각막이 매몰된 눈모음고정사시 1예

Abstract

Purpose: We report an example of successful operation of rare convergent strabismus fixus, which had previously been mistaken for orbital tumor in private clinics because of severe adduction with unseen cornea. Methods: A 57-year-old woman had convergent strabismus fixus with inward deviation of the left eye that had gradually progressed since she was around 40. Her cornea was buried in the intraorbital rim. An eye movement examination revealed that the eyeball was fixed to the internal part and that eyeball movement was impossible in all directions. When the forced duction test was performed, strong resistance was shown in all directions when abducted. During surgery, the medial rectus muscle was disinserted after resection of 3.0 mm for the left eye, and lateral rectus muscle tucking of 11.0 mm for the left eye was conducted. Since there was resistance in the inferior oblique muscle by the forced duction test during the operation, inferior oblique muscle myectomy of 4.0 mm was simultaneously performed. Results: In the forced duction test implemented immediately after the operation, resistance subsided considerably and eye movement was shown in all directions, with cosmetically satisfactory results. Optic atrophy was found in the fundus examination after the operation. Conclusions: Convergent strabismus fixus, which recurs frequently and causes severe limitation of eye movement, was changed from the primary position to orthophoria by medial rectus muscle resection with disinsertion and lateral rectus muscle tucking. The eye movement disorder was improved and a satisfactory result was obtained.

목적 : 각막이 보이지 않을 정도로 내전 정도가 심하여 개인병원에서 안와종양으로 오인된 희귀한 눈모음고정사시(convergent strabismus fixus)를 성공적으로 수술한 1예를 보고하고자 한다. 대상과 방법 : 40세경부터 좌안의 내측편위가 서서히 진행하여 각막이 안와내연안으로 매몰된 눈모음고정사시를 가진 57세 여자환자를 대상으로 하였다. 안운동검사상 안구가 내측으로 고정되어 모든 방향으로 안구운동이 소실되어 있었으며, 견인검사상 외전시 모든 방향으로 강한 저항을 나타내었다. 수술은 좌안 내직근 절제술 3. 0 mm후 해리시켰으며, 좌안 외직근 봉양술 11. 0 mm을 시행하였으며, 수술 중 견인검사에서 하사근에 저항이 있어 근부착부에서 4. 0mm 정도의 하사근육절제술도 병행하였다. 결과 : 수술직후 시행한 견인검사에서 저항이 많이 소실되었으며 모든 방향에서 미용적으로 만족할 만한 안구운동을보였다. 술후 안저검사에서는 시신경위축소견을 보였다. 결론 : 술후 재발이 빈번하고 심각한 안운동장애를 초래하는 눈모음고정사시에서 내직근 절제 및 해리술과 외직근 봉양술만으로도 일차안위에서 정위를 나타내었으며, 안구운동장애도 상당히 호전되어 만족할 만한 결과를 보였다.