Stallworth Jeannette Y, Rasool Nailyn, Indaram Maanasa
Department of Ophthalmology, University of California, San Francisco, United States.
Department of Neurology, University of California, San Francisco, United States.
Am J Ophthalmol Case Rep. 2022 Nov 12;28:101754. doi: 10.1016/j.ajoc.2022.101754. eCollection 2022 Dec.
To describe a case of incomitant divergence insufficiency esotropia in the setting of Machado-Joseph disease (spinocerebellar ataxia type 3) that recurred completely within one week after augmented bilateral medial rectus recession.
A 53-year-old female with a history of Machado-Joseph disease presented with horizontal diplopia primarily at distance consistent with divergence insufficiency esotropia. Augmented bilateral medial rectus recessions were performed which initially produced orthotropia, but recurrence of the esodeviation to the full preoperative amount occurred by post-operative week one. The patient subsequently underwent bilateral lateral rectus resections with excellent result.
Divergence insufficiency is common in the spinocerebellar ataxia variants and is thought to be secondary to atrophy of brainstem structures involved in the control of ocular vergence. Strabismus surgery in these patients may be complicated by limited response or even rapid regression despite augmented surgery as suggested for divergence insufficiency in the setting of neurologic disease. Patients should be counseled on these risks as well as the potential for multiple procedures in order to achieve surgical success.
描述1例马查多-约瑟夫病（3型脊髓小脑共济失调）患者出现非共同性散开不足性内斜视的病例，该病例在双侧内直肌后退加强术后1周内完全复发。
1例有马查多-约瑟夫病病史的53岁女性，主要表现为远距离水平复视，符合散开不足性内斜视。进行了双侧内直肌后退加强术，术后初期获得了正位，但在术后第1周内，内斜视复发至术前的完全程度。该患者随后接受了双侧外直肌缩短术，效果良好。
散开不足在脊髓小脑共济失调变异型中很常见，被认为是继发于参与控制眼球辐辏的脑干结构萎缩。尽管针对神经疾病背景下的散开不足建议进行加强手术，但这些患者的斜视手术可能会因反应有限甚至快速复发而复杂化。应向患者告知这些风险以及为实现手术成功可能需要进行多次手术的情况。
