하사근기능항진으로 오인하여 하사근 절제술 후 발생한 이차 상사근기능항진
Secondary Superior Oblique Overaction after Inferior Oblique Muscle Myectomy in a Patient Misdiagnosed with Inferior Oblique Muscle Overaction
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목적: 경미한 하사근기능항진으로 오인된 환자에서 하사근 절제술 후 발생한 지속적인 하사근기능저하와 이차 상사근기능항진으로상사근 힘줄절단술을 시행한 경우를 보고하고자 한다. 증례요약: V형 외사시와 경미한 양안 하사근기능항진으로 의심한 환자에서 양안 외직근 후전과 하사근 절제 후 속발 내사시와 하사근기능저하가 발생하였다. 속발 내사시를 수술로 교정한 이후에도 하사근기능저하는 지속되었고, 점차적으로 진행되는 이차적인 상사근기능항진으로 상사근 힘줄절단술을 시행하였다. 술 후 상사근기능항진은 교정되었으나 하사근기능저하는 계속 남아 있었다. 결론: 하사근 절제술 후에 지속적인 하사근기능저하와 이차 상사근기능항진이 발생할 수 있어, 하사근기능항진에서 진단과 수술 방법의 선택에 주의가 필요하다.
Abstract
Purpose: To report a case of superior oblique muscle tenotomy in a patient with suspected bilateral inferior oblique muscle overaction. The patient showed secondary superior oblique muscle overaction and inferior oblique muscle underaction after inferior oblique muscle myectomy. Case summary: The patient showed V-pattern exotropia with suspected bilateral inferior oblique muscle overaction. After bilateral lateral rectus muscle recession with bilateral inferior oblique muscle myectomy, the patient showed secondary esotropia and inferior oblique underaction. After the surgery, progressive secondary superior oblique muscle overaction continued and finally, a superior oblique muscle tenotomy was performed. After the superior oblique muscle tenotomy, the superior oblique muscle overaction was corrected but the inferior oblique muscle underaction continued. Conclusions: After an inferior oblique muscle myectomy, secondary superior oblique muscle overaction can develop. Thus, caution should be taken in diagnosing inferior oblique muscle overaction in patients who show minimally inferior oblique muscle overaction as well as the surgical methods chosen.
참고문헌 (16)
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