Jensen—稲富変法術後の前眼部虚血の1例

A case of anterior segment ischemia following surgery for abducens palsy by Jensen-Inatomi procedure

　外転神経麻痺の38歳女性の右眼に，内直筋後転とJensen—稲富変法での手術を行った。その翌日に前眼部虚血が発症し，角膜浮腫，瞳孔散大と鼻側偏位，虹彩色素脱出，角膜内皮細胞の減少が生じた。虹彩の赤外螢光造影で血流量の減少と部分的な血行途絶があった。6週後には視力が回復し，眼位と眼球運動はほぼ正常化したが，びまん性表層角膜炎の再発が続いている。前眼部虚血の原因は，前毛様体動脈が分割縫着した上下直筋と後転した内直筋に含まれていたことと，鼻側の後毛様体動脈の血流が本来不十分であったことにあると推測された。

We surgically treated the right eye of a 38-year-old female for bilateral abducens palsy. We performed recession of the medial rectus with Jensen-Inatomi procedure. Anterior segment ischemia developed next day of surgery including: corneal edema, dilated pupil with nasal deviation, iris atrophy and decreased number of corneal endothelial cells. The visual acuity recovered six weeks later. The eye position and movement normalized. It appeared that the postoperative complication was caused by the presence of anterior ciliary arteries in the transplanted vertical muscles and in the recessed medial rectus. Insufficient posterior ciliary artery supplying the nasal sector of the iris seemed to be another contributing factor.