乳児内斜視における交代性上斜位の手術治療成績

Outcome of surgery for dissociated vertical deviation in essential infantile esotropia

要約　目的：乳児内斜視の術後に生じた交代性上斜位（DVD）の治療成績の報告。

対象と方法：過去21年間にDVDに対する手術を行い，2年以上の経過を追えた28例を対象とした。乳児内斜視の初回手術の時期と，DVDの手術方法による術前，術1か月後と2年後の上方偏位量と水平眼位を検討した。

結果：内斜視に対し，9か月以内の超早期手術が5例，早期手術が17例，晩期手術が6例に行われた。DVDに対し，両眼の上直筋の大量後転術が17例，両眼の下斜筋の前方移動術が11例，両術式の併用が5例に行われた。超早期群では術後のDVDは改善し，上方の偏位量が全例で10Δ未満に減少した。超早期と早期手術群では，いずれの術式によっても上方の偏位量が減少し，術前後の水平眼位に変化はなかった。

結論：両眼の上直筋の大量後転術と両眼の下斜筋の前方移動術は，いずれもDVDの改善に有効であった。

Abstract　Purpose：To report the outcome of surgery for dissociated vertical deviation in essential infantile esotropia.

Cases and Method：This retrospective study was made on 28 cases who received surgery for dissociated vertical deviation（DVD）in the past 21 years and who were followed up for 2 years or longer. We evaluated the age of initial surgery for essential infantile esotropia, period of diagnosis of DVD, surgical method for DVD, vertical and horizontal ocular deviation before, one month and 2 years after surgery.

Results：Surgery for essential infantile esotropia was performed within 9 months in 5 cases（very early group）, later than 9 months in 17 cases（early group）, and very late in 6 cases（late group）. Bilateral recession of superior rectus by 8 to 10 mm was performed in 17 cases, bilateral anterior transposition of inferior oblique was performed in 11 cases, and both types of surgery were performed in 5 cases. All the cases in very early group showed resolution of DVD within 10Δ of upward deviation. Amount of upward deviation decreased in very early and early group regardless of surgical method, with no changes in horizontal eye position after surgery.

Conclusion：DVD improved after bilateral recession of superior rectus and bilateral anterior transposition of inferior oblique.