보툴리눔독소에 반응이 없는 본태눈꺼풀연축 환자에서 이마근걸기술
Frontalis Suspension Surgery for Patients with Essential Blepharospasm Unresponsive to Botulinum Toxin Injections
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목적: 보툴리눔독소 주사에 효과가 없는 눈꺼풀연축 환자를 대상으로 실리콘줄 또는 보존근막을 이용한 이마근걸기술의 효과를 알아보고자 하였다. 대상과 방법: 눈꺼풀연축 환자 중 보툴리눔독소 주사 치료에도 눈을 뜨기 어렵고 일상생활에 어려움이 있어 이마근걸기술을 시행한5명 10안을 대상으로 후향적으로 의무기록을 분석하여 결과를 알아보았다. 결과: 환자들의 평균 연령은 60.2세였고, 여성이 40%였다. 5명 중 3명은 실리콘줄을 2명은 보존근막을 사용하여 이마근걸기술을 시행하였다. Jankovic Rating Scale (JRS)을 이용하여 측정한 눈꺼풀연축의 정도와 빈도는 수술 전에 비해 수술 후 1주, 1개월, 3개월째모두 감소하였다. 수술 후 2명의 환자에서는 증상 호전으로 주사가 필요하지 않았고, 주사 치료가 필요하였던 3명의 환자에서는 보툴리눔독소 주사 치료 간격이 길어졌다. 수술 후 감염이나 봉합사의 노출 등과 같은 합병증은 관찰되지 않았다. 결론: 이마근걸기술은 보툴리눔독소 주사 치료에도 눈을 뜨기 어려운 본태눈꺼풀연축 환자의 치료에 효과적이고 안전한 수술 방법으로 생각된다.
Abstract
Purpose: To report the efficacy of frontalis suspension using a silicone rod or preserved fascia lata for patients with blepharospasm who exhibit persistent symptoms and visual dysfunction unresponsive to botulinum injections. Methods: The clinical records of five patients (10 eyes) with essential blepharospasm who underwent frontalis suspension were reviewed. Patients who continued to report eyelid-opening difficulties despite prior administration of botulinum toxin were included. Results: The mean patient age was 60.2 years; and 40% of the patients were women. The frontalis was suspended using silicone rods (n = 3) or preserved fascia lata (n = 2). Blepharospasm frequency and severity were measured using the Jankovic Rating Scale (JRS). Compared with preoperative scores, the summed JRS scores decreased 1 week, 1 month, and 3 months after surgery. Postoperatively, two patients (40%) did not require further botulinum toxin injections. In three patients, the intervals between injections were increased after surgery. No patient experienced any significant complication. Conclusions: Frontalis suspension is safe and effective for patients with blepharospasm and apraxia of eyelid opening, who have not responded to botulinum toxin injections.
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