摘要分开不足是指后天发生的获得性视远内斜视伴有同侧复视、而视近为双眼单视的一类眼部疾患.可为孤立原发性,即没有神经系统原发疾病的良性病变;亦可为伴随神经系统障碍的继发性分开不足,临床上也称分开麻痹.分开不足临床特征是视远内斜视度数一般较小,无侧方非共同性,视近为正位或小度数内隐斜视,分开性融合幅度降低,眼球外转运动无受限,水平扫视运动速度正常.良性分开不足多发生于50岁以上成年人,近年研究认为高龄患者是因眶内软组织变性致肌肉移位,为机械源性,称为年龄相关性视远内斜视或松弛眼综合征,为与展神经麻痹、潜在神经系统障碍所致的分开不足的鉴别诊断提供了依据.分开不足的治疗以消除复视为目的,采用三棱镜矫正法或手术治疗.文献报道常规内直肌减弱、外直肌加强或二者联合手术,均可有效矫正分开不足内斜视,非常规手术疗效尚需临床进行大样本研究.本文通过回顾近年国内外文献,对分开不足的病因、诊断与鉴别诊断、治疗等的最新研究进展进行总结,以期为临床研究提供参考.

abstractsDivergence insufficiency is acquired esotropia at distance fixation with symptomatic uncrossed diplopia but fusion at near.It can be divided into two forms:primary isolated form and secondary form associated with neurologic abnormalities,also called divergence palsy.The clinical features of divergence insufficiency include small esotropia only at distance but orthotropia or small esophoria at near,comitant deviation at lateral gaze,reduced divergence fusion,full abduction and normal saccadic velocities in abduction.Primary divergence insufficiency is a benign condition predominantly occurring in adults older than 50 years.Recently,studies on the etiology of age-related distance esotropia,also called sagging eye syndrome,have demonstrated that the degenerative changes of orbital tissue could induce the inferior displacement of the inferior rectus pulley,different from the neurological etiology in abducens nerve palsy and secondary divergence insufficiency.The treatment goal is to relieve diplopia.Both prism and regular surgeries including medial rectus recession and lateral rectus resection are effective.Some unusual surgeries have been applied in divergence insufficiency,but further investigations with large samples are needed.The recent research advances in the etiology,diagnosis,differential diagnosis and treatment of divergence insufficiency are reviewed in this article.