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Comparative evaluation of “closed posterior levator advancement” in simple congenital and aponeurotic ptosis 单纯性先天性上睑下垂和肌腱膜性上睑下垂的 "闭合性后上睑提肌腱膜前移术 "比较评估
IF 1.1 Q3 Medicine Pub Date : 2024-01-05 DOI: 10.4103/tjo.tjo-d-23-00081
R. Goel, Sonam Singh, Shalin Shah, S. Khanam, Priyanka Golhait, Tanvi Gaonker
The purpose of this study was to compare the outcomes of “closed posterior levator advancement” (CPLA) in acquired aponeurotic and simple congenital ptosis with good levator function (LF). A prospective interventional study was conducted on 20 adult patients, 10 simple congenital ptosis, and 10 acquired aponeurotic ptosis with LF ≥8 mm. Complicated, posttraumatic, neurogenic ptosis and previous lid surgery were excluded. A detailed history and assessment of visual acuity, upper eyelid margin reflex distance (MRD1), margin-crease distance, LF, Bell’s phenomenon, ocular surface disease index (OSDI), and phenylephrine test were undertaken. CPLA was performed in the 20 eyes and were followed up for 3 months. The ages of the study participants ranged from 18 to 64 years, and the male: female ratio was 11:9. There were nine aponeurotic and one congenital severe ptosis, the remaining 10 being mild–moderate ptosis. The etiologies in the aponeurotic group were involutional (2), contact lens wear (1), allergic conjunctivitis (3), and idiopathic in four eyes. The success rates were 90% in both groups. The amount of ptosis correction showed a positive relation with LF (r s = 0.6, P = 0.004) and phenylephrine test (r s = 0.7, P < 0.001). The complications in the aponeurotic group were lagophthalmos (2/10), subjective dry eye (2/10), subconjunctival hemorrhage (1/10), symblepharon (1/10), temporal flare (1/10), and overcorrection (1/10). The congenital group showed only undercorrection (1/10). CPLA is an effective procedure for the treatment of mild–moderate simple congenital and all grades of aponeurotic ptosis with good LF. Response to phenylephrine test serves as a useful guide to the amount of ptosis correction.
本研究旨在比较 "闭合性后上睑提肌腱膜前移术"(CPLA)对上睑提肌功能(LF)良好的后天性上睑下垂和单纯性先天性上睑下垂的治疗效果。 我们对 20 名成年患者进行了前瞻性介入研究,其中 10 名为单纯先天性上睑下垂,10 名为后天性上睑下垂且提上睑肌功能≥8 mm。研究排除了并发症、外伤后、神经源性上睑下垂和曾接受过睑板手术的患者。详细询问了病史,并评估了视力、上睑缘反射距离(MRD1)、睑缘增宽距离、LF、贝尔现象、眼表疾病指数(OSDI)和苯肾上腺素试验。对 20 只眼睛进行了 CPLA 检查,并随访 3 个月。 研究对象的年龄从18岁到64岁不等,男女比例为11:9。其中有 9 只眼球为肌腱膜性上睑下垂,1 只为先天性重度上睑下垂,其余 10 只为轻中度上睑下垂。肌腱膜性上睑下垂组的病因是内卷(2 例)、佩戴隐形眼镜(1 例)、过敏性结膜炎(3 例),另有 4 例为特发性上睑下垂。两组的成功率均为 90%。上睑下垂矫正量与 LF(r s = 0.6,P = 0.004)和苯肾上腺素试验(r s = 0.7,P < 0.001)呈正相关。肌腱组的并发症有眼睑下垂(2/10)、主观干眼症(2/10)、结膜下出血(1/10)、眼睑外翻(1/10)、颞叶外翻(1/10)和过度矫正(1/10)。先天性组仅出现矫正不足(1/10)。 CPLA 是治疗轻度-中度单纯先天性上睑下垂和各种程度的上睑下垂的有效方法,且 LF 良好。对苯肾上腺素试验的反应可作为上睑下垂矫正量的有效指导。
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引用次数: 0
Extraocular muscle bridle traction suture assisted Paul glaucoma implant surgery for severe conjunctival scarring 眼外肌桥牵引缝合辅助保罗青光眼植入手术治疗严重结膜瘢痕
IF 1.1 Q3 Medicine Pub Date : 2024-01-05 DOI: 10.4103/tjo.tjo-d-23-00118
Yi-Ching Shao, Lu-Chun Wang, Yi-An Lee
Glaucoma drainage device implantation can be complex and challenging, particularly in patients with conjunctival scarring. However, in this case, involving a young man with refractory glaucoma who had undergone multiple ocular surgeries, the implantation of a Paul glaucoma drainage device was successfully performed after the application of extraocular muscle bridle sutures. The patient exhibited a stable intraocular pressure ranging from 12 to 18 mmHg without antiglaucoma medication during the 3-month follow-up period. Thus, this surgical technique improves the accuracy and ease of inferior-temporal quadrant glaucoma drainage implantation, resulting in good treatment outcomes.
