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要約 目的:当院で施行した上斜筋麻痺に対する下斜筋前方鼻側移動術(ANTIO)についての手術効果を検討する。
方法:2023年3〜11月に,名古屋大学医学部附属病院で上斜筋麻痺に対してANTIOを施行した症例を対象とした。診療録から年齢,性別,術式,術前後の斜視角,立体視,眼底写真を抽出し,片眼ANTIO施行群(片眼群),片眼ANTIO+僚眼下斜筋後転術施行群(併施群),両眼ANTIO施行群(両眼群)に分類して,手術による効果を検討した。症例は11例(男性4例,女性7例)で,そのうち片眼群6例,併施群3例,両眼群2例であった。Kendallの順位相関係数を用いて,術前の他覚的回旋偏位量と回旋偏位の矯正効果の相関も検討した。
結果:上下偏位の矯正効果は片眼群22(13〜28)PD,併施群18(16〜25)PD,両眼群8(0〜16)PD,回旋の矯正効果は片眼群12.9(5.9〜28.8)度,併施群16.1(7.9〜21.2)度,両眼群21.6(15.5〜27.7)度であった。立体視は全例で改善または不変であった。全体において,術前の他覚的回旋偏位量と回旋偏位の矯正効果には正の相関(r=0.69,p<0.05)を認めた。
結論:ANTIOを施行することで,上下偏位・回旋偏位ともに高い矯正効果が得られた。回旋偏位の矯正効果は,術前の他覚的回旋偏位量に相関する可能性がある。
Abstract Purpose:To evaluate the surgical outcomes of Anterior Nasal Transposition of the Inferior Oblique Muscles(ANTIO) for the treatment of superior oblique palsy performed at our institution.
Methods:This study included cases of superior oblique palsy that underwent ANTIO at Nagoya University Hospital from March 2023 to November 2023. Patient records were reviewed for age, sex, surgical procedure, preoperative and postoperative eye movements, deviation angles, stereopsis, and fundus photographs. The patients were categorized into three groups:unilateral ANTIO group(unilateral group), unilateral ANTIO with fellow eye inferior oblique posterior transposition group(combined group), and bilateral ANTIO group(bilateral group). A total of 11 cases(4 males, 7 females) were included. Among these, 6 cases were in the unilateral group, 3 in the combined group, and 2 in the bilateral group. The correlation between preoperative ocular torsion and the correction of torsion was analyzed using Kendall's rank correlation coefficient.
Results:The correction of vertical deviation was 22(13-28) PD in the unilateral group, 18(16-25) PD in the combined group, and 8(0-16) PD in the bilateral group. The correction of ocular torsion was 12.9(5.9-28.8) degrees in the unilateral group, 16.1(7.9-21.2) degrees in the combined group, and 21.6(15.5-27.7) degrees in the bilateral group. Stereopsis improved or remained unchanged in all cases. A positive correlation was observed between preoperative ocular torsion and the correction of torsion(r=0.69, p<0.05).
Conclusion:ANTIO surgery resulted in high correction effect of both vertical and torsional deviations. The correction of ocular torsion may be correlated with the preoperative level of ocular torsion.

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