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J Korean Bal Soc > Volume 4(1); 2005 > Article
Journal of the Korean Balance Society 2005;4(1): 5-12.
눈모음-후퇴안진: 3차원 기록을 통한 분석
김지수, 최광동, 오선영
서울대학교 의과대학 신경과학교실, 분당서울대학교병원 신경과
Convergence-Retraction Nystagmus: Analysis with 3-dimensional Oculography
Ji Soo Kim, Kwang Dong Choi, Sun Young Oh
Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, Korea. jisookim@snu.ac.kr
ABSTRACT
Background and Objectives : Convergence-retraction oscillations are rhythmic or arrhythmic jerks of dysjunctive eye movements associated with backward displacement of the eyeballs during the convergence phase. Oscillations in convergence-retraction oscillations have been proposed to be consisted of opposed adducting saccades immediately followed by slow abducting glissades without latency. However, dynamic characteristics of convergence oscillations accompanying retraction have not been studied, and pathomechanism of these eye movements remains to be elucidated. This study was to get insights on the pathomechanisms of convergence-retraction oscillations by using 3-dimensional recording of eye movements. In particular, we intended to clarify whether the nystagmus originates from instability of vergence eye movement or of saccades. Materials and Method : Seven consecutive patients with convergence-retraction oscillations were recruited. All the patients received full neurological and neuro-ophthalmological evaluation by the senior author. Some of the patients underwent 3-dimensional recordings of convergence-retraction oscillations with video-oculography or magnetic search coil technique. Results : Wave forms of convergence-retraction oscillations were varied. The onset of convergent eye movements was either synchronous or asynchronous between both eyes. The initial directions of eye movement was same (conjugate) or opposite (disjunctive). In some, vergence eye movements occurred only in one eye (unilateral). Convergence phase of one eye was commonly consisted of multiple steps while the other eye attained final position with a single step. The following divergent eye movements commonly overshoot the orbital midposition and were followed by correcting convergent eye movements. The velocity-amplitude relationship of convergent eye movements, which was analyzed in typical pairs of vergence oscillations, did not differ between both eyes. Divergent eye movements are slower than convergent eye movements. The both convergent and divergent eye movements were slower than the microsaccades of similar amplitudes. Conclusion : Quantitative analyses of convergence-retraction oscillations revealed various patterns of wave forms. The amplitude-velocity relationships of the disjunctive eye movements suggest that the slowed saccades may be due to co-contraction of the agonist and antagonist, or due to enhanced vergence eye movements by the accompanying saccades.
Keywords: Convergence-retraction nystagmus; Oculography; Vergence; Saccades
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