青光眼引流装置的植入可能既复杂又具有挑战性,尤其是对结膜瘢痕患者而言。然而,在本病例中,一名曾接受过多次眼部手术的年轻难治性青光眼患者在进行眼外肌桥缝合后,成功植入了保罗青光眼引流装置。在 3 个月的随访期间,患者的眼压稳定在 12 至 18 mmHg 之间,无需服用抗青光眼药物。因此,该手术技术提高了下颞象限青光眼引流器植入术的准确性和简便性,取得了良好的治疗效果。
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引用次数: 0
Bilateral optic neuritis and encephalopathy as the atypical presentations of multiple sclerosis following severe acute respiratory syndrome coronavirus 2 infection 双侧视神经炎和脑病是严重急性呼吸系统综合征冠状病毒 2 感染后多发性硬化症的非典型表现
IF 1.1 Q3 Medicine Pub Date : 2024-01-05 DOI: 10.4103/tjo.tjo-d-23-00124
Sheng-Yu Liu, Wan-Jen Hsieh, Hsueh-Wen Hsueh, Chao-Wen Lin
Numerous evidence suggests coronavirus disease 2019 (COVID-19) potentially triggers demyelinating diseases, inclusive of multiple sclerosis (MS), and acute disseminated encephalomyelitis (ADEM), and various mechanisms have been proposed. We report a 42-year-old male presented with bilateral optic neuritis and encephalopathy, 2 weeks following COVID-19 infection. He denied any history or family history of neurological and ocular diseases. Severe bilateral visual impairment (only light perception) and pain with eye movement were reported. Fundoscopy revealed bilateral optic disc swelling. Magnetic resonance imaging showed tortuous bilateral optic nerves with optic nerve and nerve sheath enhancement. Multiple hyperintense nodules in bilateral cerebral white matter were noted on fluid-attenuated inversion recovery T2-weighted imaging without diffusion restriction or gadolinium contrast enhancement. Hypointense nodules in cerebral white matter were also noted on T1-weighted imaging, which implied some old lesions. Dissemination in space and time and cerebrospinal fluid-specific oligoclonal bands confirmed the diagnosis of MS. Both serum aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies were negative. He received pulse steroid therapy for 5 days, followed by slowly tapering oral prednisolone. His vision, ocular motion pain, and encephalopathy improved gradually. However, the visual outcome was still poor (bilateral 20/400), and optic atrophy was noticed during 1-year follow-up. To our knowledge, this is the first case of MS following severe acute respiratory syndrome coronavirus 2 infection presented with bilateral optic neuritis and encephalopathy. Since these manifestations are exceedingly rare in MS, we suspect acute immune reactions induced by COVID-19 could bring about the atypical ADEM-like presentations of MS.
