Helveston E M
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis.
J Pediatr Ophthalmol Strabismus. 1993 Jul-Aug;30(4):215-32. doi: 10.3928/0191-3913-19930701-03.
Congenital esotropia develops in the first 4 months of life in an infant who lacks the inborn mechanism for motor fusion. It manifests as an esotropia which is not eliminated by correction of hyperopia and occurs in an otherwise neurologically normal infant. The earliest practical time for surgery is 4 months of age. The eye is anatomically suited for surgery at this age and also, this is the earliest age that congenital esotropia can be diagnosed with confidence. The best attainable result of treatment of congenital esotropia is subnormal binocular vision. This result is more likely to be attained if infants are aligned by 18 months of age. Satisfactory alignment is produced in 80% to 85% of infants in one procedure with an appropriate bimedial rectus recession. An array of motor defects including DVD, latent nystagmus, oblique dysfunction, and A- and V-pattern appear at varying times after successful alignment. These associated findings are commonly found with, but are not unique to, congenital esotropia. The onset and clinical picture of congenital esotropia is satisfactorily explained by a theory first suggested by Worth that the strabismus is caused by an inborn defect in the motor fusion mechanism and aggravated by esotropital factors as suggested by Chavasse. In contrast to congenital esotropia, all other strabismus can be thought of as occurring on a secondary basis in a person with the inborn capacity for motor fusion, but who failed to maintain it because of conatal insurmountable strabismus (congenital third nerve palsy), who lost it because of acquired (postnatal) strabismus, who uses a strategy such as head posture alteration to retain fusion under favorable circumstances (Duane syndrome), who has intermittent strabismus with part-time suppression (X(T)), or who is maintaining alignment with nonsurgical means (refractive esotropia). For the future, I believe that advances in the management of congenital esotropia will depend on a better understanding of etiology leading to design and use of innovative nonsurgical techniques to discourage convergence and stimulate bifoveal fusion.
先天性内斜视发生于出生后4个月内的婴儿，这些婴儿缺乏先天性运动融合机制。其表现为内斜视，这种斜视不会因远视的矫正而消除，且发生在神经系统其他方面正常的婴儿身上。最早可行手术的时间是4个月大。此时眼睛在解剖结构上适合手术，而且这也是能够确诊先天性内斜视的最早年龄。先天性内斜视治疗所能达到的最佳结果是低于正常水平的双眼视觉。如果婴儿在18个月大时实现眼位正位，更有可能达到这一结果。通过适当的双眼内直肌后徙术，一次手术就能使80%至85%的婴儿获得满意的眼位正位。在成功实现眼位正位后的不同时间，会出现一系列运动缺陷，包括DVD（分离性垂直偏斜）、潜在性眼球震颤、斜肌功能障碍以及A-和V-型斜视。这些相关表现常见于先天性内斜视，但并非先天性内斜视所特有。先天性内斜视的发病及临床表现可以用沃思最早提出的一种理论来满意地解释，即斜视是由运动融合机制的先天性缺陷引起的，并如查瓦斯所指出的那样，因内斜视因素而加重。与先天性内斜视相反，所有其他斜视都可被认为是在具有先天性运动融合能力，但因先天性不可克服的斜视（先天性动眼神经麻痹）而未能维持、因后天性（出生后）斜视而丧失、在有利情况下采用如改变头位等策略来保持融合（杜安综合征）、有间歇性斜视伴部分时间抑制（X(T)）或通过非手术方法维持眼位正位（屈光性内斜视）的人身上继发出现的。展望未来，我认为先天性内斜视治疗的进展将取决于对病因有更好的理解，从而设计并使用创新的非手术技术来抑制集合并刺激双黄斑融合。
