高度近视中的重度眼综合征与下垂眼综合征
Heavy eye syndrome versus sagging eye syndrome in high myopia.
作者信息
Tan Roland Joseph D, Demer Joseph L
机构信息
Stein Eye Institute, University of California, Los Angeles.
Stein Eye Institute, University of California, Los Angeles; Department of Neurology, University of California, Los Angeles; Neuroscience Interdepartmental Program, University of California, Los Angeles; Bioengineering Interdepartmental Program, University of California, Los Angeles.
出版信息
J AAPOS. 2015 Dec;19(6):500-6. doi: 10.1016/j.jaapos.2015.08.012.
BACKGROUND
Heavy eye syndrome (HES) presents with esotropia and limited abduction due to superotemporal globe shift relative to the extraocular muscles. Sagging eye syndrome (SES) was originally described in nonmyopic patients exhibiting distance esotropia and cyclovertical strabismus with limited supraduction due to lateral rectus muscle inferodisplacement caused by degeneration of the lateral rectus-superior rectus (LR-SR) band. We hypothesized that SES might also cause strabismus in high myopia.
METHODS
Eleven strabismic subjects with high myopia underwent ophthalmological examination and orbital magnetic resonance imaging (MRI) to assess quantitative orbital anatomy.
RESULTS
Of 11 subjects, 5 had HES; 6, SES. Mean axial length in subjects with HES was 32 ± 5 mm; in subjects with SES, 32 ± 6 mm. Average distance esotropia in subjects with HES was 61(Δ) ± 39(Δ); hypotropia was 26(Δ) ± 21(Δ). Average distance esotropia in subjects with SES was 23(Δ) ± 57(Δ); hypertropia was 2(Δ) ± 2(Δ). All 5 subjects with HES had superotemporal globe prolapse; the LR-SR band was thinned in 6 orbits and ruptured in 2. The mean angle between the lateral rectus and superior rectus muscles in HES was 121° ± 7°. In SES the LR-SR band was thinned in 7 orbits and ruptured in 5, with superotemporal soft tissue prolapse. The mean angle between the lateral rectus and superior rectus muscles was 104° ± 11°, significantly less than in HES (P < 0.001).
CONCLUSIONS
SES occurs in highly myopic patients who also exhibit less relative globe dislocation than in HES. Unlike HES, SES exhibits superotemporal soft tissue prolapse that may limit superotemporal globe shift. The distinction is important because surgery for HES uniquely requires creation of a surgical connection between the superior rectus and lateral rectus muscles, whereas SES may be treated with conventional surgery. SES can cause strabismus in high axial myopia. Orbital MRI is useful in differentiating SES from HES.
背景
重度眼球综合征（HES）表现为内斜视，由于眼球相对于眼外肌向颞上移位，外展受限。下垂眼综合征（SES）最初在非近视患者中被描述，这些患者表现为远距离内斜视和旋转性斜视，由于外直肌-上直肌（LR-SR）带退变导致外直肌向下方移位，上转受限。我们推测SES也可能导致高度近视患者斜视。
方法
11例患有斜视的高度近视患者接受眼科检查和眼眶磁共振成像（MRI）以评估眼眶的定量解剖结构。
结果
11例患者中，5例患有HES；6例患有SES。HES患者的平均眼轴长度为32±5mm；SES患者为32±6mm。HES患者的平均远距离内斜视度数为61（Δ）±39（Δ）；下斜视度数为26（Δ）±21（Δ）。SES患者的平均远距离内斜视度数为23（Δ）±57（Δ）；上斜视度数为2（Δ）±2（Δ）。所有5例HES患者均有颞上眼球脱垂；LR-SR带在6个眼眶中变薄，2个眼眶中破裂。HES中外直肌与上直肌之间的平均夹角为121°±7°。在SES中，LR-SR带在7个眼眶中变薄，5个眼眶中破裂，伴有颞上软组织脱垂。外直肌与上直肌之间的平均夹角为104°±11°，显著小于HES（P<0.001）。
结论
SES发生在高度近视患者中，其眼球相对移位程度也低于HES。与HES不同，SES表现为颞上软组织脱垂，这可能会限制颞上眼球移位。这种区别很重要，因为HES的手术独特地需要在上直肌和外直肌之间建立手术连接，而SES可以采用传统手术治疗。SES可导致高度轴性近视患者斜视。眼眶MRI有助于鉴别SES和HES。
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