大量证据表明,2019 年冠状病毒病(COVID-19)可能引发脱髓鞘疾病,包括多发性硬化症(MS)和急性播散性脑脊髓炎(ADEM),并提出了各种机制。我们报告了一名 42 岁男性在感染 COVID-19 两周后出现双侧视神经炎和脑病的病例。他否认有任何神经系统和眼部疾病的病史或家族史。双侧视力严重受损(仅有光感),眼球活动时疼痛。眼底镜检查发现双侧视盘肿胀。磁共振成像显示双侧视神经迂曲,视神经和神经鞘强化。流体增强反转恢复T2加权成像显示,双侧大脑白质有多个高密度结节,但无弥散受限或钆对比剂增强。T1 加权成像还发现脑白质有低密度结节,这意味着一些陈旧性病变。空间和时间上的扩散以及脑脊液特异性寡克隆带证实了多发性硬化症的诊断。血清水波长蛋白-4和髓鞘少突胶质细胞糖蛋白抗体均为阴性。他接受了为期 5 天的脉冲类固醇治疗,随后缓慢减量口服泼尼松龙。他的视力、眼球运动疼痛和脑病逐渐好转。然而,视力仍然很差(双侧 20/400),随访 1 年期间发现视神经萎缩。据我们所知,这是第一例在感染严重急性呼吸综合征冠状病毒 2 后出现双侧视神经炎和脑病的多发性硬化症患者。由于这些表现在多发性硬化症中极为罕见,我们怀疑COVID-19诱导的急性免疫反应可能会导致多发性硬化症的非典型ADEM样表现。
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引用次数: 0
Aflibercept treatment for delayed retinotomy-associated choroidal neovascularization: A case report and literature review Aflibercept治疗延迟视网膜切除术相关脉络膜新生血管:病例报告和文献综述
IF 1.1 Q3 Medicine Pub Date : 2024-01-05 DOI: 10.4103/tjo.tjo-d-23-00072
Cyuan-Yi Yeh, Yi-Ting Liang, Cheng-Kuo Cheng
A 67-year-old male presented to our clinic with sudden onset of blurred vision and metamorphopsia of his left eye for 2 weeks. He had a history of combined rhegmatogenous retinal detachment and vitreous hemorrhage and underwent an uneventful pars plana vitrectomy, 360° scleral buckling, and drainage retinotomy for his left eye 3 years ago. The anatomic and visual outcomes after surgery were good, without complications. On examination during this visit, an orange–red subretinal mass connected to the previous drainage retinotomy scar was noted. Spectral-domain optical coherence tomography revealed severe subretinal fluid with type-2 choroidal neovascularization (CNV) mass at the superior nasal macular area in connection with the margin of the previous retinotomy scar. Fundus fluorescein angiography showed an active CNV. The patient underwent monthly intravitreal aflibercept in the left eye. After four doses of aflibercept, his CNV regressed with no recurrence on follow-up at 20 months. In conclusion, iatrogenic CNV is a rare complication following uneventful vitreoretinal surgery and can develop years after the operation. It is crucial to early diagnose and treat it with intravitreal antivascular endothelial growth factor treatment for a favorable outcome and long-term remission.
一名 67 岁的男性因左眼突然出现视力模糊和变性视力 2 周来我院就诊。他曾合并流matogenous视网膜脱离和玻璃体出血,3年前接受了左眼玻璃体旁切除术、360°巩膜扣带术和引流视网膜切开术,手术顺利。术后解剖和视力效果良好,无并发症。这次就诊时,检查发现一个橙红色的视网膜下肿块与之前的引流视网膜切开术疤痕相连。光谱域光学相干断层扫描显示,在上鼻部黄斑区有严重的视网膜下积液,并伴有 2 型脉络膜新生血管(CNV)肿块,与之前的视网膜切开术疤痕边缘相连。眼底荧光素血管造影显示有活跃的 CNV。患者左眼每月接受一次玻璃体内阿弗利百普治疗。在接受了四次阿弗利百普治疗后,他的CNV消退了,随访20个月也没有复发。总之,先天性 CNV 是顺利进行玻璃体视网膜手术后的一种罕见并发症,可在手术后数年发生。早期诊断并使用玻璃体内抗血管内皮生长因子治疗对获得良好疗效和长期缓解至关重要。
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引用次数: 0
Comparison of the efficacy of micropulse diode laser transscleral cyclophotocoagulation using different energy protocols 采用不同能量方案的微脉冲二极管激光经巩膜环形光凝术的疗效比较
IF 1.1 Q3 Medicine Pub Date : 2024-01-05 DOI: 10.4103/tjo.tjo-d-23-00129
Kuan-Yu Chen, Shirley H. L. Chang
This study aimed to explore the safety and efficacy of laser treatment settings of micropulse transscleral cyclophotocoagulation treatment in glaucoma patients and to evaluate the relationship between intraocular pressure (IOP) reduction and different treatment parameters. A total of 74 eyes in 64 glaucoma patients with IOP over 21 mmHg or under 20 mmHg with visual field progression who underwent micropulse transscleral cyclophotocoagulation treatment were included. Patients were divided into success and failure groups based on criteria of 20% IOP reduction rate. The predictive factors of IOP reduction between success and failure groups and the IOP reduction rates in the different treatment duration groups were evaluated. Predictive factors for IOP reduction were analyzed using univariate and multivariate regression models. Patients in the success group had significantly higher baseline IOP (median: 28.0 vs. 23.0 mmHg; P = 0.016) and longer treatment times (median: 240 vs. 160 s; P = 0.001). Treatment duration range between 200 and 240 s achieved significantly higher intraocular pressure reduction rates (47.8 ± 17.4%) than durations under 140 s (23.1 ± 14.2%). Univariate analysis showed that baseline IOP and treatment duration were significant contributing factors in IOP reduction. Multivariable analysis further demonstrated that treatment duration over 200 s was the significant predictive factor for IOP reduction. Treatment duration settings were the most significant factor of IOP reduction rates in micropulse cyclophotocoagulation. Customized therapy according to the target IOP reduction rate can be applied with different treatment duration settings to achieve optimal outcomes.
