마비성사시의 한방치험 2례

이승은,김윤범,Lee, Seung-eun,Kim, Yoon-bum 대한한방안이비인후피부과학회 2003 한방안이비인후피부과학회지 Vol.16 No.1

Strabismus refers to a extra-ocular muscle imbalance that results in improper alignment of the visual axes of two eyes. It may be divided into paralytic and non-paralytic strabismus. Paralytic strabismus is primarily a neurological problem: non-paralytic strabismus is more strictly an ophthalmologic problem. This case report focuses on paralytic strabismus resulting from palsies of the third and the sixth cranial nerves, respectively. Oculomotor nerve palsies result in binocular diplopia with characteristic patterns of strabismus. Oculomotor nerve provides motor and parasympathetic innervation to the eyes. Acquired oculomotor nerve palsies are not uncommon. Injury to the third nerve may result in complete or partial dysfunction. Complete third nerve palsy is manifested by ptosis, dilated pupil, an eye that is deviated down and out in primary position, and limited adduction, elevation, and depression. Patients with unilateral sixth nerve palsy complain of binocular, horizontal diplopia esotropia in the primary position due to unopposed action of the medial rectus and limitation of abduction due to weakness of the lateral rectus. Diplopia is worse in the direction of the paretic lateral rectus muscle. Paralytic strabismus are treated, based on the theory of Oriental medicine. with berbal medicines having gun-bi(健脾), bae-to(培土), gue-pung(祛風) effect of acupuncture around the eyes and etc. We describe a 63-year-old woman with complete the 3rd cranial nerve palsy and a 32-year-old woman with the unilateral 6th cranial nerve palsy who treated with acupuncture and herbal medicines and showed complete recovery.

마비성 사시환자 1례

이규진,김혜정,Lee, Kyu-jin,Kim, Hae-jung 대한한방안이비인후피부과학회 2004 한방안이비인후피부과학회지 Vol.17 No.3

Strabismus is a misalignment of eye, and which devided paralytic and non-paralytic strabismus. Paralytic strabismus is generally a neurological problem, especially 3rd, 4th or 6th nerve. The abducent nerve was most common affected. Paralytic strabismus are treated based on the theory of Oriental medicine with herbal medicine bal-san(發散) and gue-pung(祛風) effects and acupuncture around the eyes and etc. Authors experienced one case of the strabismus of abducent nerve palsy, 35-year-old male, showed disorder abduction of Lt. eye, diplopia and dizziness. Disorder abduction of Lt. eye, diplopia and dizziness and cervical pain improved under the treatment of acupuncture and herbal medicine Thus further clinical study and treatment principle should be made to raise the recovery rate for paralytic strabismus and it's effectiveness of Oriental medical treatment should be informed.

Case Reports : Recession-Resection Surgery Augmented with Botulinum Toxin A Chemodenervation for Paralytic Horizontal Strabismus

( Eun Ji Kim ),( Samin Hong ),( Jong Bok Lee ),( Sueng Han Han ) 대한안과학회 2012 Korean Journal of Ophthalmology Vol.26 No.1

In this case series study, we assessed the effects of recession-resection surgery augmented with botulinum toxin A chemodenervation for patients with chronic paralytic horizontal strabismus. In addition, we compared these effects with those of full tendon transposition (FTT) augmented with posterior intermuscular suture (PIMS). Ten patients who underwent strabismus surgery due to paralytic horizontal strabismus were retrospectively reviewed. They received a recession-resection surgery augmented with botulinum toxin A chemodenervation (type I surgery) or a FTT augmented with PIMS (type II surgery). The preoperative angle of deviation (AOD) and postoperative improvement in AOD were compared according to the type of procedure. The preoperative AOD was 60.00 ± 28.50 prism diopters (PD) for type I surgery and 68.00 ± 27.06 PD for type II (p = 0.421). Improvement in AOD was 53.20 ± 25.01 PD for type I surgery and 44.20 ± 18.74 PD for type II (p = 0.548). Recession-resection surgery augmented with botulinum toxin A chemodenervation is a concise and effective procedure for treating paralytic horizontal strabismus.

