선천 눈꺼풀처짐 환아에서 눈꺼풀올림근절제 및 이마근걸기 동시수술의 효과
Effect of the Simultaneous Operation of Levator Resection and Frontalis Suspension for Congenital Ptosis
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목적: 눈꺼풀올림근 기능이 불량한 선천 눈꺼풀처짐 환아에서 눈꺼풀올림근절제술을 시행하고 술 중 부족교정을 보이면 이마근걸기술을 병행하여 그 결과를 후향조사를 통해 알아보고자 하였다. 대상과 방법: 대상 환자는 선천 눈꺼풀처짐 4명, 눈꺼풀틈새축소증후군 1명으로 모두 5명 8안이었다. 수술 당시 평균나이는 3.3세(1.5-6.9세)였다. 전신마취하에 눈꺼풀올림근절제술을 시행하여 위눈꺼풀테가 위쪽 각막가장자리에 위치하지 않으면 이마근걸기술을병행하여 위눈꺼풀테의 높이를 조절하였다. 결과: 경과관찰은 평균 29.8개월이었으며 수술 직후에는 8안 모두에서 ʻ우수ʼ한 결과를 보였으며 갑작스런 재발은 발생하지 않았다. 노출각막미란이 6안에서 나타났으나 인공눈물 점안액 및 연고 도포로 1개월 이내에 모두 호전되었다. 최종경과관찰에서 8안 중 6안에서 양호한 ʻ우수ʼ 또는 ʻ양호ʼ한 결과를 보였으며, 부족교정 2안, 가쪽 부분눈꺼풀처짐 1안의 합병증이 관찰되었다. 결론: 선천 눈꺼풀처짐 환아에서 술 중 눈꺼풀올림근절제술로 인한 부족교정을 보이는 경우 이마근걸기의 병행 수술은 수술 직후에나타날 수 있는 부족교정과 재발을 줄이는 효과가 있는 것으로 생각한다.
Abstract
Purpose: To determine retrospectively if a simultaneous frontalis suspension could change the result of undercorrection observed during levator resection in congenital ptosis patients with poor levator functions. Methods: Eight eyes in the present study were from 5 infants, 4 infants had congenital ptosis and 1 infant had blepharophimosis. The average age was 3.3 years (range: 1.5 to 6.9 years). If the upper lid margin was not positioned on the superior limbus after performing levator resection under general anesthesia, the height of the upper lid margin was controlled by simultaneous frontalis suspension. Results: The average follow-up period was 29.8 months. After surgery on both eyes, all 8 cases showed good results and sudden relapse did not occur. Exposed corneal erosion was observed in 6 eyes, but with artificial tears, eye drops, and ointment there were significant improvements within 1 month in all cases. At final examinations, 6 out of 8 eyes showed excellent or good results; undercorrection in 2 eyes was observed and the lateral portion of ptosis in 1 eye was observed as an eye complication. Conclusions: If undercorrection caused by levator resection occurs in patients with congenital ptosis, the combination of frontalis suspension surgery may reduce undercorrection and any recurrence that might appear after surgery.
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