변형된 하라다-이토수술 및 Mendez 링 술 중 조정술을 통한 양안 상사근마비 교정 1예
Modified Harada-Ito Procedure with Intraoperative Adjustable Sutures Using a Mendez Ring for Excyclotorsion
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목적: 저자들은 양안 상사근마비 환자에서 회선편위의 교정을 위해 변형된 하라다-이토수술 및 Mendez 링을 이용한 술 중 조정술을 시행하여 만족스러운 수술 결과를 얻은 사례를 소개하고자 한다. 증례요약: 47세의 남자 환자가 뇌출혈 이후 발생한 양안 복시를 주소로 내원하였다. 양안 상사근마비로 진단하였고, 이중마독스막대검사상 양안에 각각 20° 외회선이 확인되어 양안 회선복시에 대하여 6개월 경과 관찰 후 수술적 교정을 시도하였다. 외회선 교정량을 확인하기 위해 각막윤부 6시와 12시에 마커를 이용하여 표시를 한 후 상사근에 변형된 하라다-이토수술을 시행하였고, 이후 Mendez 링을 각막윤부에 위치하도록 하여 내회선 정도로 확인하였다. 각각 30° 내회선을 목표로 하여 우안에 상사근절제술을 5 mm 추가하였다. 술 후 6개월째 복시를 호소하지 않았으며 회선편위는 관찰되지 않았다. 결론: 변형된 하라다-이토수술 및 Mendez 링을 이용한 술 중 조정술을 통하여 내회선 목표치에 정량적으로 도달할 수 있었으며, 원하는 교정 효과를 얻을 수 있었다.
Abstract
Purpose: We report a case of using a modified Harada-Ito procedure with intraoperative adjustment via a Mendez ring in a patient with bilateral superior oblique palsy, resulting in satisfactory postoperative outcomes. Case summary: A 47-year-old male patient presented with bilateral diplopia after cerebral hemorrhage. Bilateral superior oblique palsy was diagnosed, and double Maddox rod tests confirmed 20° of excyclotorsion in both eyes. After 6 months of observation, surgical correction was attempted. To check the amount of cyclodeviation, a modified Harada–Ito procedure was performed on the superior oblique muscle after marking at the 6 and 12 o'clock positions of the corneal limbus. Following the procedure, a Mendez ring was placed on the limbus to check for the amount of incyclotorsion. Thirty degrees of incyclotorsion was aimed at both eyes, and a 5-mm resection of the right superior oblique tendon was performed for additional correction. There was no complaint of diplopia at 6 months postoperatively, and no deviation was observed. Conclusions: A modified Harada-Ito procedure with intraoperative adjustment using a Mendez ring effectively corrected excyclotorsion with torsional diplopia.
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