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  • Title: [Advances in research of synergistic divergence].
    Author: Chen LP, Hao R, Zhang W.
    Journal: Zhonghua Yan Ke Za Zhi; 2019 Jan 11; 55(1):63-67. PubMed ID: 30641676.
    Abstract:
    Synergistic divergence is a rare condition characterized by complete absence of adduction that is associated with simultaneous abduction of the affected eye on attempted adduction. This causes the affected eye to move further into abduction on gaze to the normal side and results in extreme divergence of both eyes. It is sometimes referred to as exotropic Duane syndrome with synergistic divergence (type 4 Duane syndrome) or congenital fibrosis syndrome with synergistic divergence. Diseases combined with synergistic divergence fall within the category of congenital cranial dysinnervation disorders (CCDDs). The ocular associations reported with synergistic divergence are uncommon and include Horner syndrome, ocular albinism, foveal hypoplasia, Goldenhar syndrome and pupillary abnormalities. MRI and electro-oculographic study suggested that this is the result of CCDDs. Various surgical techniques have been tried in individual cases including large recession of the lateral rectus muscle, lateral rectus muscle extirpation, large resection of the medial rectus (MR) muscle, weakening procedures of the oblique muscles, combination of lateral rectus orbital wall fixation with MR resection, but further investigations with large-scale samples are needed. Recent research advances in the definition, etiology, and treatment of synergistic divergence are reviewed in this article. (Chin J Ophthalmol, 2019, 55:63-67). 协同分开是指患眼不能内转，且企图内转时同时伴有外转，导致双眼水平向非患侧方向注视时，双侧外直肌同时收缩，双眼极度分开的一种罕见眼部疾患表现，临床也称为眼球后退综合征合并协同分开或眼球后退综合征4型、先天性眼外肌纤维化合并协同分开。具有协同分开症状的疾病归类于先天性颅神经支配异常性疾病，部分患者同时合并Horner综合征、视盘发育不良等多种眼部或全身异常。治疗协同分开的常用手术包括患眼外直肌后徙或离断联合内直肌缩短术，上、下斜肌同时减弱术以及患眼外直肌眶巩膜固定联合内直肌缩短术，但手术效果有待于大样本临床研究进行观察总结。本文汇总分析了近年国内外文献中有关协同分开的基本概念、病因、临床表现及治疗等的研究进展，以期为临床研究及治疗提供参考。（中华眼科杂志，2019，55：63-67）.
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