Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
BMJ Case Rep. 2020 Dec 17;13(12):e236648. doi: 10.1136/bcr-2020-236648.
A 28-year-old man presented with a progressive inward deviation of the left eye in the last 4 years. Examination revealed -3 abduction and elevation deficit in the left eye with 50 prism diopters (PD) esotropia and 12 PD of hypotropia. The patient had multiple fibromas on the forearms with pulsatile globe and was diagnosed as neurofibromatosis type 1. Myopic strabismus fixus was suspected. MRI revealed left temporal lobe herniation through a dysplastic sphenoid wing, compressing the posterior half of the superior rectus and lateral rectus muscles, resulting in an esotropia-hypotropia complex. Surgical treatment involved suture myopexy (Yokoyama's technique) of the left superior rectus and lateral rectus muscles with a 6.5 mm left medial rectus recession. Two months postoperatively, the patient had minimal residual esotropia and hypotropia. MRI orbits should always be performed in high myopes with strabismus to assess extraocular muscle pathways.
一位 28 岁男性，4 年来左眼逐渐出现内斜视。检查发现左眼外展和上抬功能分别缺失 -3 棱镜度，伴有 50 棱镜度的内斜视和 12 棱镜度的下斜视。患者前臂有多发性纤维瘤，眼球有博动，诊断为 1 型神经纤维瘤病。怀疑为近视性固定性斜视。MRI 显示左侧颞叶通过发育不良的蝶骨翼突疝出，压迫上直肌和外直肌后段，导致内斜视-下斜视复合。手术治疗包括左眼上直肌和外直肌的缝线肌缩短术（Yokoyama 技术），同时行 6.5mm 左眼内直肌后退。术后 2 个月，患者的残余内斜视和下斜视很小。对于有斜视的高度近视患者，应始终进行眼眶 MRI 检查，以评估眼外肌通路。
