上斜筋移動術により内転および回旋偏位が改善した両眼動眼神経麻痺の1例

Transposition of superior oblique muscle was effective for adduction and intorsion in a case of bilateral oculomotor palsy

要約　目的：両眼の動眼神経麻痺による内転制限と内方回旋が上斜筋移動術により軽快した症例の報告。

症例：29歳男性。18歳時に交通事故により両眼の動眼神経麻痺が生じた。強い外斜視と左下斜視，左眼には内転制限と上転制限があり，両眼に強い眼瞼下垂があった。

経過：両眼の外直筋後転術と左眼下直筋後転術を行い，上眼瞼の吊り上げ術を同時に行った。その7か月後に残存する外斜視と右上斜視に対し，両眼の内直筋短縮術と右眼上直筋の後転術を行った。残存する左眼の上転制限と内方回旋に対し，19か月後に左眼の上斜筋移動術を行った。これにより，左眼の内転と上転制限が改善した。

結論：上斜筋移動術により，内転，下斜視，内方回旋が改善した。

Abstract　Purpose：To report a case who developed bilateral oculomotor palsy with restricted adduction and intorsion that improved after transposition of the superior oblique muscle.

Case：A 29-year-old male had developed bilateral oculomotor palsy after traffic accident at the age of 18 years. The left eye showed restricted adduction and elevation. Large exotropia with hypotropia was present in the left eye.

Clinical Course：Both eyes received recession of lateral rectus muscle. The left eye received, additionally, recession of inferior rectus muscle. Both eyes received ptosis surgery. Seven months later, bilateral resection of medial rectus muscles with recession of right superior rectus muscle was performed. Transposition of left superior oblique muscle was performed for residual restriction of upward gaze with intorsion of the left eye.

Conclusion：Transposition of superior oblique muscle resulted in improved adduction, downward gaze, and intorsion.