先天内斜視に対する手術既往をもつ成人斜視の解析と治療成績

Outcome and analysis of strabismus in adult who had underwent surgery for congenital esotropia

要約　目的：先天内斜視術後の成人斜視の特徴と問題点を明らかにする。対象：2004年からの7年間に，先天内斜視に対する手術既往があり，成人してから斜視治療を目的に当科を初診した36例（平均43.9歳）である。結果：初回手術（平均5.8歳）から当科での斜視手術までの期間は平均38.1年，当院受診時75％が外斜視で全体の72％が40 prism diopter（PD）以上の大斜視角であった。弱視合併の10例は全例が外斜視で，弱視合併群は有意に斜視角が大きかった（あり：76.0PD，なし：45.9PD）。当院での術後眼位は，交代性上斜位の合併とは相関を認めず，全体の72％が15PD以内となった。結論：先天内斜視術後は長期を経て大斜視角の斜視に至る可能性があるが，斜視手術により整容的満足は得られる。

Abstract.　Purpose：The characteristics and problems of postoperative strabismus with congenital esotropia in adults were evaluated. Subjects：In the 7-year period form 2004, 36 patients（mean age：43.9）who had history of surgery for congenital esotropia and first visited to our department for treatment for the strabismus were investigated. Results：The mean period from the first operation（mean age：5.8）to this operation was 38.1 years. Exotropia at the first visit was 75％ and 72％ of the total were large angle, over 40 prism diopter（PD）. All cases with amblyopia（10 cases）were exotropia, and cases with amblyopia showed significantly large angle strabismus compared to cases without amblyopia（76.0PD, 45.9PD, respectively）. Complication of dissociate vertical deviation was not related with postoperative ocular alignment. In postoperative eye position, 72％ of the total was within 15PD. Conclusion：There is a risk of becoming large angle strabismus for long periods after surgery for congenital esotropia. However, cosmetic aspect should be achieved with strabismus surgery.