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目的 :探讨分离性垂直性斜视 (dissociatedverticaldeviation ,简称DVD)的临床特点、病因和手术方法。方法 :回顾分析 6例DVD病例。结果 :临床特点 :DVD不同于一般的上斜视 ,因为DVD的上斜并非总是交替的 ,往往只有上隐斜 ,而不存在下斜视。DVD为双眼交替遮盖时 ,被遮盖眼呈上斜状态 ,与一般斜视的神经支配法则相矛盾的一种眼球垂直运动异常。当对侧眼注视时 ,无论那只眼都向上运动 ,处于高位 ,而且还有单眼外旋运动。所以 ,目前选用Bielschowsky提出的名称即 :DVD ,而不用交替性上斜视、遮盖性上斜视等名称。DVD可与任何类型的斜视同时存在。本文 6例 ,合并外斜视 3例 ,伴有双眼下斜肌亢进 1例。术后随诊 6～ 2 4个月 ,其中 5例病人术后角膜映光均正位 ,1例病人在第一眼位无明显上斜现象。仅在遮盖一眼时出现轻度上斜 ,因上斜度不大未再手术。结论 :当DVD病人上斜明显影响外观时应行手术治疗。
Objective: To investigate the clinical features, etiology and operation of dissociatedverticaldeviation (DVD). Methods: Six cases of DVD were retrospectively analyzed. Results: Clinical characteristics: DVD is different from the general upper oblique, because the DVD’s oblique is not always alternating, often only on the phoria, but there is no lower strabismus. DVD is alternately covered by both eyes, was covered eye was oblique state, and the general rules of strabismus contradiction of ophthalmic vertical motion abnormalities. When the contralateral eye gaze, regardless of that eye are up, in high position, but also monocular outer rotation. Therefore, the current choice of Bielschowsky proposed name is: DVD, instead of alternating on the strabismus, obscure the name of strabismus. DVD can coexist with any type of strabismus. 6 cases of this article, combined exotropia in 3 cases, accompanied by bilateral oblique hyperthyroidism in 1 case. Postoperative follow-up of 6 to 24 months, of which 5 patients postoperative corneal reflectance were positive, a patient in the first eye no significant oblique phenomenon. Only slightly covered in a slight incline, because the incline is not large no longer surgery. Conclusions: Surgical treatment should be performed when DVD patients have a clinically significant appearance effect.