아래덧눈꺼풀에서 Root Z-안쪽눈구석주름교정술과 속눈썹회전봉합술의 3년 임상결과
3-year Outcomes of Rotating Suture with Root Z-epicanthoplasty for Lower Lid Epiblepharon
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목적: 아래덧눈꺼풀 환자에서 Root Z-안쪽눈구석주름교정술을 동반한 속눈썹회전봉합술을 시행한 후 3년간 추적관찰한 임상결과를 보고하고자 한다. 대상과 방법: 본원에서 상기 수술을 시행한 환자 중 3년간 경과관찰한 환자를 대상으로 수술 전후 최대교정시력, 조절마비굴절력, 난시 값 변화와 수술 결과 및 합병증에 대해 확인하였다. 수술 전 약시의 유무를 기준으로 두 군으로 나누어 해당 값의 변화를 비교했고, 수술 당시 연령 6세를 기준으로 두 군으로 나누어 수술 전후 난시 값의 변화를 비교하였다. 결과: 전체 109안에서 모두 재발 없이 덧눈꺼풀이 성공적으로 교정되었고, 1안에서 지연성 눈꺼풀 결막 출혈이 발생하였다. 전체환자군 및 수술 전 약시가 없었던 군에서는 수술 전후 최대교정시력, 조절마비굴절력, 난시 값에서 각각 유의한 변화가 있었다(p<0.001, p<0.001, p=0.024; p<0.001, p<0.001, p=0.025). 수술 전 약시가 있었던 군에서 수술 후 유의하게 최대교정시력이 향상되고 조절마비굴절력이 근시로 이동하였으나(p<0.001, p=0.003), 난시 값은 유의미한 변화가 없었다(p=0.431). 6세 미만에서는 술 후 난시 값이 유의하게 감소한 반면(p=0.011), 6세 이상에서는 난시 값에 유의한 변화가 없었다(p=0.589). 결론: 상기 수술은 술 후 3년간 경과관찰한 결과 합병증 발생이 낮고 재발이 없어 아래덧눈꺼풀 교정에 효과적인 수술임을 확인하였다. 또한 본 수술이 소아의 정상 시력발달과 굴절이상 완화에 긍정적인 영향을 줄 수 있다는 가능성을 확인하였다.
Abstract
Purpose: To report the clinical outcomes of Root Z-epicanthoplasty combined with lower eyelid rotation suturing in patients with lower eyelid epiblepharon, focusing on a 3-year follow-up. Methods: Patients who underwent Root Z-epicanthoplasty combined with lower eyelid rotation suturing from March 2012 to February 2020 were included. Patients aged < 15 years, and who had a minimum 3-year follow-up, were included. We assessed changes in best corrected visual acuity (BCVA), cycloplegic refraction, astigmatism, and surgical outcomes. To evaluate the influence of preoperative amblyopia, patients were divided into subgroups based on amblyopic status; surgical outcomes were compared between these groups. In addition, subgroups were divided based on age at operation and astigmatism were compared between subgroups. Results: A total of 55 patients (109 eyes) exhibited successful correction of lower eyelid epiblepharon without recurrence; one case experienced a delayed episode of lower palpebral conjunctival hemorrhage. Significant changes were observed of BCVA improvement, myopic shift of cycloplegic refraction, and astigmatism reduction three years post-surgery (p < 0.001, p < 0.001, p = 0.024). In the group without preoperative amblyopia (86 eyes), significant changes were noted in BCVA, cycloplegic refraction, and astigmatism (p < 0.001, p < 0.001, p = 0.025). In patients with preoperative amblyopia (23 eyes), significant improvements were observed in BCVA and myopic shift in cycloplegic refraction (p < 0.001, p = 0.003), whereas astigmatism showed no significant change (p = 0.431). There is significant reduction of astigmatism in under 6-year-old group (p = 0.011) and no significant reduction of astigmatism in over 6-year-old group (p = 0.589). Conclusions: Root Z-epicanthoplasty with lower eyelid rotation suturing demonstrated a low complication rate and no recurrence over 3-year follow-up, confirming its effectiveness in correcting lower eyelid epiblepharon. The procedure also positively influenced visual development and reduction of astigmatism in pediatric patients.
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