하직근 손실로 인한 70프리즘디옵터 상사시의 치료로 하사근절제술을 동반한 전치술
Resection and Transposition of the Inferior Oblique for Hypertropia due to the Inferior Rectus Loss
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목적: 단안 하직근 손실로 인한 큰 각의 상사시환자에서 하사근절제술과 병행한 전치술 및 상직근후전술을 동시 시행하여 좋은 결과를 얻었기에 이를 보고하고자 한다. 증례요약: 39세 남자환자가 20년 전 좌안 외상 이후 발생한 좌안 상사시 및 수직복시를 주소로 내원하였다. 제일눈위치에서 좌안상사시 70프리즘디옵터(PD)와 외사시 16PD를 보였으며, 안구운동검사에서 좌안 상전 항진 +4, 하전 장애 -5가 관찰되었다. 좌안하직근 부착부에서 하직근이나 근피막이 관찰되지 않아 좌안 하직근의 손실 진단하에 좌안 하사근을 부착부로부터 7 mm를 절제하였고, 하직근의 원 부착부로 예상되는 부위로 하사근전치술을 시행하였고, 좌안 상직근후전술 4.5 mm를 시행하였다. 수술 후 수직정렬은 정위를 보였고, 하전 기능이 술 전 -5에서 술 후 -2로, 상전 기능이 술 전 +4에서 -2로 변하였다. 결론: 큰 각을 보이는 수직사시를 동반한 하직근 결손의 경우 많은 양의 하사근절제술을 동반한 전치술 및 상직근후전술이 성공적인 수술 결과를 얻는 데에 도움이 된다.
Abstract
Purpose: To report a case of resection and transposition of the inferior oblique muscle combined with superior rectus recession as treatment for large-angle hypertropia due to unilateral loss of the inferior rectus muscle. Case summary: A 39-year-old man presented with a complaint of left hypertropia and vertical diplopia caused by blunt trauma 20 years previously. Left hypertropia of 70 prism diopters (PD) and exotropia of 16 PD in the primary gaze were noted; ocular movements of the left eye showed overactive supraduction (+4) and underactive infraduction (-5). On surgical exploration, neither the inferior rectus muscle nor capsule were present at the insertion site. The patient was diagnosed with loss of the inferior rectus muscle, thus, 7 mm of the inferior oblique muscle was resected and transposed at the original insertion site of the inferior rectus muscle; the superior rectus muscle was then recessed by 4.5 mm. After the surgery, vertical alignment was straight in the primary position, infraduction limitation was changed from -5 preoperative to -2 postoperative, and supraduction was changed from +4 preoperative to -2 postoperative. Conclusions: Extensive resection and transposition of the inferior oblique muscle combined with recession of the superior rectus may help in obtaining a successful surgical outcome in patients with inferior rectus muscle loss with a large angle of vertical deviation
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