J Korean Ophthalmol Soc > Volume 61(10); 2020 > Article
Journal of the Korean Ophthalmological Society 2020;61(10):1230-1234.
DOI: https://doi.org/10.3341/jkos.2020.61.10.1230    Published online October 15, 2020.
Surgical Correction of V-pattern Esotropia and Inferior Oblique Overaction in a Patient with Craniosynostosis
In Jeong Lyu
Department of Ophthalmology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
두개골유합증과 연관된 V형 내사시 및 하사근기능항진의 수술적 교정
유인정
한국원자력의학원 원자력병원 안과
Correspondence:  In Jeong Lyu, Tel: 82-2-970-1297, Fax: 82-2-970-2436, 
Email: ijlyu@kirams.re.kr
Received: 14 April 2020   • Revised: 15 May 2020   • Accepted: 22 September 2020
Abstract
Purpose
We describe the use of bilateral medial rectus recession with inferior transposition and inferior oblique myectomy to treat a patient with craniosynostosis exhibiting V-pattern esotropia and inferior oblique overaction.
Case summary
An 8-year-old girl with esotropia and a history of cranioplasty for craniosynostosis visited our clinic. Her best-corrected visual acuity (BCVA) was 0.5 and 0.3 in the right and left eye, respectively. Latent nystagmus was observed in both eyes. She exhibited 40 prism diopters (PD) of esotropia in the primary position, 30 PD during upgaze, and 45 PD during downgaze. Bilateral superior oblique underaction and inferior oblique overaction were observed. Fundus examination revealed excyclotorsion in both eyes. Computed tomography (CT) revealed superior displacement of both medial rectus muscles. She underwent 5.5-mm medial rectus recession with inferior transposition and inferior oblique myectomy in both eyes. After 9 months, she exhibited 5 PD of dissociated vertical deviation at far distance in the right eye, and 10 PD of exotropia with 5 PD of dissociated vertical deviation at near distance. Ductions and versions were within the normal range in both eyes.
Conclusions
Bilateral medial rectus recession with inferior transposition and inferior oblique myectomy is useful in patients exhibiting V-pattern esotropia and inferior oblique overaction in association with craniosynostosis.
Key Words: Craniosynostosis, Esotropia, Inferior oblique myectomy, V-pattern strabismus
국문초록
목적
두개골유합증과 연관된 V형 내사시 및 하사근기능항진을 보이는 환자에서 양안 내직근후전 및 하방전위술, 하사근절제술을 시행한 1예를 보고하고자 한다.
증례요약
두개골유합증으로 두개골성형술을 받은 8세 여아가 내사시를 주소로 내원하였다. 최대교정시력은 각각 우안 0.5, 좌안 0.3이었고, 양안에 현성잠복눈떨림이 관찰되었다. 프리즘교대가림검사에서 원거리 제1안위에서 40프리즘디옵터(prism diopters, PD), 상방주시때 30 PD, 하방주시때 45 PD의 내사시를 보였다. 양안 상사근기능저하 및 하사근기능항진이 관찰되었고, 안저사진에서 양안 외회선이 보였다. 안와 전산화단층촬영검사에서 양안 내직근의 상방 편위가 확인되었다. 이에 양안 내직근을 5.5 mm 후전 및 하방전위하고, 양안 하사근절제술을 시행하였다. 9개월 후 눈 위치는 원거리에서 우안 5 PD의 해리수직편위, 근거리에서 우안 5 PD 해리수직편위 및 10 PD의 외사시 소견이 관찰되었고, 그 외 안구운동은 정상이었다.
결론
두개골유합증과 관련된 V형 내사시 및 하사근기능항진을 보이는 환자의 수술적 치료에 있어 양안 내직근후전술 및 하방전위술, 하사근절제술이 효과적일 수 있다.


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