摘要
单眼上转不足(MED)通常也称为双上转肌麻痹，是一种特殊类型的斜视，临床上根据病因和表现分为三种亚型。因三种亚型临床表现各不相同，手术方式需结合自身情况而定。近年来，减小术后残留斜视、降低二次手术率及减少术后眼前节缺血的并发症研究已成为热点。同时，又有部分学者集中关注于手术方式的改良与优化，从最初的Knapp术逐渐发展至增强Knapp术、改良Knapp术、Jensen术、Hummelsheim术、Nishida术、针对MED Ⅲ型并发水平斜视的转位联合术及直肌退截联合术。本文中笔者从MED发病机制和临床表现的角度进一步阐述其手术方式变革的研究进展，以期为个性化手术方案制定提供参考。
Abstract
Monocular elevation deficit (MED) is commonly referred to as double elevator palsy, which is a special type of strabismus. It is divided into three subtypes through etiology and clinical manifestations. Because of their different clinical manifestations, the surgical approach often needs to be tailored. In recent years, to reduce postoperative residual strabismus, the rate of secondary operations and postoperative complications of anterior segment ischemia have been paid more attention. Meanwhile, many researchers have been focused on the continuous improvement and optimization in the surgical methods for MED, gradual development from the initial Knapp operation, including enhanced Knapp, modified Knapp, Jensen, Hummelsheim, Nishida, combined transposition and rectus dissection for MED Ⅲ type and concurrent horizontal strabismus. The latest research progress of surgical methods development in the term of the pathogenesis and clinical manifestations of MED was reviewed, aiming to provide a reference for the clinical design of more appropriate personalized surgery.
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