先天性Brown症候群の手術治療の1例

Surgical treatment in a case of congenital Brown's syndrome

　内上転障害と著しいface turnを認めた先天性の3歳女児のBrown症候群に対して上斜筋減弱術を行った。右眼の内上転障害と左へ10°〜20°のface turnがあり，全麻下で行ったforcedduction testで右眼内上転方向に抵抗があったため，Brown症候群と確定し，右眼上斜筋を10mm後転した。内上転障害の改善が得られず，手術後18日目に右上斜筋腱のtenectomyを追加した。再手術後，内上転障害は消失したが，医原性の上斜筋麻痺と思われる右眼の上斜視が出現した。

A 3-year-old female infant presented with limita-tion in elevation during attempted adduction in the right eye. She also manifested face turn to the left by 10 to 20 degrees. She was diagnosed as congeni-tal Brown's syndrome. Forced duction test under general anesthesia showed restriction of elevation in adduction. Initial recession of the superior oblique was ineffective so that tenectomy was performed 18 days later. At the end of surgery, forced duction test showed no restriction of eleva-tion in adduction. Face turn disappeared after sur-gery but right hypertropia due to iatrogenic supe-rior oblique palsy became manifest. The hyper-tropia became less evident 6 months later. There was no recurrence of abnormal head posture.