감각외사시와 일치외사시의 장기 수술 결과 비교
The Comparison of Long-term Surgical Results for Sensory Exotropia and Comitant Exotropia
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목적: 감각외사시 환자와 일치외사시 환자의 장기적인 수술 성적을 비교하고, 감각외사시 수술 예후와 관련된 인자들에 대해 알아보고자 했다. 대상과 방법: 감각외사시는 편위안의 최대교정시력이 0.2 미만인 경우로 정의하였다. 감각외사시 수술 후 2년 이상 경과 관찰이 가능하였던 28명의 수술 성공률을 분석하기 위해 주시 방향에 따라 사시각의 차이가 없는 일치외사시로 수술을 받은 환자 중 감각외사시수술 환자와 성별, 연령, 수술 전 최대 원거리 및 근거리사시각을 매칭한 28명을 대조군으로 하여 의무기록을 후향적으로 분석하였다. 또한, 감각외사시 환자군 장기 수술 결과를 분석하기 위해 수술 3년 후 결과를 추가 조사하였다. 수술 성공은 최종 내원 시 원거리사시각이 정위에서 10프리즘디옵터(prism diopters, PD) 이내인 경우로 정하였다. 감각외사시 수술 후 재발과 관련된 위험 인자의 분석을위해 Cox 비례위험모형을 사용하였다. 결과: 수술 후 평균 추적 관찰 기간은 감각외사시군에서 91.7 ± 45.8개월, 대조군에서 42.6 ± 27.7개월이었다. Kaplan-Meier 생존분석에서 감각외사시군의 술 후 2년째 누적 수술 성공률은 74.5%였고 대조군은 74.4%로, 두 군 간 유의한 차이는 없었다(p=0.988). 감각외사시군에서 원근거리사시각 차이가 클수록 수술 후 재발 위험이 증가하는 것으로 나타났다(p=0.091). 결론: 감각외사시 환자와 일치외사시 환자의 수술 성공률은 유의한 차이를 보이지 않았으며 감각외사시 환자에서 원근거리사시각차이가 클수록 수술 후 재발 위험이 증가하였다.
Abstract
Purpose: To compare the long-term surgical outcomes of patients with sensory and concomitant exotropia and to define the factors associated with successful surgical outcomes in those with sensory exotropia. Methods: The medical records of patients with sensory exotropia who underwent operations and were followed-up for at least 2 years were retrospectively reviewed. We enrolled patients exhibiting only best-corrected visual acuities ≤ 20/100 of the operated eyes. Surgical success was defined as a final distance deviation < 10 prism diopters (PD) with the eye in the primary position. Twenty-eight patients operated upon to treat sensory exotropia and 28 who underwent operations to treat concomitant exotropia who did not differ in terms of the gaze deviation angle were matched in terms of age, sex, and the preoperative distance and near distributions; their surgical outcomes were compared. Factors affecting such outcomes were identified using a multivariate Cox’s proportional hazards model. Results: The mean follow-up times were 91.7 ± 45.8 months in the sensory and 42.6 ± 27.7 months in the concomitant exotropia groups. The cumulative probabilities of surgical success 2 years after surgery were 74.5% in the sensory and 74.4% in the intermittent exotropia groups, thus not significantly different (p = 0.988). The Cox’s proportional hazard model showed that a greater difference between the preoperative distant and near deviations was associated with recurrence (p = 0.091). Conclusions: The long-term surgical outcomes of patients with sensory and concomitant exotropia were comparable. A high-level near-distance disparity increased the risk of recurrence.
참고문헌 (24)
- Von Noorden GK, "Binocular vision and ocularmotility", pp.345~347 (2002), CV Mosby
- Sidikaro Y, "Observations in sensory heterotropia", J Pediatr Ophthalmol Strabismus, 19, pp.12~19 (1982)
- Min BM, "Clinical evaluation of sensory heterotropia", J Korean Ophthalmol Soc, 30, pp.767~772 (1989)
- 윤경철, "감각사시의 임상적 고찰", 대한안과학회지, 43(12), pp.17~2489 (2002), 대한안과학회
- Hunter DG, "Benefits of strabismus surgery in patients with one blind eye", Arch Ophthalmol, 113, pp.404~ (1995)
- Lawson JM, "Long-term results of botulinum toxin in consecutive and secondary exotropia : outcome in patients initially treated with botulinum toxin", J AAPOS, 2, pp.195~200 (1998)
- Hopker LM, "Surgical results after one-muscle recession for correction of horizontal sensory strabismus in children", J AAPOS, 17, pp.174~176 (2013)
- Merino P, "Horizontal sensory strabismus : characteristics and treatment results", Arch Soc Esp Oftalmol, 86, pp.358~362 (2011)
- Oliveira BF, "Sensorial strabismus : a study of 191 cases", Arq Bras Oftalmol, 69, pp.71~74 (2006)
- Erkan Turan K, "Effect of visual acuity on the surgical outcomes of secondary sensory strabismus", Turk J Ophthalmol, 45, pp.254~258 (2015)
- Botelho PJ, "The effect of aspirin on the visual outcome of nonarteritic anterior ischemic optic neuropathy", Am J Ophthalmol, 121, pp.450~451 (1996)
- Ekdawi NS, "Postoperative outcomes in children with intermittent exotropia from a population-based cohort", J AAPOS, 13, pp.4~7 (2009)
- Holmes JM, "Is intermittent exotropia a curable condition?", Eye(Lond), 29, pp.171~176 (2015)
- Pineles SL, "Long-term results of the surgical management of intermittent exotropia", J AAPOS, 14, pp.298~304 (2010)
- Pukrushpan P, "Unilateral recession and resection surgery with adjustable suture in adult sensory exotropia : long-term success and exotropic drift", Strabismus, 28, pp.151~157 (2020)
- Chung SE, "Prognostic factors for strabismus surgery after cataract surgery", J Cataract Refract Surg, 33, pp.297~300 (2007)
- 최윤정, "수평사시에서 조정수술과 비조정수술의 성공률의 장기적 추적관찰", 대한안과학회지, 53(2), pp.316~322 (2012), 대한안과학회
- Gusek-Schneider G, "Results following eye muscle surgery for secondary sensory strabismus", Strabismus, 18, pp.24~31 (2010)
- Jung EH, "Surgical results and factors affecting outcome in adult patients with sensory exotropia", Eye(Lond), 32, pp.1851~1857 (2018)
- Beneish R, "The role of stereopsis and early postoperative alignment in long-term surgical results of intermittent exotropia", Can J Ophthalmol, 29, pp.119~124 (1994)
- Chia A, "Surgical experiences with two-muscle surgery for the treatment of intermittent exotropia", J AAPOS, 10, pp.206~211 (2006)
- Keenan JM, "The outcome of strabismus surgery in childhood exotropia", Eye(Lond), 8, pp.632~637 (1994)
- Richard JM, "Intermittent exotropia : surgical results in different age groups", Ophthalmology, 90, pp.1172~1177 (1983)
- Choi DD, "Survival analysis of adult and children intermittent exotropia using a matched case-control design", Sci Rep, 9, pp.575~ (2019)