Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States Department of Ophthalmology, St. Louis University Eye Institute, St. Louis, Missouri, United States.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States.
Invest Ophthalmol Vis Sci. 2014 Dec 23;56(2):1081-7. doi: 10.1167/iovs.14-15843.
We evaluated the roles of luminance and fixation in the pathophysiology of dissociated vertical divergence (DVD).
Vertical eye position was measured in 6 subjects with DVD (ages 11-47 years, 5 females) and 6 controls (ages 16-40 years, 5 females) using video-oculography (VOG) under conditions of change in fixation and luminance.
Subjects with DVD showed the following VOG responses. When fixation was precluded with a translucent filter and bright light was shone into one eye to produce a marked binocular luminance disparity, we found some subjects had a small induced vertical divergence causing the illuminated eye to be lower than the nonilluminated eye (mean -1.6° ± 1.5°, P = 0.06 compared to no vertical divergence using the signed rank test). When fixation was precluded with a translucent filter, while alternate occlusion produced a mild binocular luminance disparity, we found a smaller vertical divergence of the eyes that was not statistically significant (1.2° ± 2.1°, P = 0.3). When alternate occlusion produced reversal of monocular fixation in the dark (with essentially no change in peripheral luminance disparity), there was a significant vertical divergence movement causing the covered eye to be relatively higher than the uncovered eye (7.2° ± 3.1°, P = 0.03). The amplitude of this vertical divergence was similar to that measured under conditions of alternate occlusion in a lighted room (where there also was a significant average relative upward movement of the covered eye of 8.1° ± 2.9°, P = 0.03). Control subjects showed no vertical divergence under any testing conditions.
Dissociated vertical divergence is mediated primarily by changes in fixation and only to a minor degree by binocular luminance disparity.
我们评估了亮度和注视在分离性垂直斜视（DVD）发病机制中的作用。
使用视频眼动描记法（VOG），在改变注视和亮度的条件下，测量 6 名 DVD 患者（年龄 11-47 岁，5 名女性）和 6 名对照者（年龄 16-40 岁，5 名女性）的垂直眼位。
DVD 患者的 VOG 反应如下。当使用半透明滤光片排除注视时，将强光照射到一只眼睛以产生明显的双眼亮度差异时，我们发现一些患者有较小的诱导垂直分离，使受光眼低于非受光眼（平均 -1.6°±1.5°，P=0.06 与使用符号秩检验时无垂直分离相比）。当使用半透明滤光片排除注视时，当交替遮盖产生轻度双眼亮度差异时，我们发现眼睛的垂直分离较小，无统计学意义（1.2°±2.1°，P=0.3）。当交替遮盖在黑暗中反转单眼注视（周边亮度差异基本不变）时，会引起明显的垂直分离运动，使遮盖眼相对高于未遮盖眼（7.2°±3.1°，P=0.03）。这种垂直分离的幅度与在有光的房间中进行交替遮盖时测量的幅度相似（遮盖眼的平均相对向上运动幅度为 8.1°±2.9°，P=0.03）。在任何测试条件下，对照者均未显示垂直分离。
分离性垂直斜视主要由注视变化引起，仅由双眼亮度差异引起较小程度的变化。
