Lost medial rectus muscleに対する修復の1例

A case of repairing lost medial rectus muscle

　Lost medial rectus muscleに対して，再手術により，筋の回収と修復を行った。症例は生後3か月から外斜視があり，9歳時に左眼斜視手術が施行されたが，術中に内直筋のmuscle lossを生じた。強い外斜視と左眼の内転制限があった。2回の再手術を行った。初回手術では，強膜上に内直筋は認められなかった。2回目の手術で，結膜弁側に癒着したテノン組織中に内直筋を確認して，前転再縫着した。Muscle lossから3年近く経過していたが，術後，外斜視の軽減と内転制限の著明な改善を得ることができた。

A 11-year-old child was referred to us after the left rectus muscle had been lost during surgery for exotropia 8 months before. He showed exotropia of 65 prism diopters with restricted adduction of the left eye. The lost medial rectus muscle could not be located at the initial attempt under general anesthe-sia. We performed a second surgery 14 months later after the lost muscle was located by computed tomography. The lost muscle was found in a retracted state in the Tenon's tissue adhering to the conjunctiva. We retrieved the muscle and sutured it to the site of original insertion. Cosmetically satis-factory result was obtained 7 weeks after the sur-gery. There remained a residual exotropia of 18 prism diopters.