Inferior oblique muscle inclusionの1例

A case of inferior oblique muscle inclusion

要約　背景：Inferior oblique muscle inclusion〔下斜筋巻き込み症候群（私案）〕は，外直筋への手術時に下斜筋が外直筋に巻き込まれ癒着する合併症である。目的：内斜視の手術後に生じた下斜筋巻き込み症候群の症例の報告。症例：41歳男性が外斜視を主訴として受診した。生来の内斜視で，3歳と8歳のときに手術を受けていた。所見と経過：両眼とも＋1.50Dの遠視があり，矯正視力は左右とも1.5であった。眼位は近見で40Δ，遠見で45Δの外斜視であり，左眼での固視時に16Δの右下斜視と右眼の上転・内転制限があった。右眼の術中所見として，内直筋は輪部から11mm，外直筋は8mm後方にあり，下斜筋はJ字型に走行し，その一部が外直筋付着部に癒着していた。内直筋前転と外直筋後転，下斜筋の癒着剝離を行い，眼位と眼球運動は改善した。結論：術中の下斜筋の所見から，下斜筋巻き込み症候群と診断し，癒着を解除して上下偏位が改善した。

Abstract.　Purpose：To report a case of inferior oblique muscle inclusion. Case：A 41-year-old male presented with exotropia as the chief complaint. He had had esotropia during infancy and had operated on his eyes at the age of 3 and 8 years. Findings：Visual acuity was 1.5 in either eye when corrected for hyperopia of ＋1.5 diopters. The eye position was exotropic at 40Δ for near and 45Δ for distance. During fixation with the left eye, the right eye showed limitation in adduction and supraduction. During surgery on the right eye, the medial rectus muscle was found to be attached 11 mm posterior to the limbus and the lateral rectus was attached 8 mm posterior to the limbus. The inferior oblique muscle was deformed into J-shape and partially attached at the insertion of the lateral rectus. Eye position and movement improved after advancement of medial rectus, recession of lateral rectus, and dissection of adherent oblique muscle. Conclusion：The present case was diagnosed with inferior oblique muscle inclusion by intraoperative findings. Vertical deviation improved after release of adhesion of inferior oblique muscle.