輻輳過多型内斜視に対するFaden手術

The faden operation for convergence excess esotropia

　術前遠近斜視角差が10 prism diopter（PD）以上ある輻輳過多型内斜視25例に対し内直筋Faden手術を行い，両内直筋後転術を行った25例と比較検討を行った．また，内直筋Faden手術後の4例にEOG検査を行い，以下の知見を得た．

　①内直筋Faden手術は両内直筋後転術にくらべ，輻輳過多型内斜視の遠近差の矯正に効果が大きかった．

　②Faden手術による遠近差の矯正効果は約12〜13PDであった．

　③術前の近見斜視角の大きいもの，および遠近斜視角差の大きいものにFaden手術の矯正効果が大きかった．

　④Faden手術両眼施行群と片眼施行群との間に矯正効果の大きな差はなかったので，まず，片眼Faden手術を試みるべきであると考えた．

　⑤Faden手術後の内転時衝動性眼球運動最大速度は，手術眼と非手術眼に大きな差がなかった事より，Faden手術は著明な麻痺を作る事のない安全な手術法と考えられた．

We made a retrospective review of 25 consecutive cases with convergence excess esotropia treated with faden operation for the medial rectus. The procedure was performed bilaterally in 5 eyes and unilaterally in 20. Convergence excess esotropia was defined as esotropia manifesting deviation of 10 prism diopters (PD) or more in the near than in the distance. These 25 cases were compared with another series of 25 cases treated by bilateral recession of the medial rectus with following findings.

The faden procedure was more effective than bimedial recession to reduce the high AC/A ratio. The amount of reduction averaged 12.5 PD. The faden oper-ation was more effective in reducing the excessive convergence in cases with esodeviation in near amount-ing 40 PD or more, and in those with large convergenceexcess of 15 PD or more for near than for distance.

There was no striking difference between unilateral and bilateral faden operations in reducing the high AC/ A ratio. The finding seemed to indicate that faden operation is to be performed unilaterally in order to reduce the excessive convergence.

There was no difference in the saccadic velocity of adduction between the operated and non-operated eyes during the postsurgical period. The faden operation seemed to be a safe procedure. No marked paresis occurred throughout the present series.

Rinsho Ganka (Jpn J Din Ophthalmol) 40(8) : 865-868, 1986