一名获得性双侧上斜肌麻痹患者在双侧原田-伊藤手术前后的定量眼动记录。

Ying Howard S, Darbandi Bejan, Shan Xiaoyan, Barker Peter, Miller Neil R, Zee David S

Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Strabismus. 2007 Jul-Sep;15(3):137-47. doi: 10.1080/09273970701505609.

PURPOSE

We examined the effects of the Harada-Ito procedure on static and dynamic alignment in an adult with acquired bilateral superior oblique palsy (SOP).

METHODS

3D eye movements were recorded before and six weeks after a bilateral Harada-Ito procedure. Superior oblique muscle (SOM) size and contractility were assessed with orbital imaging.

RESULTS

On MRI, the left SOM was smaller than the right. Little contractile thickening was present in down gaze for either eye. Preoperatively, the patient had a hypertropia: 1.9 degrees right hypertropia (at down 20 degrees , left 20 degrees ) and 6.4 degrees left hypertropia (at down 20 degrees , right 20 degrees ). Postoperatively, the vertical tropia in all positions was < 1 degrees . Listing's primary position rotated toward straight ahead for the RE but was unchanged for the LE. Postoperatively, for 40 degrees upward saccades peak dynamic intrasaccadic extorsion decreased by 2.2-3.2 degrees for both eyes and for 40 degrees downward saccades by 2.3-3.6 degrees for the RE but was unchanged for the LE. Saccade conjugacy improved and post-saccadic drift lessened for all vertical saccades.

CONCLUSIONS

The Harada-Ito procedure produced striking improvements in static and dynamic alignment in bilateral SOP. Some changes were binocular (decreased post-saccadic drift, improved saccade conjugacy, less dynamic extorsion for upward saccades) but others were much greater in the less paretic eye (torsional gradients from up to down gaze, less dynamic extorsion for downward saccades). Both central adaptive and peripheral mechanical changes explain these findings. Our results also imply that the Harada-Ito procedure has more effect when there is residual function of the SOM.

目的

我们研究了原田-伊藤手术对一名获得性双侧上斜肌麻痹（SOP）成人患者静态和动态眼位矫正的效果。

方法

在双侧原田-伊藤手术前及术后六周记录三维眼动。通过眼眶成像评估上斜肌（SOM）的大小和收缩性。

结果

在磁共振成像（MRI）上，左侧SOM比右侧小。双眼在向下注视时几乎没有收缩性增厚。术前，患者存在上斜视：右眼上斜视1.9度（向下注视20度、向左注视20度时），左眼上斜视6.4度（向下注视20度、向右注视20度时）。术后，所有眼位的垂直斜视均<1度。右眼的Listing主眼位向前旋转至正视位，而左眼未改变。术后，双眼向上注视40度扫视时，眼内扫视期峰值动态外旋减少2.2 - 3.2度；右眼向下注视40度扫视时，减少2.3 - 3.6度，而左眼未改变。所有垂直扫视的扫视共轭性改善，扫视后漂移减少。

结论

原田-伊藤手术在双侧SOP的静态和动态眼位矫正方面产生了显著改善。一些变化是双眼性的（扫视后漂移减少、扫视共轭性改善、向上扫视时动态外旋减少），但其他变化在麻痹较轻的眼睛中更为明显（从上向下注视时的扭转梯度、向下扫视时动态外旋减少）。中枢适应性和外周机械性变化均能解释这些结果。我们的结果还表明，当SOM存在残余功能时，原田-伊藤手术的效果更佳。