마비사시 소아 환자에 대한 증례 보고 1례

권지현,김경민,유선애,Kweon, Ji Hyeon,Kim, Kyeong Min,Yu, Sun Ae 대한한방소아과학회 2020 대한한방소아과학회지 Vol.34 No.1

Objectives The purpose of this study is to report the effectiveness of Korean medicine on treating paralytic strabismus in childhood. Methods We treated a 4-years-old patient who was diagnosed with paralytic strabismus with herbal medicine, laser acupuncture, T-acupuncture and moxibustion. Results After 5 months of the Korean medicine treatment, the child's strabismus, diplopia, and limitation of abduction were improved. There was no recurrence of the symptoms for 1 year and 4 months. Conclusions Korean medicine treatment can be effective in improving symptoms of paralytic strabismus. However, further studies are needed to demonstrate the treatment benefits to abducens nerve palsy.

변형근전치술의 임상 결과

문준웅,김성준,장봉린,.Jun-Woong Moon. M.D... Sung-Jun Kim. M.D... Bong-Leen Chang. M.D.. 대한안과학회 2005 대한안과학회지 Vol.46 No.8

Purpose: To report the clinical experience and surgical results of modified transposition surgery, in which half-width tendons are isolated and sutured into the paralyzed extraocular muscle. Methods: We retrospectively reviewed the medical records of 6 patients (7 eyes), who had undergone modified transposition surgery to correct severe limitation of eye movement from January 1996 to December 2001. First, we divided the half-width tendons of two rectus muscles adjacent to the paralyzed rectus muscle and disinserted the halves from the sclera. The two half-width tendons were positioned underneath of the scleral insertion of the paralyzed muscle, sutured together and then sutured to the paralyzed muscle. In the case of contracture of the antagonizing extraocular muscle, recession of the antagonist was performed. Results: Five of the six patients showed deviation under 15 prism diopters at primary gaze at distance, while synergistic divergence recurred in the sixth patient. Conclusions: Modified transposition surgery as described in this paper is thought to be an effective and safe method for correction of paralytic strabismus.

악성종양 전이로 발생한 외안근 비대 2예

정재우(Jae Woo Jung),정재호(Jae Ho Jung) 대한안과학회 2016 대한안과학회지 Vol.57 No.8

목적: 악성종양 과거력을 가진 환자에서 종양의 외안근 전이로 발생한 마비성 사시 환자 2예를 경험하여 임상양상과 방사선학적 특징을 보고하고자 한다. 증례요약: 증례 1은 소세포폐암의 대뇌 및 뼈 전이로 치료 받고 있던 56세 여자 환자가 1달 전부터 발생한 수평복시를 주소로 내원하였다. 우안 -3의 외전장애 및 내사시가 관찰되었고, 시력저하 및 안구통증은 없었다. 강제견인검사에서 수평 안 운동의 제한은 없었고, 갑상샘눈병증 관련 자가항체는 검출되지 않았으며, 조영 증강 대뇌 자기공명영상촬영에서 대뇌의 다발성 전이 병변 및 우안 외직근 및 내직근에 결절형 근비대가 관찰되었다. 증례 2는 6개월 전 유방암 수술을 받은 과거력이 있는 38세 여자 환자가 내원 3달 전부터 시작된 수평복시를 주소로 내원하였다. 좌안 -4의 외전장애와 내사시가 관찰되었고 시력저하 및 안구통증 없었다. 강제견인검사에서 수평 안 운동의 제한은 없었고, 갑상샘눈병증 관련 자가항체는 검출되지 않았으며, 조영 증강 안와 자기공명영상촬영에서 좌안 외직근 힘줄까지 침범된 결절형 근비대가 관찰되었다. 결론: 악성종양 과거력을 가지고 있는 환자에서 마비성 안운동장애가 발생할 경우 외안근 전이의 가능성을 염두에 두고 조기에 영상 검사를 시행하는 것이 진단과 치료에 도움이 될 것으로 생각한다. Purpose: To report two cases of extraocular muscle enlargement due to malignant cancer metastasis. Case summary: A 56-year-old woman presented with horizontal diplopia first noted 1 month earlier. She had a history of small cell lung cancer with brain and bone metastases. She had a -3 abduction deficit in the right eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Brain magnetic resonance image showed multiple nodular enlargements of the right lateral and medial rectus muscles, al so multiple metastatic nodules in the brain. A 38-year-old woman presented with horizontal diplopia first noted 3 months previously. She had undergone breast cancer surgery 6 months earlier. The patient had a -4 abduction deficit in the left eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Orbital magnetic resonance imaging showed nodular enlargement of left lateral rectus muscle including a tendon. Conclusions: Extraocular muscle metastasis is a possible cause of extraocular enlargement and paralytic strabismus. In a patient with malignant cancer, the physician should consider the possibility of extraocular muscle metastasis and perform imaging for early diagnosis and treatment.

