장기간 추적 관찰한 굴절조절내사시와 영아내사시 환자들의 임상 양상 비교
Long-term Clinical Outcomes of Patients with Infantile and Refractive Accommodative Esotropia
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목적: 굴절조절내사시와 영아내사시 환자의 장기간 임상 결과를 비교하였다. 대상과 방법: 굴절조절내사시, 영아내사시 환자 중 36개월 이상 경과 관찰한 환자들의 의무기록을 후향적으로 분석하였다. 초진 시조절마비굴절검사 후 굴절조절내사시 환자는 안경을 처방하였고 영아내사시 환자는 양안 내직근 후전술을 시행하였다. 시력, 굴절력, 원·근거리사시각(prism diopters, PD), 근거리 입체시(초각)를 측정하였다. 영아내사시군은 생후 24개월 이전, 이후 수술받은 군으로나누어 분석하였다. 경과 관찰 중 대상부전조절내사시와 재발내사시로 진단되어 추가 수술을 시행한 환자를 조사하였다. 결과: 69명의 환자(굴절조절내사시 40명, 영아내사시 29명)가 연구에 포함되었다. 경과 관찰 기간은 69.48 ± 28.41개월이었다. 최종방문 시 원거리 내편위는 굴절조절내사시군 2.82 ± 5.46 PD, 영아내사시군 9.28 ± 8.37 PD였다(p<0.01). 영아내사시군에서 24개월이전 수술군의 최종 원거리 내편위는 4.62 ± 5.25 PD, 근거리 입체시 중위수는 60초각, 24개월 이후 수술군은 13.06 ± 8.63 PD, 140초각이었다(p<0.01, 0.03). 추가 수술은 굴절조절내사시군에서 7명(17.5%), 영아내사시군에서 24개월 이전 수술받은 군은 2명(15.4%), 24개월 이후 수술받은 군은 10명(62.5%)였다(p<0.01). 결론: 굴절조절내사시와 24개월 이전 수술한 영아내사시 환자군에서 24개월 이후 영아내사시로 수술받은 군보다 최종 방문 시 내편위, 입체시가 좋았고 추가 수술의 빈도가 낮았다.
Abstract
Purpose: To compare the long-term clinical outcomes of patients with refractive accommodative esotropia (RAET) and infantile esotropia (IET). Methods: The medical records of patients with RAET and IET who were followed-up for more than 36 months were retrospectively analyzed. The RAET patients were prescribed spectacles to correct cycloplegic refraction and those with IET underwent bilateral, medial rectus recession. Visual acuity, refraction, the angle of esodeviation at far and near distances, and near-stereopsis were measured at each visit. The IET patients were divided into two groups by the time of surgery (before and after 24 months of age). Patients in both groups who underwent reoperations after diagnosis of partially accommodative esotropia (PAET) and recurrent IET during follow-up were analyzed. Results: Sixty-nine patients (40 with RAET and 29 with IET) were included. The follow-up period was 69.48 ± 28.41 months. At the final visit, the angles of esodeviation were 2.82 ± 5.46 prism diopters (PD) in the RAET group and 9.28 ± 8.37 PD in the IET group (p < 0.01). In IET patients who underwent surgery before and after 24 months of age, the angles of esodeviation were 4.62 ± 5.25 and 13.06 ± 8.63 PD and the median near-stereopsis values 60 and 140 arcsec at the final visit (p < 0.01, 0.03). Seven patients (17.5%) in the RAET group, and 2 (15.4%) and 10 (62.5%) IET patients who underwent surgery before and after 24 months of age, required reoperations (p < 0.01). Conclusions: RAET and IET patients who underwent surgery before 24 months of age exhibited better alignment and stereopsis at the final visit than those who underwent later surgery and the reoperation rate was lower.
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