Mimura Osamu, Ishikawa Hiroto, Kimura Naoki, Kimura Akiko, Borlongan Cesar V
Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan ; Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.
Clin Ophthalmol. 2014 Dec 11;8:2523-8. doi: 10.2147/OPTH.S72349. eCollection 2014.
Periodic alternating nystagmus (PAN) is a spontaneous horizontal nystagmus observed in disorders of the central nervous system. Patients with congenital PAN complain of oscillating vision at high rates. Medication is the first-choice treatment for PAN; however, clinicians still seek better therapy. The aim of this study was to evaluate outcomes of recession of four horizontal rectus muscle (R-FHR) in patients with congenital PAN.
This study reports a retrospective case series of ten patients (seven males and three females; mean age 24.4±10.9) with congenital PAN who underwent R-FHR between 2007 and 2012, which was performed by the same surgeon at the Hyogo College of Medicine. Patients were evaluated for complications, recession amount, deviation angle, eye movements including a nystagmus amplitude, and visual acuity during pre- and post-operative periods.
Pre-operatively, patients complained of oscillating vision, abnormal head posture, esotropia, and congenital superior oblique palsy. Post-operatively, changes from the previous observations of nystagmus amplitudes and abnormal head posture demonstrated a complete reversal in all patients. In addition, visual acuity determined with a Snellen chart improved in two patients. However, esotropia occurred in three patients who underwent additional strabismus surgery 2 days after R-FHR. R-FHR was particularly effective in eight patients who pre-operatively had periodic oscillating vision with a regular pattern of periodic nystagmus.
We demonstrated that ten patients with congenital PAN had improved vision following R-FHR, indicating that R-FHR was an effective procedure, especially in patients suffering PAN with periodic oscillating vision.
周期性交替性眼球震颤（PAN）是在中枢神经系统疾病中观察到的一种自发性水平眼球震颤。先天性PAN患者主诉有高速率的视力摆动。药物治疗是PAN的首选治疗方法；然而，临床医生仍在寻求更好的治疗方法。本研究的目的是评估先天性PAN患者四条水平直肌后徙术（R-FHR）的疗效。
本研究报告了一组回顾性病例系列，共10例先天性PAN患者（7例男性，3例女性；平均年龄24.4±10.9岁），于2007年至2012年在兵库医科大学由同一位外科医生进行了R-FHR手术。对患者术前和术后的并发症、后徙量、偏斜角度、包括眼球震颤幅度在内的眼球运动以及视力进行了评估。
术前，患者主诉视力摆动、异常头位、内斜视和先天性上斜肌麻痹。术后，所有患者的眼球震颤幅度和异常头位与术前观察相比均出现完全逆转。此外，两名患者使用斯内伦视力表测定的视力有所提高。然而，3例患者在R-FHR术后2天接受了额外的斜视手术，出现了内斜视。R-FHR对8例术前有周期性摆动视力且眼球震颤呈规则周期性模式的患者特别有效。
我们证明，10例先天性PAN患者在R-FHR术后视力得到改善，表明R-FHR是一种有效的手术方法，尤其是对患有周期性摆动视力的PAN患者。
