医原性ブラウン症候群の頻度と経過と因子

Incidence, clinical course and etiology of iatrogenic Brown's syndrome

　初回手術として4.5〜14mmの上斜筋縫縮術を施行した上斜筋麻痺の24例について，シノプトメータで眼位検査をおこない，医原性ブラウン症候群の頻度，経過，因子を調べた。術直後，22例（92％）に術眼の内転時の上転障害を認め，その大きさは10.6±6.6°（平均±標準偏差）であった。2次手術をおこなわなかった18例では，5〜65か月間に，15例（79％）で術眼の内転時の上転障害が改善した。40歳以上で，KnappのクラスⅡかⅤに分類され，内下転位と内上転位で上下偏位の差が8°を超える症例に対して，8mmを超える上斜筋縫縮術をおこなった場合，強いブラウン症候群を生じる傾向があった。

We reviewed 24 cases of unilateral superior oblique palsy treated by tucking of the superior oblique muscle. Immediately after surgery, 22 patients, 92%, showed limited elevation by 10. 6+6. 6 degrees by synoptometer during adduction of the operated eye. In 18 patients who did not need a second operation, 15 cases, 79%, showed spontane-ous improvement in Brown's syndrome during the postoperative period of 5 to 65 months. Severe Brown's syndrome was likely to occur in patients who were more than 40 years of age, who had been classified as class Ⅱ or Ⅴ after Knapp, who had large discrepancy in vertical deviation between the supra- and infra-adductional gaze positions of the affected eye, and who underwent tucking by 8 mm or more.