Yokoyama 술식으로 치료한 근시성 고정사시 1예
A Case of Yokoyama Procedure in Myopic Strabismus Fixus
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목적: 고도근시에 의해 유발되는 근시성 고정사시의 치료에 Yokoyama 술기를 시행하여 성공적으로 치료한 1예가 있어 이를 보고하고자 한다. 증례요약: 51세의 여자 환자가 15년간 지속적으로 진행하는 내사시와 복시를 주소로 내원하였다. 내원시 환자는 일차눈위치에서Krimsky 검사로 70프리즘 디옵터의 좌안내사시와 30프리즘 디옵터의 좌안하사시를 보였으며 안축장은 우안이 34.97 mm 좌안이33.71 mm였다. 환자는 근시성 고정사시로 진단받고 Yokoyama 술기를 시행 받았다. 수술 검사에서 양측 모두 내직근이 후전되어 있음을 확인하였다. 좌안의 외직근과 상직근 부착부위에서 15 mm 떨어진 지점에서 봉합사를 이용하여 상직근의 귀쪽 절반, 외직근의 상측절반을 각각 근육에서 분리하지 않고 전체 근육을 서로 묶어주었다. 수술 후 1년째에 일차눈위치에서 30프리즘 디옵터의 우안내사시와20프리즘 디옵터의 우안하사시를 보였으며 환자는 동일한 술기를 우안에 시행 받았다. 우안 수술 2개월째 일차 눈위치에서 정위를보였고 안구운동의 제한은 개선되었다. 결론: 근시성 고정사시의 치료에 Yokoyama 술기는 안구편위와 안구운동 장애의 개선에 효과가 있었다.
Abstract
Purpose: To present a surgical result of Yokoyama procedure in myopic strabismus fixus. Case summary: A 51-year-old female patient presented with progressive esotropia and diplopia. According to the Krimsky test, the patient showed 70 prism diopter esotropia and 30 prism diopter hypotropia in her left eye. The axial length was 34.97 mm in the right eye and 33.71 mm in the left eye. The patient was diagnosed with myopic strabismus fixus. The authors performed the Yokoyama procedure on her left eye. Surgical examination revealed each medial rectus muscle was recessed. Half of the muscle bellies of the superior and lateral rectus muscles were sutured together without muscle splitting 15 mm posterior from their insertion. At 1 year postoperatively, the patient showed 30 prism diopter esotropia and 20prism diopter hypotropia in her right eye by alternative prism cover test. The authors performed the same procedure on her right eye. At 2 months after the second surgery, the patient showed orthotropia in the primary position and gaze limitation was improved. Conclusions: The Yokoyama procedure can be an effective method for improving deviation and ocular motility in esotropia caused by high myopia.
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