バセドウ病に合併した重症筋無力症の眼症状

Ocular manifestations of myasthenia gravis associated with Graves' disease

　バセドウ病に合併した重症筋無力症24例の眼症状を検討した。初発症状は眼瞼下垂6例，複視15例，眼瞼下垂と複視3例であり，増悪期は複視4例，眼瞼下垂と複視20例であった。バセドウ病に合併した重症筋無力症では眼瞼下垂に比べ，複視が高頻度にみられた。CTでは外眼筋肥大が12例にみられ，4例では眼球運動障害が甲状腺眼症と重症筋無力症の両者によると考えられた。15例では治療経過を2年以上観察し，眼瞼下垂・眼球運動障害ともに消失3例，眼球運動障害のみ残存9例，眼瞼下垂・眼球運動障害ともに残存3例であった。治療の結果，眼球運動障害は眼瞼下垂に比べ残存するが，第1眼位における両眼単一視は13例（87％）に得られた。

We observed 24 cases of myasthenia gravis associated with Graves' disease. Initial ocular features included sudden onset of ptosis in 6 cases, diplopia in 15 and both in 3. During the clinical course, 20 cases developed both ptosis and diplopia. The other 4 cases showed diplopia only. Diplopia was thus more frequent than ptosis in myasthenia gravis when associated with Graves' disease. Computed tomography showed enlargement of extraocular muscles in 12 cases. In 4 cases, diplopia appeared to be due to both dysthyroid ophthalmopathy and myasthenia gravis. After follow up of 2 years or more in 15 cases, ocular motility disturbance was the sole manifestation in 9 cases, diplopia and ptosis was present in 3 and both had disappeared in 3. Binocular single vision was possible in the primary position in 13 cases (87%).