本研究旨在探讨微脉冲经巩膜环形光凝治疗青光眼患者激光治疗设置的安全性和有效性,并评估眼压降低与不同治疗参数之间的关系。 研究共纳入了 64 名青光眼患者中的 74 只眼睛,这些患者的眼压超过 21 mmHg 或低于 20 mmHg,并伴有视野恶化,他们都接受了微脉冲经巩膜环形光凝治疗。以眼压降低率达到 20% 为标准,将患者分为成功组和失败组。评估了成功组和失败组眼压降低的预测因素以及不同治疗时间组的眼压降低率。采用单变量和多变量回归模型对眼压降低的预测因素进行了分析。 成功组患者的基线眼压明显更高(中位数:28.0 对 23.0 mmHg;P = 0.016),治疗时间更长(中位数:240 对 160 秒;P = 0.001)。治疗时间范围在 200 至 240 秒之间的眼压降低率(47.8 ± 17.4%)明显高于治疗时间在 140 秒以下的眼压降低率(23.1 ± 14.2%)。单变量分析表明,基线眼压和治疗持续时间是降低眼压的重要因素。多变量分析进一步表明,治疗时间超过 200 秒是降低眼压的重要预测因素。 在微脉冲环形光凝疗法中,治疗持续时间设置是影响眼压降低率的最重要因素。根据目标眼压降低率进行定制化治疗,可采用不同的治疗持续时间设置,以获得最佳疗效。
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引用次数: 0
Therapeutic future of Fuchs endothelial corneal dystrophy: An ongoing way to explore 福氏内皮角膜营养不良症的治疗前景:不断探索
IF 1.1 Q3 Medicine Pub Date : 2024-01-05 DOI: 10.4103/tjo.tjo-d-23-00115
Jia-Xin Liu, Tung-Lin Chiang, Kai-Feng Hung, Yi-Chen Sun
Fuchs endothelial corneal dystrophy (FECD) is one of the most common corneal diseases that causes loss of visual acuity in the world. FECD is a genetically and pathogenetically heterogeneous disease that results in the failure of corneal endothelial cells to maintain fluid balance and functional homeostasis of the cornea. Corneal edema, central guttae formation, and bullae development are common corneal pathologies. Currently, the mainstay of FECD treatment is surgery. However, limited sources of corneal graft and postsurgical complications remain problematic. In recent years, with advances in medical science and technology, there have been a few promising trials of new treatment modalities for FECD. In addition to new surgical methods, novel modalities can be classified into pharmacological-associated treatment, cell therapy-associated treatment, and gene therapy-associated treatment. In this article, our primary focus is on the most recent clinical trials related to FECD, and we present a stepwise approach to enhance FECD management and ultimately improve patient outcomes. We thoroughly searched for FECD clinical trials and reviewed the study designs, methodologies, and outcomes of each trial conducted within the past decade. It is imperative for physicians to stay up-to-date with these cutting-edge treatment approaches.
