甲状腺眼症の斜視手術成績の検討

Outcome of surgery for strabismus in thyroid-associated ophthalmopathy

要約　目的：甲状腺眼症での斜視に対する手術成績の報告。対象と方法：斜視手術を行った甲状腺眼症12例を対象とした。男性8例，女性4例で，年齢は24～65歳（平均54歳）であった。内斜視1例，上下斜視11例であり，手術は複視が生じてから12か月以降に行った。罹患筋の後転術を第一選択とし，術前の牽引試験で罹患筋の伸展障害を確認した。結果：全例で最終眼位は良好であり，通常の斜視手術よりも効果が高かった。予想矯正量が大きい症例では，術後の過矯正が多かった。結論：甲状腺眼症に生じた斜視では，手術効果が通常の斜視手術よりも高く，予想矯正量が大きい症例では過矯正になりやすい傾向がある。これは罹患筋と周囲組織との癒着が強いためと推測される。

Abstract.　Purpose：To report the outcome of surgery for strabismus in thyroid-associated ophthalmopathy. Cases and Method：This retrospective study was made on 12 cases who had thyroid-associated ophthalmopathy and who received surgery for strabismus. The series comprised 8 males and 4 females. The age ranged from 24 to 65 years, average 54 years. Esotropia was present in one case and vertical strabismus in 11 cases. Surgery was performed after 12 months or longer after onset of diplopia. Recession of affected muscle, which was identified by traction prior to surgery, was performed as the first choice. Results：All the cases showed good final eye position. There was a tendency for cases with larger amount of expected correction to result in overcorrection. Conclusion：Strabismus in thyroid-associated ophthalmopathy has a tendency to overcorrection when compared with strabismus in general. This phenomen on may be due to adhesion of affected extraocular muscle to the surrounding tissue.