선천 상사근 결손 환아의 하사근 비측 전치술 치료 1예
A Case of Congenital Absence of the Superior Oblique Muscle Treated With Anterior and Nasal Transposition of the Inferior Oblique Muscle
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목적: 하사근 기능 항진을 동반한 단안 상사근 결손에 대해 하사근 비측 전치술을 시행하여 좋은 결과를 보였기에 보고하고자 한다. 증례요약: 우측으로의 머리 기울임과 좌안 상사시를 주소로 본원 내원한 2세 남아로 안과 검사상 제일안위에서 18 프리즘디옵터(PD)의좌안 상사시, 우측 머리기울임시 정위, 좌측 머리기울임시 35PD의 좌안 상사시, 동향운동 검사상 좌안 상사근 기능 저하와 하사근기능항진을 보였으며, 안와 전산화단층촬영(orbit computed topography (CT)) 상 좌측 상사근 결손 나타나 좌측 하사근 비측 전치술을 시행하였다. 수술 3주 후 원거리, 근거리 교대프리즘 검사상 정위, Bielschowsky 머리기울임검사 음성, 정상 동향운동 소견 보였으며, 우측으로의 머리기울임 및 복시는 관찰되지 않았다. 결론: 좌안에 단독으로 발생한 선천성 상사근 결손에 대해 좌안 비측 전치술을 통해 좌안 상사시, 우측 머리기울임을 치료하였기에이를 보고하고자 하는 바이다.
Abstract
Purpose: To report a patient with absence of the superior oblique (SO) muscle of the left eye, who showed improvement after anterior and nasal transposition of the inferior oblique muscle for left hyperdeviation and right head tilt. Case summary: A two-year-old boy presented with hypertropia of the left eye and right head tilt. Alternate prism-cover test in the primary position demonstrated 18 prism diopters (PD) of left hypertropia, which increased to 35 PD in the left head tilt position. A version test demonstrated overaction of the left inferior oblique muscle and underaction of the left superior oblique muscle. As an orbit CT scan showed absence of the SO muscle, the patient was diagnosed with congenital absence of SO and left anterior and nasal transposition of the inferior oblique muscle was performed. Three weeks after surgery, the patient presented with orthotropia at distant and near. The version test revealed normal oblique muscles. There was no vertical deviation shown on the Bielschowsky head tilt test. The abnormal head posturing was no longer observed. Conclusions: The authorsreport a patient manifesting abnormal head posture and hypertropia, diagnosed with absence of SO muscle, which was successfully corrected using anterior and nasal transposition of the inferior oblique muscle.
참고문헌 (10)
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