Basedow病眼症による視神経症に対する眼窩減圧術の治療成績

Outcome of orbital decompression surgery for dysthyroid optic neuropathy

要約　目的：Basedow病眼症による視神経症（DON）に対する眼窩減圧術の治療成績を評価した。対象と方法：神戸海星病院でDONに対し眼窩減圧術を行った9例15眼を対象に，診療録を後ろ向きに調査した。結果：9例中8例に術前副腎皮質ステロイド薬パルス療法が行われ，DON発症から眼窩減圧術までの期間は0.5～12か月（中央値3か月）であった。術前矯正視力は光覚なし～1.2（中央値0.1），最終矯正視力は0.03～1.5（中央値1.2）であった。術後矯正視力は術前矯正視力と相関性があった。結論：副腎皮質パルス療法に抵抗するDONに対して眼窩減圧術は有効で，術後矯正視力からみた治療時期の判断視力が高度に低下する前の施術が推奨される。

Abstract.　Purpose：To report the outcome of orbital decompression surgery for dysthyroid optic neuropathy. Cases and Method：This retrospective study was made on 15 eyes of 9 cases who received orbital decompression surgery for dysthyroid optic neuropathy in the past 3 years. The series comprised 4 males and 5 females. The age ranged from 43 to 80 years, with median of 56 years. Eight cases had received pulsed corticosteroid. Interval between onset of optic neuropathy and decompression surgery ranged from 2 weeks to 12 months, with median of 3 months. Results：Visual acuity before surgery ranged from no light perception to 1.2, with median of 0.1. Final visual acuity ranged from 0.03 to 1.5, with median of 1.2. Final visual acuity was positively correlated with initial visual acuity. Conclusion：Orbital decompression surgery was effective for dysthyroid optic neuropathy that failed to respond to pulsed corticosteroid. Surgery is recommended before visual acuity is severely affected.