눈모음부족형외사시에서 보정한 양안 외직근후전술과 증량한 단안 외직근후전술 및 내직근절제술의 수술 결과 비교
Comparison between Modified Bilateral Lateral Rectus Recession and Augmented Unilateral Recession-resection for Convergence Insufficiency Exotropia
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목적: 눈모음부족형 간헐외사시에서 보정한 양안 외직근후전술과 증량한 단안 외직근후전술 및 내직근절제술의 수술 결과를 비교해 보고자 하였다. 대상과 방법: 눈모음부족형 간헐외사시로 진단 받고 수술을 시행한 환자 37명 중 보정한 양안 외직근후전술을 시행한 13명을 bilateral lateral rectus muscle (BLR) 군으로, 증량한 단안 외직근후전술 및 내직근절제술을 시행한 24명을 unilateral recession-resection (R&R) 군으로 하여 비교하였다. 수술 성공은 수술 후 12개월째 측정한 근거리와 원거리 사시각이 모두 10PD 이내이며 근-원거리 사시각 차이도 10PD 이내인 경우로 정하였다. 결과: 수술 전 평균 사시각은 눈가림검사 후 BLR 군 원거리 사시각 29.9 ± 8.4PD, 근거리 사시각 42.3 ± 9.7PD, 근-원거리 사시각 차이 12.5 ± 3.2PD, R&R 군 각각 26.7 ± 5.8PD, 41.5 ± 7.4PD, 14.8 ± 4.3PD로 두 군 간에 유의한 차이를 보이지 않았다(p=0.235, p=0.987, p=0.123). 수술 후 12개월째 경과관찰 시 BLR 군 원거리 사시각 3.8 ± 5.1PD, 근거리 사시각 4.9 ± 6.1PD, 근-원거리사시각 차이 2.9 ± 5.9PD, R&R 군 각각 4.7 ± 6.1PD, 7.9 ± 6.6PD, 3.7 ± 5.1PD로 두 군 간에 유의한 차이를 보이지 않았다(p=0.708, p=0.162, p=0.632). 수술 후 12개월째의 수술 성공률은 BLR 군 76.9%, R&R 군 70.8%로 두 군 간에 유의한 차이는 없었다(p=0.690). 결론: 눈모음부족형 간헐외사시 환자에서 보정한 양안 외직근후전술은 증량 단안 외직근후전술 및 내직근절제술과 유사한 수술 성공률을 보였으며, 원거리 및 근거리에서의 사시각과 근-원거리 사시각의 차이를 감소시키는 데 효과적인 수술 방법이다.
Abstract
Purpose: To compare the surgical outcomes between modified bilateral lateral rectus muscle (BLR) recession and augmented unilateral recession-resection (R&R) for the convergence insufficiency intermittent exotropia (IXT). Methods: 37 patients with convergence insufficiency IXT were divided into two groups: 13 patients (underwent BLR recession) and 24 patients (underwent unilateral R&R). Success was defined as within 10 prism diopters (PD) at distance and near, and within 10 PD of the difference between them at postoperative 12 months. Results: After the patch test, the preoperative distance deviation angle in the BLR group was 29.9 ± 8.4 PD, and the near deviation angle was 42.3 ± 9.7 PD; the difference between them was 12.5 ± 3.2 PD. In the R&R group, the preoperative distance deviation angle was 26.7 ± 5.8 PD, and the near deviation angle was 41.5 ± 7.4 PD; the difference between them was 14.8 ± 4.3 PD (p = 0.235, p = 0.987, and p = 0.123). At the 12-month follow-up in the BLR group, the distance angle was 3.8 ± 5.1 PD, and the near deviation angle was 4.9 ± 6.1 PD; the difference between them was 2.9 ± 5.9 PD. In the R&R group, the postoperative distance deviation angle was 4.7 ± 6.1 PD, and the near deviation angle was 7.9 ± 6.6 PD; the difference between them was 3.65 ± 5.1 PD (p = 0.708, p = 0.162, and p = 0.632, respectively). The surgical success rate did not differ significantly between groups at 12 months postoperatively (76.9%: BLR group and 70.8%: R&R group; p = 0.690). Conclusions: Modified BLR recession showed a similar surgical success rate to augmented unilateral R&R, and was effective in reducing both distance and near exodeviation, and in decreasing the difference between distance and near deviation in convergence insufficiency IXT.
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