was done, whereas in 2 cases more recession on the lateral recti due to exotropia and in 2 cases more recession on the medial recti due to esotropia was performed. Mean follow-up time was 15.8 months (min. 6 months, max. 28 months). Improvement in visual function was achieved in 7 patients. Amplitude decreased in 9 patients. One patient had a decrease in visual acuity due to progression of her primary macular degeneration. Improvement in head posture was seen in 3 patients and there was no change in the head posture in 2 patients. One patient acquired head posture after surgery. Restriction of motility was seen in none of the patients after surgery in spite of large amounts of recession. Recession of horizontal recti decreased nystagmus amplitude and frequency in 81.8% of patients. Improvement in visual function, measured as an increase in visual acuity in terms of Snellen lines, was achieved in 63.6% of patients.

CONCLUSION

Symmetric recession of the horizontal rectus muscles is shown to be a successful procedure to perform in nystagmus patients, resulting in an increase in visual acuity and a decrease in nystagmus amplitude and frequency. It is a reliable alternative to the Kestenbaum operation and is easier to perform surgically.

目的

评估对所有四条水平直肌进行对称后徙手术治疗先天性运动性眼球震颤以及白化病、色觉异常和变性近视继发的感觉性眼球震颤患者的效果。

方法

前瞻性地对4例先天性运动性眼球震颤患者和8例感觉性眼球震颤患者进行手术。根据患者的眼位确定后徙量。每位患者在术前和术后均进行眼震电图记录以及眼科检查。

结果

患者首次就诊时的平均年龄为6.7±4.2岁（范围9个月至14岁），手术时的平均年龄为8.3±2.7岁（范围6 - 14岁）。8例患者对四条水平直肌进行了等量减弱，2例因外斜视对外侧直肌进行了更多后徙，2例因内斜视对内侧直肌进行了更多后徙。平均随访时间为15.8个月（最短6个月，最长28个月）。7例患者视觉功能得到改善。9例患者眼震幅度降低。1例患者因原发性黄斑变性进展导致视力下降。3例患者头位改善，2例患者头位无变化。1例患者术后出现头位。尽管进行了大量后徙，但术后无患者出现眼球运动受限。水平直肌后徙使81.8%的患者眼震幅度和频率降低。63.6%的患者视觉功能得到改善，表现为Snellen视力表视力提高。