사시각이 큰 마비사시 환자에게 시행한 안구의 안와골막고정술

엄희동,권영기,손병재,전보영 대한안과학회 2018 대한안과학회지 Vol.59 No.3

Purpose: To evaluate the effect of periosteal fixation in patients with large-angle paralytic strabismus that was not corrected through conventional strabismus surgery. Methods: Four eyes of three patients with large-angle paralytic strabismus who underwent periosteal fixation from June 2014 to August 2014 were examined. All patients presented with exotropia > 50 prism diopters (PD). Two of them showed exotropia caused by chronic complete oculomotor nerve palsy; the other two showed exotropia caused by medial rectus muscle injury during endoscopic sinus surgery. Results: The mean preoperative exodeviation using the Krimsky test was 58 ± 29 PD. The postoperative values were 6.5 ± 9.4 PD at 1 week, and 11.25 ± 2.5 PD at 6 months. The mean surgical effect of exodeviation was 43.75 ± 21.36 PD. Conclusions: Periosteal fixation is an effective surgery for the management of paralytic strabismus that was not corrected through conventional strabismus surgery. 목적: 고식적인 사시수술을 통해 좋은 결과를 얻을 수 없었던 사시각이 큰 마비사시 환자에서 안구의 안와골막고정술을 시행하여 수술 후 만족할 만한 결과를 얻었기에 이를 보고하고자 한다. 대상과 방법: 2014년 6월부터 2014년 8월까지 본원에서 사시각이 큰 마비사시로 진단받고 내안각 눈물언덕 결막을 통해 안구의 안와골막고정술을 시행한 3명, 4안을 대상으로 하였다. 대상 환자 모두 수술 전 50프리즘디옵터(prism diopters, PD) 이상의 외편위를 보였으며, 외편위의 원인은 만성 완전 동안신경마비가 2안, 내시경적 부비동수술 중 발생한 내직근 손상이 2안이었다. 결과: 크림스키법(Krimsky test)으로 측정한 수술 전 평균 사시각은 58 ± 29PD였다. 수술 1주일 후 6.5 ± 9.4PD였으며, 수술 6개월 후 11.25 ± 2.5PD로 감소하였다. 경과관찰 동안 안구의 안와골막고정술에 의해 교정된 평균 사시각은 43.75 ± 21.36PD였다. 결론: 특발성 및 외상으로 인한 완전 동안신경마비, 내시경적 부비동수술에 의한 내직근 손상 등과 같이 고식적인 수술방법으로 사시 교정이 어려운 마비사시 환자들에게 안구의 안와골막고정술은 효과적인 수술이라 생각된다.

麻痺性 斜視患者의 韓方治驗 5例

金中鎬,蔡炳允 경희대학교 1994 慶熙醫學 Vol.10 No.1

A Case of Paralytic Strabismus Caused by Midbrain Infarction

오세희,홍승욱 대한한방안이비인후피부과학회 2019 한방안이비인후피부과학회지 Vol.32 No.2

Objectives : Paralytic strabismus refers to the nerve paralysis in the muscles responsible for the movement of the eyeball for any reason, resulting in a restriction of eye movement. This study is to report a case of the paralytic Strabismus caused by midbrain infarction treated with Korean medicine. Methods : Patient received Korean medical treatment such as acupuncture & herbal medicine(Saengkankunbi-tang). Result & Conclusion : During 15 weeks of the treatment, patient’s strabismus and diplopia were improved.

痲痺性 斜視의 韓方治驗 3例 報告

강승범,강성길,고형균 대한침구의학회 2007 대한침구의학회지 Vol.24 No.1

Objectives : This study is to report three cases of the paralytic strabismus by acupuncture and herb medicine. Methods & Results : All patient were treated with Acupuncture and herb medicine, and the symptoms were resolved in 2 cases by above treatment during about 10 weeks. Conclusion : The cases showed proper oriental medical treatment based on the exact differentiation of symptoms had good effect on this disease as one of conservative therapies.