富克斯内皮性角膜营养不良症(Fuchs endothelial corneal dystrophy,FECD)是世界上最常见的导致视力丧失的角膜疾病之一。福氏内皮性角膜营养不良症是一种遗传和病理异质性疾病,会导致角膜内皮细胞无法维持角膜的液体平衡和功能平衡。角膜水肿、中央胶质形成和角膜鼓泡是常见的角膜病变。目前,FECD 的主要治疗方法是手术。然而,角膜移植的来源有限和手术后并发症仍然是个问题。近年来,随着医学科学和技术的进步,出现了一些治疗飞蚊症的新方法,并取得了良好的效果。除了新的手术方法外,新的治疗模式还可分为药物相关治疗、细胞相关治疗和基因相关治疗。在本文中,我们将主要关注与 FECD 相关的最新临床试验,并提出一种循序渐进的方法来加强 FECD 的治疗,最终改善患者的预后。我们彻底搜索了 FECD 临床试验,并回顾了过去十年间进行的每项试验的研究设计、方法和结果。医生必须了解这些前沿治疗方法的最新进展。
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引用次数: 0
The mechanical theory of glaucoma in terms of prelaminar, laminar, and postlaminar factors 从层前、层中和层后因素看青光眼的力学理论
IF 1.1 Q3 Medicine Pub Date : 2023-12-21 DOI: 10.4103/tjo.tjo-d-23-00103
Syed Shoeb Ahmad
The mechanical theory is one of the oldest concepts regarding the development of glaucomatous neural degeneration. However, after a prolonged period of relative monopoly among the various theories explaining the pathogenesis of glaucoma, this concept gradually faded away from discourse. Several developments in the recent past have rekindled interest in the mechanical theory of glaucoma. Now we know a lot more about the biomechanics of the eye, prelaminar changes, mechanisms of retinal ganglion cell death, biomechanical features of the optic nerve head and sclera, extracellular matrix composition and its role, astrocytic changes, axoplasmic flow, and postlaminar factors such as translaminar pressure difference. These factors and others can be categorized into prelaminar, laminar, and postlaminar elements. The objective of this review was to present a concise analysis of these recent developments. The literature search for this narrative review was performed through databases, such as PubMed, Google Scholar, and Clinical Key.
机械理论是有关青光眼神经变性发展的最古老的概念之一。然而,在解释青光眼发病机理的各种理论中,机械理论曾长期处于相对垄断地位,后来逐渐淡出了人们的视野。最近的一些进展重新点燃了人们对青光眼机械理论的兴趣。现在,我们对眼球的生物力学、层前变化、视网膜神经节细胞死亡机制、视神经头和巩膜的生物力学特征、细胞外基质的组成及其作用、星形胶质细胞的变化、轴质流动以及层后因素(如层间压差)有了更多的了解。这些因素和其他因素可分为层前因素、层间因素和层后因素。本综述旨在对这些最新进展进行简要分析。本综述的文献检索通过 PubMed、Google Scholar 和 Clinical Key 等数据库进行。
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引用次数: 0
Advancing therapies for anterior segment developmental anomalies. 推进前段发育异常的治疗。
IF 1.1 Q3 Medicine Pub Date : 2023-12-20 eCollection Date: 2023-10-01 DOI: 10.4103/tjo.TJO-D-23-00167
Muralidhar Ramappa, Ken K Nischal
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引用次数: 0
Clinical and diagnostic imaging profile of three anterior segment dysgenesis disorders presenting with infantile corneal opacities. 三种伴有婴幼儿角膜混浊的前节发育不良疾病的临床和影像诊断概况。
IF 1.1 Q3 Medicine Pub Date : 2023-12-20 eCollection Date: 2023-10-01 DOI: 10.4103/tjo.TJO-D-23-00134
Ananya Kaginalkar, Radhika Tandon, M Vanathi, Noopur Gupta, Viney Gupta, Seema Sen, Seema Kashyap, Arundhati Sharma

Purpose: To describe three anterior segment dysgenesis disorders with infantile corneal opacities, namely, congenital hereditary endothelial dystrophy (CHED), primary congenital glaucoma (PCG), and Peters anomaly (PA) in terms of clinical characteristics, histopathology, genetic association, and diagnostic imaging profiles using imaging modalities such as ultrasound biomicroscopy (UBM) and microscope-integrated intraoperative optical coherence tomography (i-OCT).

Materials and methods: Seventy-four eyes with 22 eyes of CHED, 28 eyes of PA, and 24 eyes of PCG were clinically evaluated and underwent imaging using UBM and i-OCT. Corneal buttons of 16 operated patients underwent histopathological analysis, while genetic analysis was done in 23 patients using whole-exome sequencing.

