Dell'Osso Louis F, Hertle Richard W, Jacobs Jonathan B
The Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Case Medical School, Cleveland, Ohio; Department of Neurology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio.
Children's Vision Center, Akron Children's Hospital, Akron, Ohio; Department of Surgery, College of Medicine, Northeast Ohio Medical College, Akron, Ohio.
J AAPOS. 2018 Apr;22(2):110-114.e1. doi: 10.1016/j.jaapos.2017.11.007. Epub 2018 Mar 13.
To describe the effects of extraocular muscle extirpation performed after previous eye muscle surgery in a 20-year-old woman with infantile nystagmus syndrome (INS) for whom we have 19 years of follow-up data.
Clinical examinations were performed. Eye movement data analysis was carried out using the eXpanded Nystagmus Acuity Function (NAFX) and longest foveation domain (LFD).
The patient re-presented to the authors at age 20, 2 years after bilateral anterior myectomy of the horizontal rectus muscles, bilateral anterior nasal transposition of the inferior oblique muscle, and bilateral superior oblique recessions. Evaluation revealed deterioration in nystagmus at lateral gaze angles, new incomitant strabismus with severe loss of convergence, limited ductions, saccadic hypometria, slow saccades, and hypo-accommodation. Also, there was a pre- to post-extirpation minimal change of 21% in her peak NAFX, a 50% decrease in LFD, plus a predominant, asymmetric, multiplanar oscillation.
It appears that in this patient, horizontal extirpation failed to abolish the nystagmus and caused significant, new, symptomatic deficits interfering with many of the patient's visual functions.
描述一名患有婴儿型眼球震颤综合征（INS）的20岁女性在先前眼部肌肉手术后进行眼外肌切除的效果，我们对其进行了19年的随访数据。
进行临床检查。使用扩展的眼球震颤视力功能（NAFX）和最长注视域（LFD）进行眼动数据分析。
该患者在20岁时再次就诊，此时距离双侧水平直肌前徙切除术、双侧下斜肌前鼻移位术和双侧上斜肌后徙术已过去2年。评估显示，在侧方注视角度时眼球震颤恶化，出现新的非共同性斜视且伴有严重的集合功能丧失、眼球运动受限、扫视幅度减小、扫视速度减慢以及调节不足。此外，眼球震颤切除术前至术后，其峰值NAFX最小变化为21%，LFD下降50%，同时还出现了主要的、不对称的多平面振荡。
在该患者中，水平肌切除似乎未能消除眼球震颤，反而导致了明显的、新的、有症状的功能缺陷，影响了患者的许多视觉功能。
