성장하면서 원시 감소가 나타난 +4.00디옵터 이상 원시 환아의 특징
Clinical Features of Children with +4.00 Diopters or More Hyperopia Weaning with Age
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목적: 성장하면서 원시가 감소한 고도원시 환아의 특징을 알아보고자 하였다. 대상과 방법: 조절마비굴절검사에서 적어도 한눈 구면렌즈대응치가 +4.00 diopters (D) 이상이며 3년 이상 경과 관찰한 환아 203명의 의무기록을 후향적으로 조사하였다. 성장하면서 1.50D 이상 원시가 감소한 군과 원시가 지속된 군으로 나누어 안경착용나이, 원시도수, 사시각, 조절눈모음비, 약시와 굴절부등 빈도를 비교하였다. 결과: 원시 감소군은 47명, 원시 지속군은 156명이었다. 평균 안경착용 시작 나이는 감소군 5.0 ± 2.3세, 지속군 4.1 ± 2.4세로 감소군이 늦었다. 처음 원시안의 평균 구면렌즈대응치는 감소군 6.29 ± 2.18D, 지속군 5.47 ± 1.38D로 감소군에서 의미 있게 높았고, 1년 후 감소군 4.83 ± 1.72D, 지속군 4.89 ± 1.55D였고, 최종 관찰 시기에는 감소군 3.15 ± 1.72D, 지속군 4.65 ± 1.56D였다. 감소군은 평균 3.9년 동안 3.14 ± 2.02D의 원시가 감소하였고 첫 1년에 감소량이 가장 많았다. 지속군에서 감소군보다 내사시 빈도가 의미있게 높았고, 원거리 내사시각과 원시교정 전후 근거리 내사시각이 모두 의미 있게 컸다. 약시와 굴절부등 빈도, 조절눈모음비는 두군 차이가 없었으나, 최종 관찰 시기에 약시 빈도는 감소군에서 지속군보다 의미 있게 낮았다. 결론: 내사시가 없거나 내사시각이 적고 약시가 호전된 +4.00D 이상의 고도원시 환아에서는 성장하면서 의미 있는 원시 감소를 기대해 볼 수 있겠다.
Abstract
Purpose: To evaluate the clinical features of children with high hyperopia weaning with age. Methods: The medical records of 203 children wearing spectacles due to hyperopia of +4.00 diopters (D) or greater in at least one eye based on the cycloplegic refraction and with follow-up for 3 years or more were reviewed. The patients were divided into those who showed a decrease in the spherical equivalent (SE) of 1.50 D or greater and those who maintained. The age of wearing spectacles, the magnitude of hyperopia, the angle of deviation, the ratio of accommodative-convergence to accommodation (AC/A), and the frequency of amblyopia and anisometropia were compared. Results: Forty seven patients with decreased hyperopia and 156 patients with sustained hyperopia were included. The decreased- group started to wear spectacles later than the sustained-group (5.0 ± 2.3 years vs. 4.1 ± 2.4 years). The mean SE of the hyperopic eye in the decreased-group was significantly greater at the initial visit than in the sustained-group (6.29 ± 2.18 D vs. 5.47 ± 1.38 D); was identical at the 1 year follow-up (4.83 ± 1.72 D vs. 4.89 ± 1.55 D); and significantly lower at the last follow- up (3.15 ± 1.72 D vs. 4.65 ± 1.56 D). In the decreased-group, the mean hyperopia of 3.14 ± 2.02 D decreased during a mean period of 3.9 years, especially during the first year after spectacle correction. At baseline, the frequency and angle of esotropia at both distant and near with/without hyperopic correction was significantly larger in the sustained-group. The frequency of amblyopia and anisometropia and the AC/A were identical between the two groups, while the frequency of amblyopia at the last follow- up was significantly lower in the decreased-group. Conclusions: Some patients with hyperopia of +4.00 D or greater who had none or a small angle of esotropia and improved amblyopia showed a decrease in hyperopia with age.
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