Metz H S
J Pediatr Ophthalmol Strabismus. 1981 Mar-Apr;18(2):31-5. doi: 10.3928/0191-3913-19810301-08.
The majority of patients with monocular limitation of elevation probably have an inferior restriction as the cause of limited elevation. When there is no vertical deviation in the primary position, the absence of a superior rectus palsy is most likely. Treatment of cases with inferior restrictions consists of recession of the tight inferior rectus and conjunctival recession. If the vertical deviation in the primary position is large enough, inferior rectus recession may be combined with superior rectus resection. When superior rectus palsy is the cause of limited upgaze, transposition surgery, utilizing the lateral and medial rectus muscles transposed to the superior rectus insertion, can be utilized. This often results in significant correction of the vertical deviation in primary gaze, but only yields modest improvement of elevation. Restrictions, which may also be present, must first be released before transposition surgery can succeed. The evidence suggests that rarely need the mechanism of "double elevator palsy" be invoked to explain monocular limitation of elevation. When there is true weakness of elevation, superior rectus palsy alone can account for the clinical findings.
大多数单眼上抬受限的患者可能存在下直肌受限，这是上抬受限的原因。当第一眼位无垂直偏斜时，最可能不存在上直肌麻痹。下直肌受限病例的治疗包括收紧的下直肌后徙术和结膜后徙术。如果第一眼位的垂直偏斜足够大，下直肌后徙术可与上直肌缩短术联合应用。当上直肌麻痹是上视受限的原因时，可采用转位手术，即将外直肌和内直肌转位至上直肌附着点。这通常会显著矫正第一眼位的垂直偏斜，但对上抬的改善仅为中等程度。转位手术成功之前，可能存在的限制必须首先解除。有证据表明，很少需要用“双上直肌麻痹”机制来解释单眼上抬受限。当存在真正的上抬无力时，仅上直肌麻痹就能解释临床表现。
