Ocular torsion reveals the mechanisms of cyclovertical strabismus - The Weisenfeld Lecture
Ocular torsion reveals the mechanisms of cyclovertical strabismus - The Weisenfeld Lecture
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DOI：
10.1167/iovs.07-0739
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发表时间：
2008-03-01
影响因子：
4.4
通讯作者：
Guyton, David L.
中科院分区：
文献类型：
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作者：
Guyton, David L.
20世纪70年代中期，我在约翰霍普金斯大学接受眼科培训期间，对常见的眼睛水平错位（水平斜视）的机制有了相当好的理解。至少知道了涉及的肌肉。但即使是常见的旋转垂直性斜视，我们也知之甚少：斜肌过度活动/活动不足、“A”型和“V”型、分离性垂直偏斜和先天性上级斜肌麻痹。在我的职业生涯中，理解这些形式的旋转垂直斜视的机制的关键是眼球扭转。这是一个按时间顺序排列的故事，讲述了我是如何认识到眼球扭转的，学会了如何测量它，并与一系列同事一起利用眼球的扭转位置和扭转运动来深入了解这些形式的旋转垂直斜视的机制。我相信我们发现的一些“真理”对许多人来说似乎是非常投机的-几乎是“信仰的飞跃”。当我们继续为这里提出的理论寻找进一步的证据时，我经常想起19世纪哲学家亚瑟·叔本华的“真理的三个阶段”1：“所有真理都经过三个阶段。首先，它被嘲笑。第二，它遭到强烈反对。第三，它被认为是不言而喻的。”我希望我所说的话会有新的、有价值的东西，有足够的价值，经得起时间的考验。
In the mid 1970s, during my ophthalmology training at Johns Hopkins, the mechanisms involved in the common horizontal misalignments of the eyes (horizontal strabismus) were reasonably well understood. At least the muscles involved were known. But even the common forms of cyclovertical strabismus were poorly understood: overacting/underacting oblique muscles,“A” and “V” patterns, dissociated vertical deviation, and congenital superior oblique paresis. Over the course of my career, the key to understanding the mechanisms involved in these forms of cyclovertical strabismus has been ocular torsion. This is a chronologic story of how I came to appreciate ocular torsion, learned how to measure it, and with a succession of colleagues have been able to use the torsional positions and torsional movements of the eyes to gain useful insight into the mechanisms involved in these forms of cyclovertical strabismus.Some of the “truths” that I believe we have discovered will seem very speculative to many—almost “leaps of faith.” As we continue to seek further evidence for the theories presented here, I frequently recall the “three stages of truth” attributed to the 19th-century philosopher Arthur Schopenhauer 1:“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. And third, it is accepted as being self-evident.” My hope is that there will prove to be something new and valuable in what I have to say, valuable enough to withstand the test of time.