先天性麻痹性斜视眼外肌的超微结构改变及临床意义  

A study on ultrastructural changes of extraocular muscles in patients with congenital paralytic strabismus and it's clinical significance

作　　者：张晶晶[1] 孙建宁[1] 张东生[2] 万美玲[2] 

机构地区：[1]东南大学附属中大医院眼科,江苏南京210009 [2]东南大学基础医学院电镜室,江苏南京210009

出　　处：《现代医学》2009年第3期171-174,共4页Modern Medical Journal

基　　金：国家自然科学基金资助项目(30770584)

摘　　要：目的观察先天性麻痹性斜视者眼外肌超微结构改变,探讨先天性麻痹性斜视的发病机制及手术时机。方法先天性麻痹性斜视患者16例,按年龄不同分为3组,即3岁及以下组、4～8岁组和9岁及以上组,术中取拮抗肌组织行电镜观察。结果3组病例眼外肌超微结构均发生了改变。主要表现为肌纤维排列紊乱、变性、萎缩;肌小节结构不规则,Z带紊乱,M线模糊或消失,肌丝溶解;线粒体肿胀、空泡变及疝形成,可见较多斑马样小体,局部线粒体明显增生;肌质网扩张、空泡化,溶酶体及脂滴增多;间质内胶原纤维增生,且年龄越大、病程越长,其改变越明显。结论先天性麻痹性斜视发病早期眼外肌就发生了明显的超微结构改变,提示对先天性麻痹性斜视应尽早手术治疗以恢复双眼视功能,避免失代偿。Objective To study the ultrastructural changes of extraocular muscles in patients with congenital paralytic strabismus and investigate it＇s pathogenesis and surgical time.Methods Sixteen cases of congenital paralytic strabismus were divided into three groups according to the patients＇ age.The specimens of antagonistic muscles were taken during the operation and then examined by transmission electron microscope （TEM）.Results Ultrastructural changes had taken place in the three groups.Irregular arrangement,degeneration and atrophy of myofibers were found.There was disordered structure of sarcomere with Z zones confused,M line blurred or disappeared,myofilament dissolved.Mitochondria edema,vacuolization,obvious proliferation were seen.Mitochondria herniation and Zebra-like bodies were visualized in myofibers.There was dilation and vacuolization of sarcoplasmic reticulum.The number of lysosomes and lipid droplets increased.There was obvious proliferation of collagen fiber in matrix.With the increasing of age,the longer the pathogenesis develops the more obvious pathological changes.Conclusion Ultrastructural changes of extraocular muscles exist in the early stage of congenital paralytic strabismus.It suggests that congenital paralytic strabismus should be operated as soon as possible to avoid decompensation and restore binocular vision.

关 键 词：麻痹性斜视 眼外肌 超微结构 线粒体 

分 类 号：R777.4[医药卫生—眼科]