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Is Accommodative Esotropia Masked?-A Case Report

是調節性內斜視偽裝像嬰幼兒內斜視嗎?-病例報告

摘要


目的:報告一例嬰幼兒性內斜視手術後兩個月併發調節性內斜視。 方法:病例報告。 結果:一例4歲女童患有長期斜視及頭右側傾斜前往我們的門診就醫檢查。雙眼光學檢查經睫狀肌麻痺後分別為右眼球面鏡+2.0屈光度及左眼球面鏡+1.75屈光度;兩眼裸視視力皆為20/25。斜視檢查看近點或看遠點皆為內斜視33稜鏡度。眼球運動顯示雙眼下斜肌亢進。因此她接受雙眼5公釐的內直肌徙後手術及雙眼下斜肌截斷術。術後看近點及遠點皆殘餘內斜視3稜鏡度;頭右傾斜情形獲得改善。但在兩個月後的門診追蹤,在沒戴眼鏡的情況下,雖然看近點內斜視仍是3稜鏡度,但看遠點則變為外斜視5稜鏡度。右眼屈調度數增加至球面鏡+3.0屈光度;左眼球面鏡為+3.25兼圓柱鏡-0.5屈光度。術後兩個月出現了調節性內斜視。 結論:嬰幼兒內斜視被定義為交替性大角度的內斜視,好發於年齡六個月大以前。屈調特徵是經睫狀肌麻痺後遠視度數小於3屈光度而沒有因調節力過量所引起的內斜角度。過去眼科論文報告指出調節性內斜視常在嬰幼兒內斜視治療後產生:但如本文報告的病例-在手術後兩個月內產生並不常見。我們推測可能是調節性內斜視偽裝像嬰幼兒內斜視。由此經驗,我們建議在治療即使只有輕度遠視的嬰幼兒內斜視病人時,去除因調節力過量所造成的內斜角度是治療的優先要務。

關鍵字

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並列摘要


Purpose: To report a case developing accommodative esotropia after surgery for infantile esotropia in 2 months. Methods: Interventional case report. Results: A 4-year-old girl presented to our clinic with symptoms of a turned eye and right head tilt for a long time. Cycloplegic refraction was +2.0 diopter (D) in the right eye and +1.75D in the left eye without astigmatism. Bare visual acuity was 20/25 in both eyes. Esotropia 33 prism diopters (△) for both near and distance were measured. In addition, she had bilateral inferior oblique overaction. Thus, she had undergone bilateral medial rectus recession of 5 mm and bilateral inferior oblique myectomy. After the surgery, residual esotropia 3△ for both near and distance was found and abnormal head tilt was improved. However, the eyes remained to be esodeviation 3△ for near but became exotropic 5△ for distance without correction after two months. Cycloplegic refraction revealed +3D in the right eye and +3.25D/-0.5D Ax 170 in the left eye. Accommodative esotropia was impressed. Conclusion: Infantile esotropia is defined as alternating large-angle esotropia with onset before 6 m/o. Cycloplegic refraction revealed < 3D of hyperopia without refractive or accommodative component. It is well-known that accommodative esotropia often occurs consecutively among children treated for infantile esotropia. Development of accommodative esotropia following the surgery in 2 months is rare. We speculated that it was masked preoperatively. Anti-accommodative therapy for esotropia even with low hypermetropia should be considered as first priority.

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