Results: Corneal diameters (CD) and UBM parameters like anterior chamber depth (ACD), iris thickness (IT), and ciliary body (CB) thickness revealed a statistically significant difference between the three categories. In PA, 9 eyes had a third rare phenotype with only a posterior corneal defect with no iris adhesions. Genetic mutations were seen in all tested patients with CHED, in 83.3% of patients with PCG, and in 80% of patients with the third type of PA. i-OCT helped in the characterization of corneal opacity, identification of posterior corneal defects, iridocorneal adhesions, and contour of Descemet's membrane.

Conclusion: Overlapping phenotypes of the above disorders cause a diagnostic dilemma and parameters like CDs, UBM ACD, IT, and CB thickness help differentiate between them. i-OCT can help in classifying the diseases in a high resolution, non-contact manner, and can better delineate corneal characteristics. The rare third type of PA phenotype may have a genetic association.

目的:利用超声生物显微镜(UBM)和显微镜一体化术中光学相干断层扫描(i-OCT)等成像模式,从临床特征、组织病理学、遗传关联以及成像诊断概况等方面描述三种伴有婴幼儿角膜翳的前节发育不良疾病,即先天性遗传性内皮营养不良(CHED)、原发性先天性青光眼(PCG)和彼得斯异常(PA):对74只眼睛进行了临床评估,其中22只眼睛为CHED,28只眼睛为PA,24只眼睛为PCG,并使用UBM和i-OCT进行了成像。对 16 名手术患者的角膜瓣进行了组织病理学分析,并使用全基因组测序技术对 23 名患者进行了基因分析:结果:角膜直径(CD)和前房深度(ACD)、虹膜厚度(IT)和睫状体厚度(CB)等 UBM 参数显示,三个类别之间存在显著的统计学差异。在 PA 中,有 9 只眼睛具有第三种罕见的表型,即只有后角膜缺损,没有虹膜粘连。所有接受检测的 CHED 患者、83.3% 的 PCG 患者和 80% 的第三种 PA 患者都出现了基因突变。i-OCT 有助于确定角膜混浊的特征、识别角膜后部缺损、虹膜角膜粘连和 Descemet's 膜的轮廓:i-OCT有助于以高分辨率、非接触方式对疾病进行分类,并能更好地描述角膜特征。罕见的第三种 PA 表型可能与遗传有关。
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引用次数: 0
Duane syndrome: An overview on the current management. 杜安综合征:当前管理概述。
IF 1.1 Q3 Medicine Pub Date : 2023-12-20 eCollection Date: 2023-10-01 DOI: 10.4103/tjo.TJO-D-23-00078
Priyanka Prasad, Abhyuday Saxena, Rohit Saxena

Duane syndrome is one of the most common restrictive congenital strabismus characterized by variable horizontal duction deficits with globe retraction and shoots on attempted adduction and narrowing of the palpebral aperture. It is now listed as a congenital cranial dysinnervation disorder. The disease is usually unilateral with female preponderance. Basic etiopathogenesis involves dysinnervation of the lateral rectus (LR) due to aplastic/hypoplastic abducens nucleus with a secondary aberrant supply to the LR by the medial rectus (MR) subnucleus of the oculomotor nerve. Diagnosis of the disease is usually clinical. Due to the variable presentation of the disease, surgical management is a challenge and has to be individualized to achieve alignment in the primary gaze, reduction in globe retraction, upshoots and downshoots, and correction of any abnormal head posture. Differential recessions of the lateral and MR muscles are done to correct esotropia or exotropia in the primary gaze. For globe retraction and shoots, Y-split or periosteal fixation of the LR muscles is done depending on the severity.

杜安综合征是最常见的局限性先天性斜视之一,其特征是不同程度的水平内收障碍,在尝试内收时出现球体回缩和射击,以及睑孔变窄。目前已被列为先天性颅神经支配障碍。该病通常为单侧,女性居多。基本发病机制是由于外侧直肌(LR)神经支配障碍,原因是外侧直肌外侧核发育不良/发育不全,眼球运动神经内侧直肌(MR)亚核继发异常供应外侧直肌。该病的诊断通常依靠临床表现。由于该病的表现形式多变,手术治疗是一项挑战,必须因人而异,以达到主要注视对齐、减少球体后缩、上斜和下斜以及纠正任何异常头部姿势的目的。外侧肌肉和MR肌肉的不同凹陷可矫正主要注视的内斜或外斜。对于球后缩和球弓,可根据严重程度对LR肌肉进行Y形分割或骨膜固定。
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引用次数: 0
期刊
Taiwan Journal of Ophthalmology
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