Kushner B J
Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA.
Arch Ophthalmol. 1995 Nov;113(11):1426-30. doi: 10.1001/archopht.1995.01100110086030.
To evaluate the usefulness of various optical and surgical treatment modalities in the treatment of patients who were symptom free in the primary position of gaze yet had symptomatic diplopia in the reading position (down gaze at near).
A retrospective chart review was conducted to identify all patients with presbyopia I have treated who were symptom free in the primary position but had diplopia in down gaze associated with vertically incomitant strabismus. Of 51 patients identified, 32 were symptomatic in down gaze due to a hypertropia associated with a unilateral inferior rectus muscle underaction. Twenty-two of these patients had previously undergone recession of the affected inferior rectus muscle for treatment of thyroid eye disease; four patients, for correction of entrapment secondary to blow-out orbital fracture; and four patients, for treatment of superior oblique muscle palsy. Two patients had undergone prior surgery for superior oblique myokymia. Eight patients had horizontal diplopia associated with an A pattern, and eight patients had horizontal diplopia associated with a V pattern. Three patients had vertical and horizontal diplopia after partial recovery from third-nerve palsy.
The treatment modalities were varied and individualized. Treatment consisted of optical management (20 patients), surgical management (21 patients), or a combination of both (10 patients). These treatment modalities resulted in comfortable single binocular vision for reading in 41 of the 51 patients. Successful optical treatment consisted of Fresnel prisms (four patients), slab-off prisms (two patients), single-vision readers (seven patients), switch to nonprogressive bifocal lenses (three patients), and a high bifocal segment (16 patients). Successful surgical modalities included posterior fixation of the contralateral inferior rectus muscle (10 patients), surgery for A- or V- pattern strabismus (five patients), or bilateral inferior rectus muscle recession (six patients).
Diplopia in the reading position frequently can be alleviated with a systematic approach that includes both optical and surgical modalities.
评估各种光学和手术治疗方式对在第一眼位无症状但在阅读位（向下注视近物）出现症状性复视的患者的治疗效果。
进行一项回顾性病历审查，以确定所有我治疗过的老花眼患者，这些患者在第一眼位无症状，但在向下注视时伴有垂直非共同性斜视出现复视。在确定的51例患者中，32例因患侧下直肌功能不足导致的上斜视在向下注视时出现症状。其中22例患者此前曾接受患侧下直肌后徙术以治疗甲状腺眼病；4例患者因爆裂性眼眶骨折继发的眼球嵌顿进行矫正手术；4例患者因上斜肌麻痹接受治疗。2例患者曾接受上斜肌肌纤维颤搐的手术治疗。8例患者伴有A征的水平复视，8例患者伴有V征的水平复视。3例患者在动眼神经麻痹部分恢复后出现垂直和水平复视。
治疗方式多样且个体化。治疗包括光学处理（20例患者）、手术处理（21例患者）或两者结合（10例患者）。这些治疗方式使51例患者中的41例在阅读时获得了舒适的双眼单视。成功的光学治疗包括使用菲涅尔棱镜（4例患者）、削薄棱镜（2例患者）、单焦点阅读镜（7例患者）、更换为非渐进多焦点镜片（3例患者）以及高双焦点区（16例患者）。成功的手术方式包括对侧下直肌后固定术（10例患者）、A征或V征斜视手术（5例患者）或双侧下直肌后徙术（6例患者）。
通过包括光学和手术方式的系统方法，阅读位复视通常可以得到缓解。
