Lee Ji Eun, Yang Hee Kyung, Kim Jae Hyoung, Hwang Jeong-Min
Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Invest Ophthalmol Vis Sci. 2017 Oct 1;58(12):5526-5531. doi: 10.1167/iovs.17-22452.
To investigate the relationship between objective ocular torsion and the presence or absence of the trochlear nerve in subjects with unilateral superior oblique palsy (SOP).
A total of 159 subjects with congenital and acquired unilateral SOP were reviewed. Eighty-four subjects who had a normal trochlear nerve (present group) and 75 subjects without a trochlear nerve (absent group) were included. Cyclovertical motility parameters and objective ocular torsion were compared between groups, and factors related to ocular torsion were evaluated.
The degree of "net" excyclotorsion in the paretic eye was larger in the absent group compared to the present group (P = 0.002). The proportion of net excyclotorsion in the paretic eye was greater in the absent group (11% vs. 37%), while net incyclotorsion was greater in the present group (41% vs. 23%) (P < 0.001). Net excyclotorsion of the paretic eye was associated with absence of the trochlear nerve (P < 0.001) and smaller size of the paretic SO (P < 0.001). Net incyclotorsion of the paretic eye was related with a normal trochlear nerve (P = 0.005), larger size of the paretic SO (P = 0.002), and greater hypertropia during ipsilateral gaze (P = 0.024).
The status of the trochlear nerve, paretic SO size, and hypertropia during ipsilateral gaze which reflects the tensile strength of the ipsilateral superior rectus, significantly contribute to ocular torsion in unilateral SOP.
研究单侧上斜肌麻痹（SOP）患者的客观眼扭转与滑车神经有无之间的关系。
回顾了159例先天性和后天性单侧SOP患者。纳入84例滑车神经正常的患者（存在组）和75例无滑车神经的患者（缺失组）。比较两组之间的眼球垂直运动参数和客观眼扭转，并评估与眼扭转相关的因素。
与存在组相比，缺失组患眼的“净”外旋转扭转程度更大（P = 0.002）。缺失组患眼净外旋转扭转的比例更高（11%对37%），而存在组净内旋转扭转更高（41%对23%）（P < 0.001）。患眼的净外旋转扭转与滑车神经缺失（P < 0.001）和患侧上斜肌较小的尺寸（P < 0.001）相关。患眼的净内旋转扭转与滑车神经正常（P = 0.005）、患侧上斜肌较大的尺寸（P = 0.002）以及同侧注视时更大的上斜视（P = 0.024）有关。
滑车神经状态、患侧上斜肌尺寸以及同侧注视时反映同侧上直肌拉伸强度的上斜视，对单侧SOP中的眼扭转有显著影响。
