Clinical analysis of dissociated vertical deviation
【Abstract】 Objective To investigate the clinical production of dissociated vertical deviation in order to choose a reasonable operative procedure. Methods 267 cases of dissociated vertical deviation in patients with eye position and surgical approach to clinical analysis. The results of dissociated vertical deviation more complicated with other kinds of squint, 1 / 3 associated with the inferior oblique hyperfunction. Conclusion dissociated vertical deviation with inferior oblique hyperfunction are closely related, resulting in dissociated vertical deviation may be related to more than one point of each other into the role of the extraocular muscles together.
Key words Strabismus; extraocular muscle
Clinical analysis of dissociated vertical deviation
[Abstract] Objective To explore the cause of dissociated vertical deviation (DVD), so that choose reasonable modus operandi.Methods The position of eye and modus operandi of 267
DVD cases patients were analysed.Results Many DVDs combine with other typus strabismus, and one third cases accompany with accentuation of inferior obliquus.Conclusion DVD closely correlates with accentuation of inferior obliquus.Cause to bring about DVD more possibly relates with cooperate effect of more strips mutual angularity ocular muscles
[Key words] strabismus; ocular muscles
Dissociated vertical strabismus (dissociated vertical deviation, DVD) gradually awareness and understanding. As
regards its etiology is not clear, the clinical look at the
phenomenon more as an independent, treatment often used on the rectus muscle surgery after the resettlement. The author of the Tianjin Eye Hospital in January 1997 ~ October 2002 267 cases of DVD-patient analysis of the clinical data, found that patients with multiple DVD merging with other types of strabismus, or for other types of strabismus examination revealed the existence DVD.
1 Data and methods
1.1 General information on this group of patients a total of 267 cases, 128 cases of male and female 139 cases, aged 2 to 40 years old, with an average of 12.5 years old, vertical strabismus degrees 10 ? ~ 80 ?.
1.2 Inspection methods generally examination: visual acuity and refraction correction. Ocular examination: eye position using Hirschberg test, alternate prism cover test combined with determination and with depending on plane squint degrees were also observed, including translocation eye cover, the original office, the eyes of places outside the booth, identify inferior oblique hyperfunction and superior oblique palsy.
1.3 Diagnostic criteria in order to turn inward and outside the turn, when in front of watching eyes up separate cover, to cover the post-rotation to the original office,
diagnosed with DVD. DVD of the patients will be diagnosed with the eye position respectively, the statistics will be imposed within the AV oblique, external oblique AV strabismus syndrome classified as a special type. Are the horizontal ? 15 ?,
vertical position ? 10 ?, as an indication for corrective
surgery, 267 patients underwent surgery.
2 Results
This group of 267 cases of the simple DVD 61 cases, 206 cases combined with other types of strabismus, in Table 1.
Table 1 DVD and DVD combined type of simple composition ratio of 22.85%, the merger the composition of other types of strabismus ratio of 77.15%, showing that DVD more associated with other types of strabismus. Exotropia in which most common, accounting for 40.45%.
In the 267 cases of patients, the presence of Statistics there are 91 cases of inferior oblique muscle surgery in parallel oblique hyperfunction 34.08%. Now a simple DVD case that is, not associated with other types of strabismus, according to whether the presence of oblique hyperfunction is divided into two categories, in Table 2. Table 2 a simple DVD and inferior oblique hyperfunction 267 cases of patients underwent surgical treatment, according to surgical group, Table 3. For those on the float to a lesser extent (<10 ?)
the level of combined internal and external strabismus can only solve the problem (there are 11 cases the level of muscle surgery); the 34 cases not associated with other eye-bit skew
and the inferior oblique hyperfunction, line on the rectus
After the resettlement operation. Table 3 single direction surgery and multi-directional operation 2 days after surgery, and basic to obtain satisfactory results, indicating very likely more than one DVD each other into a point of extraocular muscle force effects. Reposted elsewhere in the paper for free download http://
3 Discussion
DVD is based on alternate cover, is cover up eye separation and external rotation, external rotation, characterized by a special type of strabismus, the
pathogenesis is not clear, because of their inconsistent with Hering's Law, Bicschowsky that the DVD there is a dominant eye in patients with vertical separate sports center, located in central, this hub of an intermittent abnormality caused by
nerve impulses DVD series of symptoms and signs. Schveygyer that the advantage of the flexibility of the upper and lower turn caused muscle Dwane: paralysis factors, especially the immediate transfer of incomplete muscle paralysis, from the bottom of both sides of the vestibular nerve impulse imbalance [1], in accordance with this group of 267 cases of clinical cases the results of classification analysis, showing the DVD more associated with other types of strabismus, 84.19% among patients with two or more into the angle of strabismus
essential to obtain satisfactory results. Xu Jiangtao [2], Sun Mei [3], Jiang Xiang-Zhe [4], Su-Ping Wang [5] and other
samples have reported similar conclusions, suggesting that DVD is likely together with the extraocular muscles related to the
role; and closely related to the inferior oblique hyperfunction this country Gan Xiaoling DVD and other scholars
about the different surgical procedures reported [5 ~ 8] have confirmed that the inferior oblique muscle transposition surgery some clinical effect, to the author's argument provides a clinical basis. Superior rectus in clinical practice a large number of post-resettlement given more
satisfactory results [6,7], contact arc analysis rectus average 6.5 mm, a large number of post-resettlement (? 7 mm,
? 6 mm), either abnormal nerve impulses , or turn on the factors together, are affected to varying degrees on the transfer function of the eye, therefore, not a separate clinical cognitive DVD, there are other types of squint, especially in oblique view, should pay attention to the possibility of a DVD. At the same time, be sure check the existence of the inferior oblique muscle in patients with hyperthyroidism, according to Kubota Nobue law will be divided into four design superior oblique surgical methods and
surgical volume [9], the presence of oblique hyperfunction of the first line of cut or switch operation, reduced inferior oblique forces and strengthen the next turn muscle function after surgery according to the amount of the remaining surplus
after the resettlement superior rectus, superior rectus commonly used unconventional post-resettlement after
resettlement, these 267 cases, in addition to 21 cases of patients with DVD's eyes drift due to the extent different,
light or with inferior oblique hyperfunction of strabismus degree <5 ?, line after the resettlement rectus <6 mm, the rest were performed ? 6 mm post-resettlement volume
strabismus were associated with other types of analysis which the main , according to design primary and secondary
corrective surgery. DVD are as intermittent exotropia, eye cover to cover there was a deflection, to cover the post-
orthotopic can be controlled, and the oblique angle instability characteristics, its mechanisms still need a lot
of experimental research and clinical study.
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