比较 1 型 Duane 综合征与第六颅神经麻痹的第一眼位测量值和外展不足。

Comparison of primary position measurements and abduction deficit between type 1 Duane syndrome and sixth cranial nerve palsy.

机构信息

Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, USA.

出版信息

J Neuroophthalmol. 2011 Jun;31(2):117-20. doi: 10.1097/WNO.0b013e3182059ebf.

DOI:10.1097/WNO.0b013e3182059ebf

PMID:21343829

Abstract

BACKGROUND

Unilateral Duane retraction syndrome type 1 (DRS-I) and unilateral sixth nerve palsy (6NP) present with limitation of abduction, incomitant esotropia, and frequently, a compensatory head turn. The purpose of this study was to compare the mean primary position measurement and to correlate this with the abduction deficit to determine if these measurements may be used to differentiate between the 2 conditions when other clinical signs of DRS-I (globe retraction, changes in lid fissure height, and upshoots/downshoots) are subtle.

METHODS

A database search of patients examined over a 5-year period revealed 69 cases of DRS-I and 62 cases of unilateral 6NP. Primary position measurements both at distance and near and limitation of abduction on version testing were recorded and compared.

RESULTS

Mean abduction deficit was -3.5 ± 0.1 for DRS-I and -2.6 ± 0.2 for 6NP (P = 0.0004). Mean esotropia at near was 8.4 ± 1.1 prism diopters (PD) for DRS-I and 27.2 ± 2.4 PD for 6NP (P < 0.0001). Mean esotropia at distance was 10.3 ± 1.3 PD for DRS-I and 36.4 ± 2.4 PD for 6NP (P < 0.0001). The mean distance-near disparity for DRS-I was 1.94 ± 0.62 PD and 9.19 ± 1.28 PD for 6NP (P < 0.0001). The age-group of ≤2 years consisted of 23 DRS-I and only 2 6NP cases. The age-group between >2 years and <18 years had 41 DRS-I and 16 6NP cases, respectively. Finally, the age-group of ≥18 years had only 5 DRS-I and 44 6NP cases (P < 0.0001).

CONCLUSION

Patients with DRS-I showed greater abduction deficit yet significantly less esotropia in primary position than those with 6NP. Patients with 6NP were more likely to have a significant distance-near disparity. In addition, patients with DRS-I tended to be younger than those with 6NP. This report documents that DRS-I and 6NP can be differentiated based on magnitude of primary position esotropia, comparison of primary position esotropia with severity of abduction deficit, distance-near disparity, and patient age.

摘要

背景

单侧 Duane 退缩综合征 1 型（DRS-I）和单侧 6 神经麻痹（6NP）表现为外展受限、斜视、代偿性头部转动。本研究的目的是比较原发性位置测量的平均值，并将其与外展缺陷相关联，以确定在其他 DRS-I 的临床迹象（眼球退缩、睑裂高度变化和上射/下射）不明显时，这些测量值是否可用于区分这两种情况。

方法

对 5 年内检查的患者进行数据库搜索，发现 69 例 DRS-I 和 62 例单侧 6NP。记录并比较了远距离和近距离的原发性位置测量值以及在斜视测试中外展受限的程度。

结果

DRS-I 的平均外展缺陷为-3.5±0.1，6NP 为-2.6±0.2（P=0.0004）。DRS-I 的近距内斜视均值为 8.4±1.1 棱镜度（PD），6NP 为 27.2±2.4 PD（P<0.0001）。DRS-I 的远距离内斜视均值为 10.3±1.3 PD，6NP 为 36.4±2.4 PD（P<0.0001）。DRS-I 的远近距离差异均值为 1.94±0.62 PD，6NP 为 9.19±1.28 PD（P<0.0001）。年龄在 2 岁以下的患者有 23 例 DRS-I 和 2 例 6NP，年龄在 2 至 18 岁之间的患者有 41 例 DRS-I 和 16 例 6NP，年龄在 18 岁以上的患者仅有 5 例 DRS-I 和 44 例 6NP（P<0.0001）。

结论

DRS-I 患者的外展缺陷比 6NP 患者更明显，但原发性位置斜视明显较小。6NP 患者更有可能出现明显的远距离-近距离差异。此外，DRS-I 患者的年龄往往小于 6NP 患者。本报告记录了 DRS-I 和 6NP 可以通过原发性位置斜视的程度、原发性位置斜视与外展缺陷的严重程度、远距离-近距离差异以及患者年龄来区分。