先天性上斜筋麻痺にともなう偏心固視例

抄録

A 5-year-old girl, suffering from the right superior oblique palsy accompanied by amblypoia with an eccentric fixation with vertical component of the right eye. Fixation pattern, R. E.: about 1 & 1/2 disc diameter above the fovea by fixation photographs. Far vision, R. E.: (0.03) Deviations, 35 prism diameters RHT and 25 prism diameters XT. Motility, paresis of the right superior oblique muscle. Binocurarity, suppression of the right eye. Retinal correspondence, unknown.
For 37 days, we applied Cüppers methods twice a day joined with total occulusion of the good eye. Foveal fixation was regained in supraduction and abduction. But in the primary position it was noticed on a slightly upper and nasal region of fovea. A marked dislocation of the fixation point was revealed in the infraduction.
The changing of the fixation pattern during the eye rotation is closely related to the muscle imbalance (R. S. O. palsy).
Following operations were performed. Indication for surgery, R. E.: Tucking of S. O. 12mm Resection of I. R. 4mm.
Nine days after surgery, foveal fixation was regained in all direction of ductions. But 30 prism diopters RHT and 25 prism diopters XT remained, so second operation was performed. Indication for surgery, R. E.: Resection of I. R. 3mm. Recession of S. R. 5mm.
Now, four months after the second surgery, the deviations have been neutralized using 8 prism diopters in front of the left eye with the apex towards up. The patient shows good binocularity in free space and Far vision, R. E. (0.8p).
It is necessary to more carefull examinations of fixation pattern and ocular motility. If the changing of fixation pattern are revealed in cardinal positions of duction, a central fixation may be regained by normalizing motor imbalance of the involved eye.