근거리 사시각이 큰 기본형 간헐외사시에서 단안 외직근후전술과 내직근절제술의 비교
Surgical Outcomes of Unilateral One-muscle Surgery in Basic Intermittent Exotropia with Larger Near Deviation
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목적: 근거리 사시각이 원거리 사시각보다 큰 25 프리즘디옵터(prism diopters, PD) 이내의 기본형 간헐외사시에서 단안 단일근 수술의 효과를 평가하기 위하여 시행한 단안 내직근절제술과 단안 외직근후전술의 임상 결과를 비교하였다. 대상과 방법: 근거리 사시각이 큰 25 PD 이내의 기본형 간헐외사시 환자를 대상으로, 일차 수술로 단안 내직근절제술(1군)을 시행한 23명과 단안 외직근후전술(2군)을 시행한 32명을 후향적으로 조사하였다. 수술 후 1주, 1, 3, 6개월과 1년에 각각 근거리, 원거리 사시각을 측정하였고, 수술 성공은 수술 후 1년째 4 PD 이내의 내편위나 10 PD 이내의 외편위로 정하였다. 결과: 수술 전 평균 원거리 사시각은 1군이 20.18 ± 2.55 PD, 2군이 19.30 ± 2.77 PD, 근-원거리 사시각 차이는 1군이 6.83 ± 2.67 PD, 2군이 5.18 ± 1.56 PD였다. 수술 후 1년에 원거리 사시각은 1군이 9.43 ± 5.82 PD, 2군이 5.94 ± 6.49 PD, 근-원거리 사시각 차이는 1군이 0.91 ± 3.96 PD, 2군이 0.81 ± 2.07 PD였다. 수술 후 1년 성공률은 1군이 65.2%, 2군이 72.7% (p=0.362)로, 두 군 모두 수술 후 사시각과 근-원거리 사시각 차이를 감소시키는 데 효과가 있으나, 두 군 간 유의한 차이는 없었다. 결론: 근거리 사시각이 큰 25 PD 이내의 기본형 간헐외사시에서 일차 수술로써 단안 내직근절제술과 단안 외직근후전술 모두 효과적이었다.
Abstract
Purpose: To compare the postoperative changes between unilateral medial rectus resection and lateral rectus recession and evaluate surgical outcomes of unilateral one-muscle surgery in basic intermittent exotropia under 25 prism diopters (PD) with a larger near than distance deviation. Methods: This study was conducted on patients with basic intermittent exotropia under 25 PD and a larger near than distance deviation. A retrospective analysis was conducted on 23 patients who underwent unilateral medial rectus resection (Group 1) and 32 patients who underwent unilateral lateral rectus recession (Group 2) as primary surgery. The angle of deviation at near and distance was measured at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Surgical success was defined as within 4 PD of esophoria or 10 PD of exophoria at 1 year after surgery. Results: The mean preoperative deviation angle was 20.18 ± 2.55 PD for Group 1 and 19.30 ± 2.77 PD for Group 2, while the mean near-distance disparity was 6.83 ± 2.67 PD for Group 1 and 5.18 ± 1.56 PD for Group 2. At 1 year postoperatively, the mean distance deviation angle was 9.43 ± 5.82 PD for Group 1 and 5.94 ± 6.49 PD for Group 2. The mean near-distance disparity at 1 year was 0.91 ± 3.96 PD for Group 1 and 0.81 ± 2.07 PD for Group 2. The success rates at 1 year were 65.2% for Group 1 and 72.7% for Group 2 (p = 0.362). Both groups showed effective reductions in the postoperative angle of deviation and near-distance disparity with no significant difference between the groups. Conclusions: Unilateral medial rectus resection and lateral rectus recession both effectively manage basic intermittent exotropia under 25 PD with larger near than distance deviation as the primary surgery.
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