Veverka Kevin K, Hatt Sarah R, Leske David A, Brown William L, Iezzi Raymond, Holmes Jonathan M
Mayo Clinic School of Medicine, Rochester, Minnesota.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Am J Ophthalmol. 2017 Jul;179:39-45. doi: 10.1016/j.ajo.2017.04.014. Epub 2017 Apr 27.
To describe the causes of diplopia in patients with an epiretinal membrane (ERM) and presenting diplopia.
Retrospective observational case series.
We reviewed patients diagnosed with an ERM, who had been seen by both retinal and strabismus specialists in a tertiary medical center. Data recorded: orthoptic evaluation, retinal misregistration (optotype-frame test, and synoptophore central peripheral superimposition slides at 5 and 10 degrees), and cause of any diplopia (retinal misregistration vs strabismus vs optical/refractive error). We defined central-peripheral rivalry-type diplopia as presenting symptomatic diplopia with evidence of retinal misregistration, and where other causes did not fully explain diplopia. The frequency of each cause of diplopia in patients with ERM was determined.
Of 50 patients with ERM, 25 had symptomatic diplopia and 25 had no diplopia. Eleven of 25 diplopic patients (44%) had retinal misregistration as the sole cause (central-peripheral rivalry-type diplopia), 7 (28%) strabismus (1 of 7 initally appeared to have central-peripheral rivalry-type diplopia), 1 (4%) optical/refractive error (monocular diplopia), 2 (8%) mixed retinal misregistration (central-peripheral rivalry-type diplopia) and strabismus, and for 4 (16%) diplopia cause was indeterminate. Unexpectedly, 15 of 25 patients without diplopia (60%) had evidence of retinal misregistration.
Patients with ERM and presenting diplopia may have 1 of several causes of diplopia, most commonly retinal misregistration (central-peripheral rivalry-type diplopia). Nevertheless, diplopic patients with retinal misregistration may also have treatable strabismus or optical/refractive error as the primary barrier to single vision and therefore many potential barriers to single vision should be considered.
描述视网膜前膜（ERM）患者出现复视的原因。
回顾性观察病例系列。
我们对在一家三级医疗中心接受视网膜和斜视专科医生诊治的诊断为ERM的患者进行了回顾。记录的数据包括：眼肌检查评估、视网膜配准失调（视标框架试验，以及在5度和10度时的同视机中央周边叠加幻灯片），以及任何复视的原因（视网膜配准失调与斜视与光学/屈光不正）。我们将中央周边竞争型复视定义为出现有症状的复视且有视网膜配准失调的证据，且其他原因不能完全解释复视。确定了ERM患者中每种复视原因的频率。
在50例ERM患者中，25例有症状性复视，25例无复视。25例复视患者中有11例（44%）以视网膜配准失调为唯一原因（中央周边竞争型复视），7例（28%）为斜视（7例中有1例最初似乎有中央周边竞争型复视），1例（4%）为光学/屈光不正（单眼复视），2例（8%）为视网膜配准失调（中央周边竞争型复视）与斜视混合，4例（16%）复视原因不明。出乎意料的是，25例无复视患者中有15例（60%）有视网膜配准失调的证据。
患有ERM且出现复视的患者可能有多种复视原因中的一种，最常见的是视网膜配准失调（中央周边竞争型复视）。然而，有视网膜配准失调的复视患者也可能有可治疗的斜视或光学/屈光不正作为双眼单视的主要障碍，因此应考虑许多双眼单视的潜在障碍。
