[综述]
Duane眼球后退综合征(DRS)是一种先天性脑神经异常支配性疾病。由于神经异常支配的程度不一，患者第一眼位的斜视类型、眼球内转和/或外转受限程度、肌肉挛缩程度也不同，其临床表现变化多样，因此DRS的治疗方法不一。根据患者第一眼位的斜视度将其分为内斜视型、外斜视型或正位型DRS更有临床意义。制定DRS的治疗方案时应考虑患者第一眼位的斜视度、代偿头位的严重程度、眼球内转和外转限制程度、眼球后退程度、是否合并眼球上射及下射从而进行个性化的治疗。单眼内斜视型DRS主要治疗方案包括单眼内直肌后徙术、单眼上直肌转位术或联合内直肌后徙术、双眼内直肌后徙术及患眼内直肌后徙联合小量外直肌截除术。单眼外斜视型DRS治疗方案包括患眼外直肌后徙术及双眼不对称的外直肌后徙术。双眼内斜视型DRS首选的手术方式为双眼内直肌后徙术。双眼外斜视型DRS是DRS中少见的类型，手术方案需要个体化设计。DRS患者的异常神经支配可导致眼球内转时内、外直肌共同收缩而发生眼球后退，因此可通过内、外直肌的大量后徙进行治疗。外直肌Y形劈开联合或不联合外直肌后徙术可治疗DRS外直肌机械缰绳效应引起的眼球上、下射。对于年幼的DRS患儿及合适的DRS病例，眼外肌注射内毒毒素可作为一种替代疗法。本文介绍了近年来治疗不同类型DRS的手术设计和治疗方案，并对这些治疗方案的优缺点及可能的并发症进行综述。
Duane retraction syndrome (DRS) is an abnormal eye movement disease caused by congenital cranial dysinnervation.Treatment of DRS is challenging because of the variety of clinical features with different types of strabismus in the primary position, different degrees of limitation of abduction/adduction, and different degrees of muscle contraction.It is more clinically meaningful to categorize patients as having esotropia, exotropia or orthostatic DRS based on the degree of strabismus in the primary position.The treatment plan for DRS should be individualized by considering the degree of strabismus in the patient's primary position, the severity of abnormal head position, the amount of ocular deviation, abnormal head position, degree of globe retraction, combined with or without upshoot or downshoot.The main treatment options for DRS patients having monocular esotropia include monocular recession of the medial rectus muscle, superior rectus transposition only or combined with medial rectus muscle recession, binocular recession of the medial rectus muscle, and combination of recession of the medial rectus muscle and a small amount of lateral rectus muscle resection in the affected eye.The treatment plan for DRS patients having unilateral exotropia DRS includes lateral rectus muscle recession surgery for the affected eye and lateral rectus muscle recession surgery for bilateral asymmetry.The preferred surgical method for DRS patients having bilateral esotropia is bilateral recession of the medial rectus muscle.Bilateral exotropia DRS is a rare type of DRS, and the surgical plan needs to be individualized.Abnormal neural innervation in DRS patients can lead to joint contraction of the medial and lateral rectus muscles during eye rotation, resulting in eye retraction.Therefore, patients can be treated through extensive recession of the medial and lateral rectus muscles.The Y-shaped split of the lateral rectus muscle with or without lateral rectus muscle recession surgery can treat the upshoot or downshoot of the eyeball caused by the DRS lateral rectus muscle mechanical reins effect.For young children with DRS and suitable DRS cases, extraocular muscle injection of botulinum toxin can be used as an alternative therapy.This paper reviews the latest views and strategies on DRS treatment, and discussed the advantages, disadvantages and possible complications of these procedures.
王镇,王利华. Duane眼球后退综合征治疗进展[J]. 中华实验眼科杂志,2024,42(10)：970-976.
DOI:10.3760/cma.j.cn115989-20200610-00415版权归中华医学会所有。
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