甲状腺眼症患者の眼窩縮小術による眼窩外眼症と眼球外視症の治療

Orbital Decompression for Exorbitism and Exophthalmos in a Patient With Thyroid Eye Disease.

• Satoshi Kakutani
• Makoto Ito
• Hirohiko Kakizaki
• Yasuhiro Takahashi

抄録

Basedow病を患う34歳男性が、障害性眼瞼下垂症の治療のために当院を受診した。診察では右下眼瞼後退と右下直腸筋肥大を呈し、甲状腺眼症と一致した。ヘルテル外眼鏡検査では、右下眼瞼下垂は25.5、左下眼瞼下垂は24.0"Zs_200A"mmであった。CT画像では蝶形骨のドアジャンブがないことが確認された。外眼瞼外反症と外眼瞼外反症を改善するために、全身麻酔下で眼窩脂肪を除去しながら、両側の眼窩壁を浅く減圧した。著者らは左右の眼窩内側象限からそれぞれ2.5、1.0"Zs_200A"mLの眼窩脂肪を摘出した。術後3ヶ月後の矢状CT画像上での軸球位置の測定結果から、術後の眼窩前突症は左右でそれぞれ7.5、6.5"Zs_200A"mmの減少が認められた。

A 34-year-old man with Basedow disease consulted us to treat disfiguring proptosis. On examination, the patient showed right lower eyelid retraction and right inferior rectus muscle enlargement, which were consistent with thyroid eye disease. Hertel's exophthalmometric examination demonstrated proptosis of 25.5 and 24.0 mm on the right and left sides, respectively. Computed tomography (CT) images revealed absence of the sphenoid door jamb. To correct both exorbitism and exophthalmos, the patient underwent bilateral "shallow" decompression of the lateral and medial orbital walls with orbital fat removal under general anesthesia. The authors removed 2.5 and 1.0 mL of orbital fat from the inferolateral quadrant of the right and left orbits, respectively. At 3 months postoperatively, based on the measurements of the axial globe position on sagittal CT images, postoperative proptosis reductions of 7.5 and 6.5 mm were observed on the right and left sides, respectively.