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要約 目的:浜松医科大学医学部附属病院(当院)で斜視手術を施行した高齢患者の特徴とその過去20年間の変化について検討した。
対象と方法:2003年,2008年,2013年,2018年,2023年の5年ごとに当院で斜視手術を受けた65歳以上の患者を抽出した。診療録をもとに2003年,2008年,2013年を前期,2018年,2023年を後期とし,年齢,性別,主訴,斜視の病態,術前の遠見斜視角,麻酔の種類につき後ろ向きに調査した。統計解析にはMann-WhitneyのU検定,χ2検定,母比率の差の検定を用いた。
結果:斜視手術患者のうち65歳以上の患者は,2003年は8/86症例(9.3%),2008年は18/175症例(10.3%),2013年は18/146例(12.3%),2018年は27/181例(14.9%),2023年は52/292例(17.8%)と増加していた。外斜視,内斜視,上下回旋斜視の割合はそれぞれ前期40.9%,27.3%,15.9%,後期44.3%,25.3%,22.8%で有意差はなかった。しかし内斜視患者の術前遠見斜視角の平均は,前期55.4PD,後期31.2PDと有意に減少していた(p=0.02)。内斜視,上下回旋斜視で複視を主訴とした患者の割合はそれぞれ前期50%,71%,後期80%,89%と有意に増加していた(p<0.05)。
結論:過去20年間に斜視手術を受ける高齢者の割合は増加していた。複視の改善を目的に,小さい斜視角でも手術を受ける高齢者が増加していたことから,高齢者にもより高度な斜視治療が求められていると考えられた。
Abstract Purpose:To characterize older adults who underwent strabismus surgery at Hamamatsu University Hospital and the changes observed over the past 20 years.
Participants and Methods:Patients aged ≥65 years who underwent strabismus surgery at our hospital between 2003 and 2023 were extracted at 5-year intervals. Data regarding age, sex, chief complaints, manifestations of strabismus, pre-operative angle of deviation at a far distance, and type of anesthesia were retrospectively collected from medical records. The years 2003, 2008, and 2013 were defined as the earlier period, whereas the years 2018 and 2023 were defined as later period. Statistical analyses were conducted using the Mann-Whitney U test, chi-square test and test of equal or given proportions.
Results:The number of patients aged ≥65 years who underwent strabismus surgery increased from 8/86 patients(9.3%)in 2003 to 18/175(10.3%), 18/146(12.3%), 27/181(14.9%), and 52/292(17.8%)in 2008, 2013, 2018, and 2023, respectively. Exotropia, esotropia, and vertical/torsional strabismus accounted for 40.9%, 27.3%, and 15.9% of cases, respectively, in the earlier period, and 44.3%, 25.3%, and 22.8%, respectively, in the later period. The mean pre-operative angle of deviation at far distance among the patients with esotropia was 55.4 PD and 31.2 PD in the earlier and later periods, respectively, indicating a significant decrease(p=0.02). Diplopia was the chief complaint in 50% and 71% of patients with esotropia and patients with vertical/torsional strabismus, respectively, in the earlier period. This percentage increased to 80% and 89%, respectively, in the later period(p<0.05).
Conclusion:The proportion of older patients undergoing strabismus surgery has increased over the past 20 years. The increase in the number of patients undergoing surgery to improve diplopia, even for small-angle strabismus, emphasizes the requirement for developing more advanced treatment strategies for older individuals with strabismus.

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