Emoto Yuko, Emoto Hirofumi, Fujie Waki, Wakakura Masato
Department of Neuro-ophthalmology, Inouye Eye Hospital, Tokyo Medical and Dental University, Kanda, Chiyoda-ku, Tokyo, Japan.
J Pediatr Ophthalmol Strabismus. 2009 Nov-Dec;46(6):358-61. doi: 10.3928/01913913-20091104-07. Epub 2009 Nov 18.
Variable eye misalignment and blepharoptosis in childhood ocular myasthenia gravis can lead to permanent binocular visual loss. However, a standard ophthalmologic intervention for this condition has yet to be fully established. This study investigated the influence of variable eye misalignment and asymmetric blepharoptosis on the development of binocular vision in childhood ocular myasthenia gravis.
The authors retrospectively reviewed clinical records of consecutive patients with childhood ocular myasthenia gravis whose age of onset was younger than 36 months and who had follow-up periods of more than 1 year. Five patients were enrolled and were treated medically with pyridostigmine or corticosteroids. Eye alignment, eye movements, and blepharoptosis were observed during the follow-up period. Stereoacuity was recorded before and at the end of follow-up using Titmus stereoscopic and major amblyoscopic tests.
None of the patients had amblyopia or anisometropia, but all had blepharoptosis that improved within 2 weeks after medication was administered. There was only one case in which stereoacutiy failed to develop, and this patient had a long period of constant exotropia lasting 48 months. In the remaining four cases, there was constant exotropia lasting less than 4 months or intermittent exotropia throughout the follow-up period. All of these patients regained or maintained binocular vision.
Prolonged constant eye misalignment may be attributable to impaired binocular vision, and prompt eye alignment may be necessary in childhood ocular myasthenia gravis. Therefore, treatment based on precise assessment by a neuro-ophthalmologist or pediatric ophthalmologist that evaluates even slight eye misalignment is essential in ensuring normal development of binocular vision.
儿童眼型重症肌无力患者出现的可变眼位偏斜和上睑下垂可导致永久性双眼视力丧失。然而，针对这种情况的标准眼科干预措施尚未完全确立。本研究调查了可变眼位偏斜和不对称上睑下垂对儿童眼型重症肌无力患者双眼视觉发育的影响。
作者回顾性分析了连续的儿童眼型重症肌无力患者的临床记录，这些患者发病年龄小于36个月，随访时间超过1年。共纳入5例患者，采用吡啶斯的明或皮质类固醇进行药物治疗。在随访期间观察眼位、眼球运动和上睑下垂情况。使用Titmus立体视觉和主要弱视镜检查在随访开始前和结束时记录立体视锐度。
所有患者均无弱视或屈光参差，但均有上睑下垂，用药后2周内上睑下垂有所改善。仅有1例患者未形成立体视，该患者有长达48个月的持续性外斜视。其余4例患者在随访期间存在持续时间小于4个月的持续性外斜视或间歇性外斜视。所有这些患者均恢复或维持了双眼视力。
长期持续性眼位偏斜可能导致双眼视力受损，儿童眼型重症肌无力可能需要及时矫正眼位。因此，由神经眼科医生或小儿眼科医生进行精确评估，即使是轻微的眼位偏斜也进行评估，在此基础上进行治疗对于确保双眼视力的正常发育至关重要。
