Eppenberger Leila Sara, DiTaranto Rahel, Bücheler Andrea, Heckmann Jan, Sturm Veit
Augenklinik, Kantonsspital St. Gallen, Schweiz.
Klin Monbl Augenheilkd. 2021 Apr;238(4):474-477. doi: 10.1055/a-1407-9437. Epub 2021 Apr 30.
The therapeutic treatment of ocular motility disorders and anomalous head postures (AHP) is often challenging. We report our experience with prism use in these patients.
Retrospective case series of three patients with ocular motility disorders and associated AHP who were treated with prism correction.
A 37-year-old male with a traumatic left oculomotor nerve palsy suffered from a residual minor depression deficit and a severe elevation palsy. With OS: 10^ base-up he was corrected for left hypotropia only in down gaze. Ten yoked prisms base-up shifted the field of binocular single vision in primary position. A 45-year-old male with traumatic Parinaud syndrome and upward gaze palsy suffered from neck pain due to his pronounced chin elevation. He also had a right amaurosis with secondary exotropia. With OS: 8^ base-up, his AHP was corrected and his neck pain was alleviated. A 69-year-old woman with a left abducens nerve palsy adopted a left turn of 20° to compensate for her deviation in extreme right gaze. With OS: 20^ base-out, her AHP was corrected and she experienced no double vision in primary position.
Prisms are used to correct strabismic deviations but also can successfully shift images towards another gaze in different clinical scenarios. Reduction of AHP, therefore, can be obtained by a prism-induced gaze shift in the direction of the motility restriction.
眼球运动障碍和异常头位（AHP）的治疗通常具有挑战性。我们报告我们在这些患者中使用棱镜的经验。
对3例接受棱镜矫正治疗的眼球运动障碍及相关AHP患者进行回顾性病例系列研究。
一名37岁男性，因左侧动眼神经外伤性麻痹，存在残余轻度下转不足和严重上转麻痹。左眼使用10^底朝上棱镜仅在向下注视时矫正了左眼上斜视。10个同向性底朝上棱镜使双眼单视在原在位时的视野发生了偏移。一名45岁男性，患有外伤性Parinaud综合征及上视麻痹，因明显的下巴上抬而颈部疼痛。他还患有右眼黑矇并继发外斜视。左眼使用8^底朝上棱镜后，其异常头位得到矫正，颈部疼痛缓解。一名69岁女性，因左侧展神经麻痹，向左转动20°以代偿其在极右侧注视时的斜视。左眼使用20^底向外棱镜后，其异常头位得到矫正，原在位时无复视。
棱镜用于矫正斜视偏差，还能在不同临床情况下成功地将图像向另一个注视方向偏移。因此，通过棱镜诱导的注视向运动受限方向偏移可减轻异常头位。
