新しい筋移動術の検討

A new muscle transposition procedure for abducens palsy

（1）新しい筋移動術を考案し，筋のトーヌスがほとんど消失している外転神経麻痺患者5例7眼に行い，1眼あたり平均23±6.2度と良好な眼位改善が得られた．

（2）手術を行うにあたって，拮抗筋の拘縮が強い場合は，術前処置として拘縮の軽減を目的とした拮抗筋の伸展，すなわち筋マッサージの併用が必要と考えられた．

（3）術後前毛様動脈損傷による前眼部虚血など，重篤な合併症は見られず，上下ひきも良好に保たれた．

（4）この術式はJensen法と同様，移動筋を切腱する必要がなく，さらには麻痺筋に何ら操作を加えることなしに上下直筋のみを二分し，麻痺側の強膜に縫着するだけでよい極めて安全な術式と考えられた．

Muscle transposition is at present the sole treat-ment for complete paralysis of the extraocular muscle. Of the available transposition techniques, the Jensen procedure is generally rated safest as it renders unnecessary the cutting of the extraocular muscle tendons and thus prevents anterior segment ischemia. Recently, we developed a new method of transposition for abducens palsy which preserves the features of the Jensen procedure while eliminat-ing division of the lateral rectus muscle.

Longitudinal cuts are made in the superior andinferior rectus muscles. The temporal halves are then sutured to the sclera near the superior and inferior margins of the lateral rectus. Use of this procedure on 7 eyes in 5 patients showed it to be very effective in Correcting eye position. Postoper-ative eye positions were between +5° and -5°, with a mean improvement by 23±6.2°.

No severe postoperative complications, such as anterior segment ischemia, occurred in the present series. This method thus appears to be at least equal to the Jensen procedure in safety and effec-tiveness.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(6) : 823-826, 1988