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목적 : Double depressor palsy (DDP), which is a rare condition, refers to simultaneous paralysis of the inferior rectus muscle and superior oblique muscle of the same eye. This condition may occur because of congenital disorders, cerebrovascular disease, or trauma and superior rectus contracture after strabismus surgery. To the best of our knowledge, DDP caused by ocular myasthenia gravis (OMG) has not been reported to date. Therefore, we present a case of DDP caused by OMG and review the related literature.
방법 : A 65-year-old man who had been experiencing diplopia in front and down gaze for 15 days visited our hospital. Ophthalmic examinations revealed normal vision in both eyes and no abnormal pupillary reflex. Hypertropia was noted in the patient’s left eye and limitation of depression was found in the adduction, primary gaze, and abduction. And the patient complained of ptosis in the left eye. An ice test was performed and the ptosis was resolved after the test. Then, anti-acetylcholine receptor binding antibody levels were checked and found to be slightly elevated(0.416nmol/L).
결과 : We prescribed methylprednisolone P.O 24 mg for 2 weeks, and his symptoms improved after 2 weeks. Five weeks after his first visit, the patient showed an ortho result in the alternate prism cover test, normal ocular movements, near-normal muscle action in the Hess screen test, and almost complete resolution of diplopia.
결론 : This may be the first case in which OMG presented as DDP, and in such cases, the possibility of OMG should be considered to rule out double elevator palsy.
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