経皮的眼窩内脂肪除去術を行った甲状腺眼症の1例

A case of dysthyroid ophthalmopathy treated by transpalpebral surgical decompression

　著明な眼球突出と眼球運動制限および高眼圧症を有する甲状腺眼症の44歳の男性に対し，放射線照射およびステロイドパルス療法を行った後，経皮的眼窩内脂肪除去術を行った。術後，眼球突出度はほとんど変化しなかったが，眼圧の低下と眼球運動の改善を認めた。本手術は眼窩骨壁開窓術と比較して，手術侵襲が小さく，眼位ずれおよび眼球運動障害が少ないため，外眼筋よりも眼窩脂肪織に変化が強く，眼球突出や高眼圧症が主体で，視神経症や複視を認めない甲状腺眼症に有効な方法と考えられた。しかし，減圧量が少ないこと，涙腺，外眼筋および眼窩内神経の損傷の危険性や，手術時期の決定などについては問題点があると思われた。

A 44-year-old male presented with bilateral dysthyroid exophthalmos of 5 months'duration.Hewas treated by irradiation and corticosteroid pulse therapy and, later, by transpalpebral surgical decompres-sion including anterior orbitotomy for either eye.The surgery induced remarkable reduction in intraocularpressure and improved eye movement.The exophthalmos remained unaffected. There were minimal compli-cations after this procedure as compared with conventional orbital decompression surgeries.This procedureappeared to be indicated for dysthyroid ophthalmopathy with grossly increased orbital fat,marked exophth-almos and elevated intraocular pressure without diplopia or compression optic neuropathy.Due attention isadvocated to avoid injury to the lacrimal gland, extraocular muscles and intraorbital nerves.Timing ofsurgery is another crucial factor.