Rose Loreto V T, Elder James E
Department of Ophthalmology, Royal Children's Hospital, Melbourne, Victoria, Australia.
Clin Exp Ophthalmol. 2007 Dec;35(9):840-6. doi: 10.1111/j.1442-9071.2007.01613.x.
To document the presentation and management of congenital III nerve palsy and monocular elevation deficiency to single ophthalmologist over a 14-year period. Surgical management was reviewed and visual outcome was analysed.
A retrospective study was conducted of all patients presenting during a period between 1992 and 2006 to the private practice of a paediatric ophthalmologist, with either congenital III or monocular elevation deficiency. For patients requiring surgical intervention pre- and post-surgical data were documented and analysed.
A total of 19 congenital III and 13 monocular elevation deficiency patients were identified. There were eight surgical patients in each congenital III nerve palsy group and in the monocular elevation deficiency group. The congenital III group had a preoperative mean exotropia for near of -36 prism dioptres (PD) compared with postoperative mean exotropia for near -16 PD. Preoperative mean hypotropia for near of -19 PD was improved to postoperative mean hypotropia of -5 PD. The monocular elevation deficiency group had preoperative mean esotropia for near of +6 PD compared with postoperative mean exotropia for near -5 PD. Preoperative mean hypotropia for near of -15 PD was improved to postoperative mean hypotropia of -7 PD. At last follow up both groups had a majority of mild or no amblyopia noted.
Superficially, congenital III and monocular elevation deficiency may appear similar, both frequently having ptosis and hypotropia as features. Careful clinical assessment of the horizontal alignment and the result of forced duction testing will usually allow them to be distinguished. Congenital III more frequently requires surgery for exotropia as well as surgery for hypotropia and monocular elevation deficiency more often requires surgery just for hypotropia. The ptosis surgery is similar for either diagnosis in this study. Significant cosmetic improvement, as well as excellent visual acuity outcomes can be achieved.
记录14年间一名眼科医生对先天性动眼神经麻痹和单眼上睑提肌功能不全的诊治情况。回顾手术治疗方法并分析视觉预后。
对1992年至2006年间在一名小儿眼科医生私人诊所就诊的所有先天性动眼神经麻痹或单眼上睑提肌功能不全患者进行回顾性研究。记录并分析需要手术干预患者的术前和术后数据。
共确定19例先天性动眼神经麻痹患者和13例单眼上睑提肌功能不全患者。先天性动眼神经麻痹组和单眼上睑提肌功能不全组各有8例手术患者。先天性动眼神经麻痹组术前近距平均外斜度为-36棱镜度（PD），术后近距平均外斜度为-16PD。术前近距平均下斜度为-19PD，术后改善为平均下斜度-5PD。单眼上睑提肌功能不全组术前近距平均内斜度为+6PD，术后近距平均外斜度为-5PD。术前近距平均下斜度为-15PD，术后改善为平均下斜度-7PD。在最后一次随访时，两组大多数患者弱视程度较轻或无弱视。
表面上看，先天性动眼神经麻痹和单眼上睑提肌功能不全可能相似，两者都常以上睑下垂和下斜视为特征。仔细的临床水平斜视评估和强迫牵拉试验结果通常可将它们区分开来。先天性动眼神经麻痹更常需要进行外斜视手术以及下斜视手术，而单眼上睑提肌功能不全更常仅需进行下斜视手术。本研究中，两种诊断的上睑下垂手术相似。可实现显著的外观改善以及良好的视力预后。
