成人代償不全型先天性上斜筋麻痺に対する下斜筋後転術の矯正効果

Correction of decompensated congenital superior oblique palsy in adults by recession of inferior oblique muscle

要約　目的：代償不全型先天性上斜筋麻痺の24例に対して行った下斜筋後転術の成績の報告。症例と方法：症例の性別は男性13例，女性11例で，年齢は16～82歳（平均48歳）であった。初回手術として，球後麻酔下で患眼の下斜筋後転術10mmを施行した。術前と術後に視能訓練士が行った斜視検査データを解析した。結果：術後の過矯正はなく，第1眼位，内転位，患側頭部傾斜での上下偏位を改善するうえで有効であった。患側への頭部傾斜の際の上下偏位の改善効果は，第1眼位における上下偏位の矯正効果を上回らなかった。遠見での両眼単一視の獲得は必ずしも良好ではなかった。結論：患眼の下斜筋後転術は，成人の代償不全型先天性上斜筋麻痺に対して概して有効ではあるが，その効果には限界がある。

Abstract.　Purpose：To report the outcome of recession of inferior oblique muscle for decompensated congenital superior oblique palsy in adults. Cases and Method：The present series comprised 13 males and 11 females. Their age ranged from 16 to 82 years,average 48 years. Each case received,as initial surgery,recession of ipsilateral inferior oblique muscle by 10mm. The outcome of surgery was evaluated by retrospective analysis of data regarding eye position and motility. Results：There was no case of overcorrection in the present series. The current surgical procedure was effective in improving the primary position,eye position during adduction,and vertical deviation during head tilting towards the affected side. Improvement of vertical deviation during head tilting towards the affected side was not better than that of primary eye position. The surgery did not necessariy result in binocular single vision in the distance. Conclusion：Recession of inferior oblique muscle is effective for decompensated congenital superior oblique palsy in adults with certain limitations.