Офтальмохирургия. 2019; : 87-92
Первичная гиперфункция нижних косых мышц
https://doi.org/10.25276/0235-4160-2019-1-87-92Аннотация
В условиях развития современной страбизмологии всё еще остаются дискутабельными вопросы, среди которых наиболее важным и длительно существующим является выбор тактики методов лечения первичной гиперфункции нижней косой мышцы. В статье представлен литературный обзор наиболее значимых публикаций отечественных и зарубежных авторов, касающихся этой темы: критерии дифференциальной диагностики первичной и вторичной гиперфункции нижней косой мышцы, выделены основные патофизиологические механизмы её возникновения: дисбаланс между верхней и нижней косыми мышцами, дистопия мышц горизонтального действия, а также длительная окклюзия и призматическая коррекция. Обобщена эпидемиология возникновения первичной гиперфункции нижней косой мышцы, которая более чем в половине процентов случаев развивается у пациентов в возрасте до 4-х лет. Оперированная до года врождённая эзотропия не является однозначным залогом успеха в профилактике развития рассматриваемой патологии. Первичная гиперфункция возникает в равной степени у пациентов с аккомодационной и перемежающейся формами эзотропии, реже в случаях с приобретенной эзотропией. Дан анализ различным вариантам классификаций первичной гиперфункции. Рассмотрены показания для проведения хирургического лечения и критерии оценки его эффективности. Моно- или билатеральность гиперэлевации в привидении, её симметричность, наличие V-паттерна определяют тактику и методы лечения, выбор которых зависит от степени гипертропии в сочетании с горизонтальной девиацией. Оценены положительные и отрицательные моменты наиболее часто выполняемых оперативных вмешательств на нижней косой мышце, технические особенности проведения краевой миотомии, миоэктомии, рецессии и антериоризации.
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44. Talebnejad M.R., Tahamtan M., Nowroozzadeh M.H. Botulinum toxin injection for treatment of acute traumatic superior oblique muscle palsy. J. Ophthalmic Vis. Res. 2015;10(3): 263-267. Available from: https://doi. org/10.4103/2008-322x.170350.
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Fyodorov Journal of Ophthalmic Surgery. 2019; : 87-92
Primary hyperfunction of the inferior oblique muscles
https://doi.org/10.25276/0235-4160-2019-1-87-92Abstract
In the context of the development of modern strabismology debatable issues still remain, among which the most important and long-term is the choice of tactics for the treatment of primary hyperfunction of the inferior oblique muscle. This article presents a literature review of the most significant publications of national and foreign authors concerning this topic. Criteria of differential diagnostics of primary and secondary hyperfunction of the inferior oblique muscle are presented. The main pathophysiological mechanisms of its occurrence are identified: imbalance between the superior and inferior oblique muscles, horizontal muscle dystopia, as well as prolonged occlusion and prismatic correction. The epidemiology of primary hyperfunction of the inferior oblique muscle, which develops in patients under the age of 4 years in more than half of cases, is summarized. Congenital esotropia operated on toddlers is not a clear guarantee of success in the prevention of the development of the current pathology. Primary hyperfunction occurs equally in patients with accommodative and intermittent forms of esotropia, less often in cases of acquired esotropia. The analysis of different classifications of primary hyperfunction is provided. The indications for surgical treatment and the criteria for evaluation of its efficiency are considered. The mono- or bilaterality of hyper-elevation in adduction, its symmetry, the presence of a V pattern determine the tactics and methods of treatment, the choice of which depends on the degree of hypertropy in combination with horizontal deviation.
Positive and negative aspects of the most frequently performed surgical interventions on the inferior oblique muscle; technical features of marginal myotomy, myoectomy, recession and anteriorization were evaluated.
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