副眼外肌畸形一例及文献复习

摘要

目的 手术探查一例伴随眼球运动受限及眼球后退现象的垂直非共同性斜视患者.方法 病例报告.运用MRI影像学检查了解该病例眼外肌结构特征,通过手术松解异常结构对眼球运动的限制并手术矫正斜视,组织病理学检查确定异常结构的组织学成分.结果 位于眼眶肌锥内间隙(外下象限),外直肌内下方、下直肌外上方,起自眶尖,附着于眼球后巩膜的类似眼外肌的异常结构是本例斜视患者的可能原因.通过手术松解其对眼球运动的限制并适当后退下直肌达到了矫正斜视的效果.眼球运动改善不明显.异常结构病理报告来源于肌肉组织.结论 本病例MRI检查发现的异常结构,术中发现与眼球运动限制有一定关系,该异常结构组织学检查为来源于肌肉组织,考虑为副眼外肌畸形.对伴随眼球运动受限及眼球后退现象的垂直非共同性斜视,要考虑到眼眶内异常结构的可能,有必要用MRI影像学检查,协助明确诊断.%Objective Explored the causation of a case of incomitant vertical strabismus accompanied with elevation deficit and globe retraction by surgery.Methonds Case report.Orbital imaging study of MRI was used to discover the anatomic feature of extraocular muscle.By released the restrictive structure to treat strabismus. Histopathologic inspection was used to confirm the origin of the abnormal structure.Results Abnormal extraocular muscle that located within the cone formed by the four recti muscles was the causation of strabismus.It arose at the annulus of Zinn,passing forwards between the inferior rectus muscle and lateral rectus muscle,and insert directly on the sclera.After Released it from eyeball and recession of inferior rectus muscle the strabismus was improved. Elevation deficit was not improved.Histopathologic inspection confirmed that the structure was muscular in origin.Conclusion The abnormal structure that found by MRI was the cause of elevation deficit and globe retraction. Its histopathologic inspection confirmed the muscular origin. The abnormal structure was an accessory extraocular muscle.For incomitant vertical strabismus accompanied with elevation deficit and globe retraction anomalous orbital structures maybe the causation.Orbital imaging studies should be done to explore the origin of disease.