甲状腺眼症の下眼瞼後退と内反に対する多孔性ポリエチレンの使用経験

Use of porous polyethylene material for lower eyelid retraction or entropion in thyroid eye disease

要約　目的：甲状腺眼症による下眼瞼後退や眼瞼内反症例に対して，瞼板の補強を目的として多孔性ポリエチレン（Medpor^®）を使用した手術の治療成績を報告する。対象と方法：下眼瞼後退や眼瞼内反を認めた29例41眼を対象とした。年齢は平均44歳。6眼に眼窩減圧術，12眼に下直筋後転術の既往があった。術式は皮膚切開後，瞼板下縁にMedpor^®を縫合した。結果：41眼中37眼に瞼裂高の改善を認め，平均瞼裂高は，術前10.7mmから術後9.1mmに減少した。改善のない4眼も内反の改善をみた。術後，5眼はMedpor^®の露出により再縫合を要し，4眼に入れ替えを施行した。結論：甲状腺眼症の下眼瞼後退や眼瞼内反に対してMedpor^®の挿入は有効な手術方法であると考えられた。

Abstract.　Purpose：To report the outcome of surgery using a porous polyethylene material for lower eyelid retraction or entropion in thyroid eye disease. Cases and Method：This study was made on 29 cases of lower eyelid retraction or entropion as manifestation of thyroid eye disease. The series comprised 14 males and 15 females. The age ranged from 21 to 63 years. Six patients had received orbital decompression and 12 patients had received recession of inferior rectus muscle in the past. A porous polyethylene material,Medpor^®,was inserted along the inferior edge of tarsal plate of the lower eyelid after skin incision. Results：The height of opening of lid fissure averaged 10.7 mm before and 9.1 mm after surgery. It improved in 37 of 41 eyes. The remaining 4 eyes showed improvement in entropion. Four eyes needed resuturing for exposure of the porous polyethylene material. Another 4 eyes needed replacing. Conclusion：The present cases illustrate that adjunctive use of porous polyethylene material,Medpor^®,promises to be effective for inferior eyelid retraction or entropion as manifestation of thyroid eye disease.