Clark Robert A, Choy Andrew E, Demer Joseph L
Department of Ophthalmology, David Geffen Medical School at University of California, Los Angeles; Stein Eye Institute, David Geffen Medical School at University of California, Los Angeles; Long Beach Memorial Medical Center, Long Beach, California.
Department of Ophthalmology, David Geffen Medical School at University of California, Los Angeles; Stein Eye Institute, David Geffen Medical School at University of California, Los Angeles; Department of Neurology, David Geffen Medical School at University of California, Los Angeles; Department of Neuroscience, David Geffen Medical School at University of California, Los Angeles; Bioengineering Interdepartmental Programs, David Geffen Medical School at University of California, Los Angeles.
J AAPOS. 2019 Apr;23(2):81.e1-81.e5. doi: 10.1016/j.jaapos.2018.12.005. Epub 2019 Feb 21.
To describe the clinical and intraoperative findings of an anatomic abnormality in children that resembles sagging eye syndrome documented in older adults and that led to recurrent esotropia after surgery.
We reviewed records of 4 patients with substantial recurrent esotropia after bilateral medial rectus recession who required subsequent surgery combining lateral rectus resection with correction of the anatomic abnormality affecting the lateral rectus path. Binocular alignment was sequentially analyzed.
Three young patients (2-3 years of age) presented with acquired esotropia but minimal cycloplegic refractive error. The fourth patient (14 years of age) initially had moderate hyperopia and partially accommodative esotropia, but subsequently developed marked bilateral overelevation in adduction. In all patients, esotropia recurred within 5 of preoperative deviation after bilateral medial rectus recession. Surgical exposure demonstrated that bilateral lateral rectus paths were inferiorly displaced more than one-half tendon width from their normal paths near the globe's equator, despite normal scleral insertions. Equatorial myopexy and lateral rectus resection resulted in stable esotropia correction.
Lateral rectus sag in children creates a type of acquired esotropia and overelevation in adduction poorly responsive to standard surgery but correctable with lateral rectus resection and equatorial myopexy that normalizes the lateral rectus path through permanent scleral fixation.
描述儿童中一种解剖学异常的临床及术中发现，该异常类似于在成年人中记录的下垂眼综合征，并导致术后反复出现内斜视。
我们回顾了4例双侧内直肌后徙术后出现大量反复内斜视的患者记录，这些患者随后需要进行手术，将外直肌切除术与影响外直肌路径的解剖学异常矫正相结合。依次分析双眼视轴对准情况。
3例年轻患者（2 - 3岁）表现为后天性内斜视，但睫状肌麻痹验光误差极小。第4例患者（14岁）最初有中度远视和部分调节性内斜视，但随后在内转时出现明显的双侧上睑过度上抬。在所有患者中，双侧内直肌后徙术后，内斜视在术前斜视度的5度范围内复发。手术暴露显示，尽管巩膜附着正常，但双侧外直肌路径在眼球赤道附近从其正常路径向下移位超过半条肌腱宽度。赤道部肌固定术和外直肌切除术导致内斜视矫正稳定。
儿童外直肌下垂会导致一种后天性内斜视和内转时上睑过度上抬，对标准手术反应不佳，但可通过外直肌切除术和赤道部肌固定术矫正，通过永久性巩膜固定使外直肌路径正常化。
