양상전근 마비의 임상 양상 및 수술 결과
Clinical Manifestations and Surgical Outcomes of Double Elevator Palsy
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 양상전근 마비의 임상 양상 및 수술적 치료의 결과에 대해 알아보고자 하였다. 대상과 방법: 1999년부터 2012년까지 연세대학교 세브란스 의료원 안과에 내원하여 양상전근 마비로 진단받고 수술적 치료를 시행한모든 환자들을 대상으로 후향적인 조사를 진행하였다. 결과: 총 15명의 환자 중 7명은 남성, 8명은 여성이었으며 첫 사시 교정 수술을 시행한 평균 연령은 14.6세였다. 모든 환자들은 1차사시 교정 수술로서 하직근 후전술을 시행 받았다. 9명(60.0%)의 환자에서 2차 교정수술이 필요했으며, 이 중 4명은 수평근 전위술,2명은 외사시 교정술, 그리고 3명에서는 하사시와 외사시 교정술을 동시에 시행하였다. 수술 전 평균 하사시는 29.9 ± 8.4 PD였으며수술 후 평균 4.7 ± 5.3 PD로 감소하였다. 평균 경과 관찰 기간은 40.9개월이었다. 7명(46.7%)의 진성 안검하수 환자에서 안검하수교정술을 시행하였다. 최종 경과 관찰 시 11명 중 8명의 환자에서 약시가 없거나 경도의 약시만 남았다. 결론: 일차적으로 하직근 후전술을 단독으로 시행하거나 추가적으로 이차적인 근전위술을 시행하여 양상전근 마비의 치료에서 효과적인 결과를 얻었다. 이번 연구를 통해 분석한 양상전근 마비의 임상 양상 및 수술 결과는 환자의 적절한 치료 방법 설정 및 예후예측에 도움이 될 것으로 생각한다.
Abstract
Purpose: To evaluate the clinical manifestations of double elevator palsy and describe the surgery outcomes in patients. Methods: We performed a retrospective chart review of all patients who were treated surgically for double elevator palsy between1999 and 2012 at Yonsei University, Severance Hospital in Seoul, Korea. Results: Overall, 15 subjects (7 males and 8 females) with a mean age of 14.6 years (range, 3-40 years) underwent their first surgeryduring the study period. All patients received inferior rectus recession as a primary procedure. Nine patients (60.0%) underwenta secondary procedure which included 4 cases of horizontal muscle transposition, 2 cases of correction of exotropia, and3 cases of correction of hypotropia and exotropia simultaneously. The mean preoperative hypotropia was decreased from 29.9± 8.4 prism diopter (PD) to 4.7 ± 5.3 PD postoperatively. Mean follow-up period was 40.9 ± 48.2 months. Seven patients (46.7%)underwent eyelid surgery for true ptosis. At last follow-up, a majority of patients showed mild or no amblyopia. Conclusions: Primary inferior rectus recession and additive secondary horizontal muscle transposition surgery was effective intreatment of double elevator palsy. The clinical manifestations and surgical outcomes of monocular elevation deficiency in thepresent study can help in the treatment of Korean patients.
참고문헌 (20)
- Knapp P, "The surgical treatment of double-elevator paralysis", Trans Am Ophthalmol Soc, 67, pp.304~323 (1969)
- Rose LV, "Management of congenital elevation deficiency due to congenital third nerve palsy and monocular elevation deficiency", Clin Experiment Ophthalmol, 35, pp.840~846 (2007)
- Yurdakul NS, "Surgical treatment in patients with double elevator palsy", Eur J Ophthalmol, 19, pp.697~701 (2009)
- Mcneer KW, "Double elevator palsy caused by anomalous insertion of the inferior rectus", Am J Ophthalmol, 59, pp.317~319 (1965)
- Ford CS, "Monocular elevation paresis caused by an ipsilateral lesion", Neurology, 34, pp.1264~1267 (1984)
- Muñoz M, "Acquired double elevator palsy in a child with a pineocytoma", Am J Ophthalmol, 118, pp.810~811 (1994)
- Olson RJ, "Dissociative phenomena in congenital monocular elevation deficiency", J AAPOS, 2, pp.72~78 (1998)
- Bagheri A, "Double elevator palsy, subtypes and outcomes of surgery", J Ophthalmic Vis Res, 3, pp.108~113 (2008)
- Pediatric Eye Disease Investigator Group, "The clinical profile of moderate amblyopia in children younger than 7 years", Arch Ophthalmol, 120, pp.281~287 (2002)
- Metz HS, "Double elevator palsy", Arch Ophthalmol, 97, pp.901~903 (1979)
- Scott WE, "Double elevator palsy: the significance of inferior rectus restriction", Am Orthopt J, 27, pp.5~10 (1977)
- Kim JH, "Congenital monocular elevation deficiency", Ophthalmology, 116, pp.580~584 (2009)
- Ziffer AJ, "Congenital double elevator palsy: vertical saccadic velocity utilizing the scleral search coil technique", J Pediatr Ophthalmol Strabismus, 29, pp.142~149 (1992)
- Burke JP, "Vertical transposition of the horizontal recti (Knapp procedure) for the treatment of double elevator palsy: effectiveness and long-term stability", Br J Ophthalmol, 76, pp.734~737 (1992)
- Caldeira JA, "Vertical transposition of the horizontal rectus muscles for congenital", early onset "acquired" double elevator palsy: a retrospective long term study of 10 consecutive patients, 2000, pp.15, 29~38
- Kocak-Altintas AG, "Selective management of double elevator palsy by either inferior rectus recession and", or knapp type transposition surgery, 2000, pp.15, 39~46
- Metz HS, "Double elevator palsy", J Pediatr Ophthalmol Strabismus, 18, pp.31~35 (1981)
- Williams C, "Amblyopia treatment outcomes after preschool screening v school entry screening: observational data from a prospective cohort study", Br J Ophthalmol, 87, pp.988~993 (2003)
- Jewell G, "The effectiveness of vision screening by school nurses in secondary school", Arch Dis Child, 70, pp.14~18 (1994)
- Lennerstrand G, "Screening for ocular dysfunction in children: approaching a common program", Acta Ophthalmol Scand Suppl, 214, pp.26~38 (1995)