급성후천일치내사시 임상 양상과 증량한 내직근후전술 결과
Clinical Characteristics and Outcomes after Augmented Medial Rectus Muscle Recession in Patients with Acute Acquired Comitant Esotropia
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목적: 급성후천일치내사시 환자들의 임상 양상과 증량된 내직근후전술 결과를 분석하고, 수술량에 대한 지표를 제시하고자 하였다. 대상과 방법: 2016년부터 2022년까지 급성후천일치내사시로 진단하고 내직근후전술을 시행한 환자를 대상으로 후향적으로 분석하였다. 내직근후전양은 다른 종류의 내사시를 수술할 때보다 평균 1-2 mm를 추가로 시행하였다. 수술 결과는 수술 6개월째 사시각과복시 유무를 기준으로 분석하였으며, 수술 성공을 위해 필요한 수술량과 증량이 더 필요하였던 군의 특징, 사시각에 따른 수술량 변화를 분석하였다. 결과: 총 38명이 포함되었고 평균 굴절이상은 -3.79 ± 3.11 diopters (D)였다. 수술 시 평균 나이는 25.6 ± 18.2세였고 수술 전 최대사시각은 38.1 ± 11.5 prism diopters (PD)였다. 내직근후전술 양은 6.25 ± 1.4 mm로 기존 내사시 수술량에 비해서 1.2 ± 1.0 mm 추가로 후전하였으며, 내직근후전 증량 정도는 24.1 ± 18.8%였다. 수술 성공률은 사시각 기준 92.1%였고, 감각 성공률은 97.4%였다. 내직근후전 증량 정도는 30 PD 미만, 30-40 PD 그리고 40 PD 이상군에서 각각 26.9%. 25.5%, 20.0%였다. 내직근후전량을 25% 초과로 증량한 군이 나이가 더 많았고, 사시각이 커질수록 수술량에 대한 수술 효과가 증가하였다. 결론: 급성후천일치내사시 수술의 성공적인 결과를 위해서는 수술량을 늘리는 것이 필요하였다. 내직근후전술을 하는 경우 평균 24% 의 증량이 필요하였으며, 수술량을 결정할 때 나이, 사시각 등과 같은 임상인자들을 같이 고려해야겠다.
Abstract
Purpose: To analyze the clinical characteristics of patients with acute acquired comitant esotropia, evaluate the outcomes of augmented medial rectus muscle recession, and propose indicators for determining the appropriate surgical dosage. Methods: Data of patients with acute acquired esotropia who underwent medial rectus recession between 2016 and 2022 were retrospectively analyzed. The amount of medial rectus muscle recession was 1-2 mm greater than for other types of esotropia. Surgical success was assessed by reference to the angle of deviation and diplopia status 6 months after surgery. We investigated the amount of additional recession required for favorable surgical outcomes, the characteristics of groups that required augmentation, and changes in surgical amount according to the deviation angle. Results: A total of 38 patients were included; the average refractive error was -3.79 ± 3.11 diopters (D). Patient age at the time of surgery was 25.6 ± 18.2 years and the preoperative deviation angle was 38.1 ± 11.5 prism diopters (PD). The amount of medial rectus muscle recession was 6.25 ± 1.4 mm, i.e., 1.2 ± 1.0 mm greater than during other surgeries. The average augmentation was 24.1 ± 18.8%. The motor surgical success rate was 92.1% and the sensory success rate was 97.4%. The required augmentation was 26.9% for those with angles of deviation < 30 PD, 25.5% for patients with angles between 30 and 40 PD, and 20.0% for those with angles > 40 PD. Patients who required augmentation > 25% were older, and the surgical effect was greater as the angle of deviation increased. Conclusions: To ensure successful surgical outcomes of patients with acute acquired comitant esotropia, it is essential to increase the amount of medial rectus recession compared to that during other surgeries; the average augmentation was 24% in this study.
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