눈벌림부족 환자에서 시행한 양안 외직근 접치기술의 결과
Outcomes of Bilateral Lateral Rectus Tucking in Patients with Divergence Insufficiency
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목적: 눈벌림부족은 원거리 주시 시 일치내사시 및 비교차복시를 호소하고 근거리에서 작은 각의 내사시 또는 정위를 보이며 외전장애를 보이지 않는 것을 의미한다. 눈벌림부족 환자에서 양안 외직근 접치기술을 시행한 후 수술 결과를 분석해 보고자 하였다. 대상과 방법: 눈벌림부족 증상 발현 후 최소 6개월 이상 원거리에서 복시와 일치내사시가 지속된 환자에서 프리즘적응검사를 포함하여 반복 측정된 모든 사시각 중 최대 원거리사시각을 기준으로 양안 외직근 접치기술을 시행한 후 수술 결과를 평가하였다. 결과: 대상은 24명이었으며 수술 후 추적 관찰 기간은 평균 14개월(1-48개월)이었다. 프리즘교대가림검사의 최대사시각은 원거리24.79 ± 8.15 prism diopter (PD), 근거리 15.45 ± 9.30 PD였고, 프리즘적응검사 후에는 원거리 28.50 ± 7.77 PD, 근거리 25.88 ± 8.07 PD로 증가하였으나 원-근거리 차이는 평균 3 PD 이하로 감소하였다. 수술 1년째까지 경과 관찰이 가능하였던 14명(58%)에서는 원거리에서 복시가 재발한 1명을 제외하면 최종 경과 관찰 시까지 복시나 내사시의 재발, 근거리에서 과교정이 발생한 경우는 없었다. 결론: 눈벌림부족 환자에서 1시간 프리즘적응검사로 측정한 최대 원거리사시각을 기준으로 양안 외직근 접치기술을 시행하면 근거리에서 과교정이나 원거리에서 저교정 없이 좋은 결과를 얻을 수 있을 것으로 생각된다.
Abstract
Purpose: Divergence insufficiency is characterized by esotropia at far distance with symptomatic diplopia, minimal or no deviation at near distance, and full ocular duction and version. We analyzed the results of bilateral lateral rectus (BLR) tucking in patients with divergence insufficiency. Methods: Surgery was performed on patients with persistent distance diplopia with esotropia for at least 6 months after diplopia onset. The surgical results were evaluated after BLR tucking based on the maximum angle of deviation at distance among all the angles of deviation measured repeatedly, including the results of the prism adaptation test (PAT). Results: 24 patients were included. The average follow-up period was 14 months (1-48 months). The maximum deviations measured by alternate prism and cover test before surgery were 24.79 ± 8.15 prism diopter (PD) at far distance and 15.45 ± 9.30 PD at near distance. The PAT revealed that, the far distance deviation increased to 28.50 ± 7.77 PD and that at near distance to 25.88 ± 8.07 PD, but the difference between the two values fell to less than 3 PD on average. In 14 patients (58%), followed-up for up to 1 year, we noted no recurrence of diplopia or esotropia, or near distance overcorrection, with the exception of one patient who developed diplopia recurrence at far distance. Conclusions: BLR tucking guided by the maximum distance deviation of the 1 hour PAT affords stable results in patients with divergence insufficiency without overcorrection at near distance or undercorrection at far distance.
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