麻痺性水平斜視手術の検討

Review of surgery for paralytic strabismus

　滋賀医科大学で1981年から1995年に行った後天性麻痺性水平斜視34名37眼の手術結果について検討した。判定は麻痺性水平斜視治療効果判定基準（1994年，丸尾）による。動眼神経麻痺に対し前後転術を8眼，筋移動術を4眼に行った。術前眼球運動が正中を超える例には前後転術を行い，87％が整容治癒以上であった。正中を超えて動かない完全麻痺や拘縮が強い例には，筋移動術と前後転術を併用しても整容治癒以上には至らなかった。外転神経麻痺に対し前後転術を9名9眼，筋移動術を13名15眼に行った。前後転術のみを予定していた例では，整容治癒以上は86％であった。術前の眼球運動が正中を超えない場合でも，筋移動術を行えば整容治癒以上は85％で動眼神経麻痺症例よりも良好であった。

We reviewed the surgical outcome in 34 eyes of 37 cases of acquired paralytic strabismus during the foregoing 15 years. The success of surgery was evaluated after the standards by Maruo, 1994. There were 12 cases of oculomotor palsy and 22 of abducens palsy. Recession/resection was performed in cases in which the eyes could move over the midline. This procedure was performed in 8 cases of oculomotor palsy and in 9 of abducens palsy. Muscle transposition was performed in other cases, including 4 of oculomotor palsy and 13 of abducens palsy. Surgical outcome was satisfactory in 57 of oculomotor palsy and 77% of abducens palsy. If the eyes had little difficulty in moving over the midline, the results were satisfactory in 87% of oculomotor palsy and 86% of abducens palsy. If the eyes could not move over the midline, the results were satisfactory in none of oculomotor palsy and in 85% of abducens palsy.