斜視之手術治療　第五篇　單眼固視症候羣

Surgical Result of Strabismus (5) Monofixation Syndrome

林惠朗(Huey-Lan Lin) ； 陳正敏(Cheng-Min Chen)

《中華民國眼科醫學會會刊》 27卷1期 (1988/05) Pp. 284-291

https://doi.org/10.30048/ACTASOS.198805.0051

摘要

本篇係以斜視手術後矯正在15△以內的病人400人，（內斜191、外斜209），來做視機能檢查，以探討其視機能之狀態。結果有74%（296人），呈單眼固視，有26%（104人）呈兩眼固視。但在單眼固視群中有5.5%（22人）為兩眼固視之非標準型反應，在兩眼固視群中有1.5%（6人）呈假性兩眼固視，因此，真正單眼固視者為70% （280人），兩眼固視者為30% （120人）。
在兩眼固視群中，有良好立體感者占76.7% (92/120)，有初級立體感者占17.5%(21/120)，完全無立體感者占5.8% (7/120)，我們認為立體感的缺損可以是先天的，也可以是後天的，並以本篇資料討論之。在單眼固視的病人中，以Titmus立體感檢查，有初級立體感者占27.5% (77/280)，完全無立體感者占72.5%(230/250)。以Bagolini檢查周邊網膜適應狀態，有39.6%(111/280)是NRC，40% (112/280)是ARC，20.4% (57/280)呈網膜抑制。以4△ test檢查黃斑部抑制暗點時，我們發現這種抑制暗點可以是兼性的，也可以是專性的。我們並以這次檢查結果來推論，在280位單眼固視群中真正屬於單眼固視症候群的只有71位。並認為單眼固視症候群及microtropia的發病機序應係由於其中心立體感和其融像運動機序缺損所引起，而固邊性立體感和其融像運動機序公須正常，這樣才能與一般斜視及小角度斜視區別之。

並列摘要

The purpose of this paper is to study and discuss about the nature of monofixation syndrome.
The visual function tests (4-diopter prism test, W-4-D test, stereo acuity test, Bagolini test) were performed on 400 strabismic patients whose post-operative deviation were within 15 prism diopters.
After operation, there were 296 patients showing monofixation, and 104 patients representing bifixation, accounting for 74% and 26% respectively. In monofixation group (296), 28 patients had good stereopsis in which 22 patients showed atypical response by 4-diopter prism test (good stereopsis, diplopia on 4-diopter prism test) while another 6 patients were due to monocular cue (no stereopsis on TNO or on animal of Titmus). In bifixation group (104), 6 patients, in whom rapid alternating fixation can be noted if more attention were paid during the test, were diagnosed as pseudobifixation, they were mono- fixation virtually.
Macular suppression in our cases can be facultative or obligatory which obviously result from the defect of central stereopsis and its vergency mechemism.
Among those 280 patients with monofixation, only 71% patients having good peripheral fusion associated with coarse stereopsis were true monofixation syndrome, that mean their peripheral stereopsis and its accompanied wergency mechenism are intact.
The conclusion of this study is to point out that patients with monofixation syndrome or microtropia were those whose central stereopsis are defect while peripheral stereopsis and its vergency mechenism are intact. This can be clarified itself from small angle strabismus.

並列關鍵字

central stereopsis ； peripheral stereopsis ； vergence mechanism ； suppression