간헐외사시 재수술 후 발생한 속발내사시의 위험인자 및 임상양상
Clinical Course of Consecutive Esotropia after Surgery to Correct Recurrent Intermittent Exotropia
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목적: 간헐외사시 재수술 후 발생한 속발내사시의 임상양상을 분석하고 위험인자 및 예후 등을 알아보았다. 대상과 방법: 재발된 간헐외사시 수술을 시행 받은 34명의 환자에서 속발내사시의 발생빈도, 위험인자, 치료방법, 예후 등을 분석하였다. 결과: 전체 환자 34명에서 12명이 재수술 후 한 달 이후에도 지속되는 속발내사시가 발생하였고 22명은 속발내사시가 발생하지 않았다. 재수술 전 나이, 사시각, 굴절력, 부등시, 바깥쪽불일치, 회선 ․ 수직근기능이상 여부는 속발내사시의 발생에 영향이 없었으나 술 후 1일째 16프리즘디옵터(prism diopter, PD) 이상의 내편위가 보이거나 재수술 방법으로 한 눈 외직근후전술과 내직근절제술을 시행 받은 경우에는 속발내사시가 잘 발생하였다(p<0.05). 속발내사시가 발생한 환자 12명에서 10명이 가림치료와 프레넬프리즘 착용 등의 보존적 치료를 시행하여 내사시가 개선되었다. 결론: 간헐외사시 재수술 후 발생한 속발내사시는 한 눈 외직근후전술과 내직근절제술을 시행 받거나 수술 후 1일째 내사시각이 16PD 이상인 경우 잘 발생하였다. 반면 보존적 치료에는 잘 반응하여 예후는 좋았다.
Abstract
Purpose: To analyze the clinical aspects of consecutive esotropia after intermittent exotropia reoperation and study the prognosis and associated risk factors. Methods: The present study included 34 patients with intermittent exotropia who underwent reoperation; incidence rate, risk factors, treatment methods and prognosis of the postoperative consecutive esotropia were analyzed. Results: Of the 34 patients, 12 developed consecutive esotropia that persisted longer than a month after the reoperation; a higher incidence rate was observed in patients with esodeviation greater than 16 prism diopter (PD) on postoperative day 1 and in patients who received unilateral lateral muscle recession and medial muscle resection during the operation (p < 0.05). Conversely, factors such as age, deviation angle, refractive power, anisometropia, lateral incomitance and oblique muscle dysfunction prior to the reoperation did not affect the incidence of consecutive esotropia. The patients who developed consecutive esotropia received conservative treatments such as alternative occlusion therapy and fresnel prism wearing; 10 of 12 patients showed significant clinical improvements. Conclusions: Consecutive esotropia frequently occurs after intermittent exotropia reoperation if the patient had esodeviation greater than 16 PD on postoperative day 1 or received unilateral lateral muscle recession and medial muscle resection. The conservative treatments of the consecutive esotropia showed good clinical response and improved prognosis.
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