Department of Ophthalmology, University of California, Los Angeles, California; David Geffen Medical School, University of California, Los Angeles, California.
Department of Ophthalmology, University of California, Los Angeles, California; Department of Neurology, University of California, Los Angeles, California; Department of Neuroscience, University of California, Los Angeles, California; Biomedical Engineering Interdepartmental Programs, University of California, Los Angeles, California; David Geffen Medical School, University of California, Los Angeles, California.
Am J Ophthalmol. 2014 Feb;157(2):479-487.e2. doi: 10.1016/j.ajo.2013.09.027. Epub 2013 Sep 29.
To employ magnetic resonance imaging (MRI) to seek evidence of compartmental lateral rectus atrophy consistent with a lesion involving selective denervation of only 1 of the 2 neuromuscular compartments of the lateral rectus.
Prospective observational case-control series.
At a single institution, surface coil coronal MRI was obtained at 312 μm resolution in quasi-coronal planes 2 mm thick throughout the orbit in 20 normal volunteers and 18 patients with unilateral lateral rectus palsy fixated monocularly on a target placed in central gaze. Maximum cross sections and posterior volumes of the superior and inferior lateral rectus compartments were computed and correlated with clinical findings.
Twelve patients with lateral rectus palsy demonstrated symmetric, highly significant 40% reductions in maximum cross sections and 50% reductions in posterior volumes from normal for both compartments (P < 10(-6) for all comparisons). Six patients with lateral rectus palsy had similar significant but asymmetric reductions in those measures only for the superior compartment of the affected lateral rectus (P < 10(-4) for all comparisons), with insignificant 20%-30% reductions for the inferior compartment (P > 0.2 for all comparisons).
A subset of patients with clinical lateral rectus palsy may have palsy limited to the superior compartment. Paralytic esotropia may be caused by lateral rectus superior compartment palsy despite an intact lateral rectus inferior compartment. This finding is consistent with evidence supporting independent innervation of the 2 lateral rectus neuromuscular compartments.
利用磁共振成像（MRI）寻找证据，证明外侧直肌隔室性萎缩，这与选择性仅支配外侧直肌的 2 个神经肌肉隔室之一的神经损伤相一致。
前瞻性观察性病例对照系列研究。
在一个机构中，对 20 名正常志愿者和 18 名单侧外直肌麻痹患者的进行了表面线圈冠状 MRI 扫描，在准冠状位上获得了 312μm 的分辨率，厚度为 2mm，在整个眼眶中。计算了上、下外侧直肌隔室的最大横截面积和后体积，并与临床发现相关。
12 例外直肌麻痹患者的最大横截面积和后体积均有对称的、显著的 40%减少，与正常对照组相比均减少了 50%（所有比较的 P<10(-6)）。6 例外直肌麻痹患者的这些测量值只有患侧上直肌隔室有类似的显著但不对称性减少（所有比较的 P<10(-4)），下直肌隔室的减少不显著，为 20%-30%（所有比较的 P>0.2）。
一部分临床外侧直肌麻痹患者可能局限于上直肌隔室。尽管下直肌隔室完整，但麻痹性外斜视可能是由外侧直肌上隔室麻痹引起的。这一发现与支持外侧直肌的 2 个神经肌肉隔室独立支配的证据一致。
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