Adams Wendy E, Leavitt Jacqueline A, Holmes Jonathan M
Department of Ophthalmology Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
J AAPOS. 2009 Feb;13(1):13-5. doi: 10.1016/j.jaapos.2008.08.008. Epub 2008 Dec 12.
Internuclear ophthalmoplegia (INO) is a disabling condition affecting up to 40% of patients with multiple sclerosis (MS). Management of bilateral internuclear ophthalmoplegia (BINO) with exotropia in MS has been controversial because of the uncertain course of MS. Diplopia associated with INO severely impacts the patient's quality of life and, therefore, treatment should be considered.
Three patients (ages 28, 62, and 82 years) who had BINO with exotropia and disabling diplopia secondary to MS underwent bilateral medial rectus resections with either unilateral or bilateral adjustable lateral rectus recession(s). Alignment was measured preoperatively and postoperatively, and symptoms were recorded.
Preoperative exotropia ranged from 40(Delta) to 64(Delta) for distance fixation and from 50(Delta) to 70(Delta) for near fixation. Preoperatively, all patients had diplopia at distance and near fixation. Immediately after surgery, patients were adjusted to 10(Delta) to 18(Delta) ET at distance fixation with the expectation of an exotropic drift. None of the patients had a tropia at distance and near fixation 6 months after surgery, with single vision in primary position and reading. Two patients had a 2-year follow-up examination; 1 required a small amount of base-in prism for comfortable reading.
Three patients who had BINO with exotropia secondary to MS all benefited from surgery. Surgery should be considered as an option for symptomatic patients who have BINO with exotropia caused by MS.
核间性眼肌麻痹（INO）是一种致残性疾病，影响多达40%的多发性硬化症（MS）患者。由于MS病程不确定，MS合并外斜视的双侧核间性眼肌麻痹（BINO）的治疗一直存在争议。INO相关的复视严重影响患者的生活质量，因此应考虑进行治疗。
3例（年龄分别为28岁、62岁和82岁）患有继发于MS的BINO并伴有外斜视和致残性复视的患者接受了双侧内直肌切除术，并联合单侧或双侧可调节外直肌后徙术。术前和术后测量眼位，并记录症状。
远距离注视时术前外斜视度数范围为40△至64△，近距离注视时为50△至70△。术前，所有患者在远距离和近距离注视时均有复视。手术后即刻，患者在远距离注视时眼位调整为10△至18△外斜视，预期会有外斜视漂移。术后6个月，所有患者在远距离和近距离注视时均无斜视，正位和阅读时均为单眼视。2例患者进行了2年的随访检查；1例患者在舒适阅读时需要少量底向内棱镜。
3例继发于MS的BINO并伴有外斜视的患者均从手术中获益。对于患有继发于MS的BINO并伴有外斜视的有症状患者，应考虑将手术作为一种治疗选择。
