先天性和获得性孤立性下直肌功能不全的临床和影像学特征。
Clinical and imaging features of congenital and acquired isolated inferior rectus muscle hypofunction.
机构信息
Department of Ophthalmology, David Geffen Medical School at the University of California, Los Angeles; Stein Eye Institute, David Geffen Medical School at the University of California, Los Angeles; Pontificia Universidad Católica de Chile, Santiago, Chile.
Department of Ophthalmology, David Geffen Medical School at the University of California, Los Angeles; Stein Eye Institute, David Geffen Medical School at the University of California, Los Angeles; Bioengineering Department, David Geffen Medical School at the University of California, Los Angeles; Department of Neurology, David Geffen Medical School at the University of California, Los Angeles.
出版信息
J AAPOS. 2021 Feb;25(1):11.e1-11.e9. doi: 10.1016/j.jaapos.2020.09.007. Epub 2021 Feb 16.
BACKGROUND
Inferior rectus (IR) underaction may arise from various causes that are distinguishable through imaging. We investigated clinical and imaging characteristics of congenital and acquired causes of IR underaction.
METHODS
Cases of IR underaction were selected from data prospectively collected in a study of orbital imaging in strabismic patients.
RESULTS
Review identified 3 cases of congenital IR underaction (2 with bilateral IR aplasia and 1 with unilateral IR hypoplasia), 12 acquired cases, including 4 due to denervation (2 idiopathic, 1 after multiple strabismus surgeries, 1 after head trauma), and 8 cases of direct IR damage (5 with orbital trauma and 3 with previous surgery, including 2 sinus surgery and 1 laser blepharoplasty). Of the 23 cases, 11 adults had high-resolution magnetic resonance imaging, and 2 children had computed tomography. Imaging identified the anatomic diagnosis in congenital cases; in acquired cases, imaging helped to identify atrophy and exclude alternative orbital causes; and in direct mechanical damage, imaging clarified the mechanism of underaction, extent of IR damaged, and the degree of retained contractility. Patients with congenital IR absence or hypoplasia exhibited A pattern exotropia that was typically absent in isolated acquired denervation or direct IR damage.
CONCLUSIONS
Orbital imaging demonstrates a variety of abnormalities in patients with congenital or acquired IR hypofunction, helping to clarify the underlying mechanism and guide management.
背景
下直肌（IR）功能不足可能由各种可通过影像学区分的原因引起。我们研究了先天性和获得性下直肌功能不足的病因的临床和影像学特征。
方法
从斜视患者眶部影像学研究中前瞻性收集的数据中选择下直肌功能不足的病例。
结果
回顾性研究共发现 3 例先天性下直肌功能不足（2 例双侧下直肌缺如，1 例单侧下直肌发育不良），12 例获得性病例，包括 4 例因失神经支配（2 例特发性，1 例在多次斜视手术后，1 例在头部外伤后）和 8 例直接下直肌损伤（5 例眼眶外伤，3 例有既往手术史，其中 2 例鼻窦手术，1 例激光眼睑成形术）。在 23 例患者中，11 例成人接受了高分辨率磁共振成像，2 例儿童接受了计算机断层扫描。影像学在先天性病例中确定了解剖学诊断；在获得性病例中，影像学有助于识别萎缩并排除其他眶部病因；在直接机械损伤中，影像学明确了功能不足的机制、下直肌受损的程度以及保留收缩性的程度。先天性下直肌缺如或发育不良的患者表现出 A 型外斜视，而单纯获得性失神经支配或直接下直肌损伤通常不存在这种斜视。
结论
眼眶影像学显示先天性或获得性下直肌功能不足的患者存在多种异常，有助于明确潜在机制并指导治疗。
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