Study of pathophysiology and treatment of superior oblique palsy.

上级斜肌具有下引、外展和内旋的作用。其他眼外肌可代偿上级斜肌功能障碍。内旋肌扭转与下屈肌和外展肌相比，很少有其他肌肉代偿，大多数获得性上级斜肌麻痹患者以扭转性复视为主诉。正常人的回旋扭转融合幅度较大，而中枢神经系统疾病患者的回旋扭转融合幅度很窄。因此，我们对上级斜肌进行了以下研究。1)眼球扭转运动与眼外肌结构的关系。2)1）上级斜肌麻痹患者，如果上级斜肌发育不良，患者会出现垂直偏斜、外斜视，往往需要大量的肌肉手术才能达到满意的效果。我们报告了手术的有效性，以纠正眼球和眼外肌之间的相对位置。我们证实，影像学检查是重要的，以评估肌肉功能。我们报告斜视手术后眼外肌的位置。眼外肌在眶深部的位置无明显变化。我们研究了黄斑转位手术后视网膜旋转量和主观睫状体扭转。我们发现黄斑移位手术度数超过15度的患者常出现复视。正常人最大可达15度，黄斑移位术后患者也可达15度。我们报告，上级斜肌肌腱移位进入Tenon囊的患者，在斜视手术后，立体视觉较差，双眼恢复困难。

A superior oblique muscle has actions of infraduction, abduction and incyclotorsion. Other extra ocular muscles can compensate dysfunction of superior oblique muscle. Compare to infraduction and abduction, incyclotorsion is rarely compensated by other muscles and most patients with acquired Superior oblique palsy complain torsional diplopia. Fusional amplitude of cyclotorsion is large in normal subjects, but it is very narrow in the patients with central nervous system problems. We therefore performed the following studies on superior oblique muscles. 1) The relationship between ocular torsional movement and structure of extraocular muscles. 2) the relationship between ocular torsional movement and binocular vision.1)In the patients with superior oblique palsy, if the superior oblique muscle is hypoplastic, patients have vertical deviation, exotropia and they often require larger number of muscles to be operated to achieve satisfactory result. We reported the effectiveness of the surgery to correct the relative position between the eyeball and extraocular muscles. We confirmed that imaging studies are important to evaluate muscle functions. We reported the position of extraocular muscles after strabismus surgery. The positions of extraocular muscles did not alter in the deep orbit. The alteration occurred only anterior to the equator.We studied the amount of retinal rotation and subjective cyclotorsion alter macular translocation surgery. We found that the patients who underwent macular translocation surgery exceeded 1 5 degrees often complain diplopia. Normal subjects adapt cyclotorsion up to 15 degrees, and the patients who underwent macular translocation surgety also adapted up to 15 degrees of cyclotorsion. We reported that the patients whose superior oblique tendon migrating into the Tenon's capsule showed poor stereopsis and recovering binocularity after strabismus surgery was difficult.