摘要
眼性斜頸是指病患因眼位不正，而引起的一種代償性頭部向一側偏斜的現象，本文收集了上斜視病患32人，其中有代償性斜頸19人，對於每位病患，詳細紀錄其病史，眼部檢查，斜視檢查，各項資料，統計整理，其中有13位病患接受手術治療，我們也詳細統計了其開刀前，開刀後，各種症狀改善的情形。在正常眼位(primary position)平均改善9.6△，麻痺方向眼位(paretic position)平均改善11.3△，機能過度方向眼位(overaction position)平均改善18.8△，在症狀改善，7位術前有代償性斜頭病患，術後頭部皆恢復至正常正立位置，5位術前有複視現象病患，術後複視現象消失，融像機能，13位病患中，11位皆有進步，13位病人在術後，不論在身體頭部姿勢上，眼位上皆獲得美觀上的改善。
關鍵字
無資料並列摘要
Ocular torticollis is congential or infantile incomitant squint. It is seen particularly in children. In most cases, it is due to insufficiency of a suprior oblique, associated with overaction of the inferior oblique of the same eye, or underaction of the superior rectus with an overatction of the inferior oblique of the other eye. The attitude, being adopted to avoid diplopia and maintain binocular vision, is assumed contemporaneously with the development of fusion so that it becomes evident early in life. Its presence can almost be accepted as a diagnostic indication that the palsy is of congenital or early infantile origin. In all cases the postural deformity is functional and the head can be passively moved or straightened. While most authorities consider the reaction a compensatory mechanism to assist binocular vision, this view has been questioned. Satanousky (1932), observing torticollis in a case of superior oblique paralysis with corneal opacities sufficiently dense in one eye to exclude the possibility of binocular vision, suggest that the tilt was an attempt to obviate false projection due to the extorsion of the eye. Cabannes (1927) also stressed a proprioceptive rather than visual origin and Mc Mallen (1936) the importance of the postural reflexes associating the neck muscles with torsion of the eyes, thus raising the possibility of an octavo-motor rather than a visual stimulation. Records of 32 consecutive patiens who have vertical musele paresis. To diagnose the paretic vertical muscles and any accompanying horizontal deviations on vertical gaze, all of the following methods of examination were used. Visual acuity (including bare vision and refractive corrected visual acuity) versions, ductions, comitance test in nine positions of gaze. Photographs of the eyes were taken in nine positions of gaze. Diplopia were examined with the Hess chart. Abnormal head positions and ptosis were noted and recorded. The sensory state was determined with the Worth 4-dot test (Distance & Near), Titmus Book and Synoptophore. A head tilt was recorded in 19 of the 32 cases used in this report. The head tilt assumed by patients with a paretic vertical muscle can be stated that the head is tilt in a direction in which the paretic muscle's torsional action is not required. There are 13 cases received the operation. The operation performance are as follows: IO myectomy 7 cases, IO mycetomy plus SR recession 1 case, IR recession 1 case, SO tenectomy 1 case, IO myectomy plus SO tucking 1 case, the mean effect of surgery was 9.6∆ in primary position of gaze, 11.3∆ in paretic position of gaze, 18.8∆ in overaction position of gaze. Ocular torticollis was eliminated in 100% (7/7) of the patients. Diplopia was eliminated in 100% (5/5) of the patients. Fusion status improved in 85% (11/13) of the patients and all the patients were satisfied with the cosmetic correction.
延伸閱讀
- Hsu, H. N., Huang, J. J., & Yang, M. L. (1997). 於重度弱視眼施行斜視手術之結果. 中華民國眼科醫學會雜誌, 36(3), 199-203. https://doi.org/10.30048/ACTASOS.199709.0008
- 黃鐘瑩、高玲玉、楊孟玲（2012）。斜視治療的目標。中華民國眼科醫學會雜誌，51(2)，132-136。https://doi.org/10.30048/ACTASOS.201210.0002
- 劉寬鎔、林隆光（1986）。眼屈折組成在斜視手術後的變化。中華民國眼科醫學會雜誌，25(1)，1-4。https://doi.org/10.30048/ACTASOS.198605.0001
- 陳清華（2007）。Torticollis。中醫藥研究論叢，10(1)，73-79。https://doi.org/10.6516/TJTCM.200703_10(1).0008
- 陳俊澈、鄭芳仁、鄭英明（1990）。Clinical Manifestations of Ocular Toxocariasis。中華民國眼科醫學會雜誌，29(2)，1055-1061。https://doi.org/10.30048/ACTASOS.199005.0185