내시경적 안와감압술을 시행한 갑상샘눈병증 환자에서 안와 구조와 안구돌출 변화의 관계
Associations between Orbital Morphology and Exophthalmos Changes after Endoscopic Orbital Decompression to Treat Thyroid-related Orbitopathy
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목적: 내시경적 안와감압술을 시행한 갑상샘눈병증 환자에서 수술 전후 안와 구조와 안구돌출 변화의 관계에 대해 알아보고자 하였다. 대상과 방법: 갑상샘눈병증을 진단받고 내시경을 이용하여 단독 안와내벽감압술을 시행받은 환자 18명의 33안을 대상으로 수술 전후안구돌출계 검사와 2차원 얼굴 전산화단층촬영을 이용하여 안와 구조와 연관된 지표들을 측정하였다. 단변량선형회귀분석을 시행하여 수술 후 안구돌출 변화와 관련성이 있는 것으로 확인된 변수들을 평가한 뒤, 다변량선형회귀분석을 시행하였다. 결과: 단변량선형회귀분석에서 수술 전 안와내벽의 길이(β=0.179, p=0.032)와 수술 후 결손된 안와내벽에서 안와첨부까지의 길이(β =-0.139, p=0.006)가 수술 후 안구돌출의 변화와 연관된 것으로 확인되었다. 두 가지 변수를 반영한 다변량선형회귀분석에서 수술후 안구돌출의 변화는 결손된 안와내벽에서 안와첨부까지의 길이(β=-0.118, p=0.019)와 관련이 있는 것으로 나타났다. 결론: 내시경적 안와감압술 후 안구돌출의 변화는 결손된 안와내벽에서 안와첨부까지의 길이와 관련이 있었다. 이를 토대로 감상샘눈병증 환자에서 안와감압술을 계획할 때 안구돌출 정도의 변화를 예측하는 지표로 고려해볼 수 있을 것이다.
Abstract
Purpose: To investigate orbital morphology parameters associated with exophthalmos changes in patients undergoing endoscopic orbital decompression to treat thyroid-related orbitopathy. Methods: In total, 33 eyes of 18 patients with thyroid-related orbitopathy who underwent endoscopic orbital decompression were included in this retrospective study. Data were collected before and 6 months after surgery. We performed Hertel exophthalmometry and derived orbital morphology parameters from two-dimensional facial computed tomography records. Parameters associated with exophthalmos reduction on univariate linear regression analysis were subjected to multivariate linear regression analyses. Results: Univariate linear regression showed that the preoperative length of the medial orbital wall (β = 0.179, p = 0.032) and the postoperative distance from the cone apex to the medial wall defect (β = -0.139, p = 0.006) were associated with exophthalmos reduction after endoscopic orbital decompression surgery. Multivariate linear regression of these two parameters showed that the distance from the apex to the medial wall defect was associated with exophthalmos reduction (β = -0.118, p = 0.019). Conclusions: The postoperative distance from the cone apex to the medial wall defect was associated with exophthalmos reduction. In patients with thyroid-related orbitopathy, this association should be considered when planning endoscopic orbital decompression.
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