Broniarczyk-Loba Anna, Nowakowska Olimpia, Loba Piotr
Przyklinicznej Poradni Leczenia Zeza przy Uniwersyteckim Szpitalu Klinicznym nr 1 im. N. Barlickiego w Łodzi.
Klin Oczna. 2007;109(7-9):292-6.
Oblique muscles motility disorders may influence the magnitude of dissociated vertical deviation (DVD), resulting in greater vertical deviation in abduction and smaller in adduction. The diagnosis of this pattern of dissociation is essential for the selection of appropriate surgical management.
The aim of this study was to assess optimal diagnostic and treatment procedures in patients with incomitant dissociated vertical deviation, superior oblique overaction and esotropia.
Five patients with the constellation of esotropia, bilateral superior oblique overaction, A-pattern, and incomitant dissociated vertical deviation are presented. In each case the magnitude of vertical deviation was greater in abduction and minimal or absent in adduction. Four patients underwent asymmetric bilateral superior rectus recessions and partial tenotomy of the posterior and middle fibers of superior oblique tendons. In one case additional surgery of horizontal muscles was performed.
In all cases the A-pattern, DVD was markedly reduced or eliminated, and comitancy was achieved.
Recognition of the described pattern is important in selecting appropriate surgical management. Asymmetric bilateral superior rectus recessions and partial tenotomy of the posterior and middle fibers of superior oblique tendons is useful in reducing the A-pattern and incommitancy in DVD.
斜肌运动障碍可能会影响分离性垂直偏斜（DVD）的程度，导致外展时垂直偏斜更大，内收时更小。这种分离模式的诊断对于选择合适的手术治疗至关重要。
本研究的目的是评估伴有非共同性分离性垂直偏斜、上斜肌亢进和内斜视患者的最佳诊断和治疗方法。
介绍了5例患有内斜视、双侧上斜肌亢进、A型模式和非共同性分离性垂直偏斜的患者。在每种情况下，垂直偏斜的程度在外展时更大，在内收时最小或不存在。4例患者接受了不对称双侧上直肌后徙术和上斜肌腱后、中纤维部分切断术。1例患者进行了额外的水平肌手术。
在所有病例中，A型模式、DVD明显减轻或消除，实现了共同性。
认识到所描述的模式对于选择合适的手术治疗很重要。不对称双侧上直肌后徙术和上斜肌腱后、中纤维部分切断术有助于减少A型模式和DVD的非共同性。
