속발외사시의 수술 결과 및 예후인자
Surgical Outcomes and Prognostic Factors of Consecutive Exotropia
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목적: 속발외사시의 수술 결과에 따른 임상양상을 비교하여 수술 예후인자를 분석해 보고자 한다. 대상과 방법: 1988년 7월 1일부터 2013년 12월 31일 사이에 내사시 수술 후 발생한 속발외사시로 수술을 시행 받은 환자 65명을 대상으로 처음에 있었던 내사시의 분류와 진단 나이, 내사시 수술의 방법과 시기, 외사시 수술의 방법과 시기, 내전장애의 유무, 약시의유무, 외사시 수술 전후의 사시각 등을 분석하였다. 결과: 속발외사시 수술 후 평균 경과관찰 기간은 5.1 ± 5.2년(0.5-17.4년)으로, 최종 경과관찰 시 50명(76.9%)에서 수술성공을 보였으며 속발외사시의 누적성공률은 수술 후 7.7년부터 68.2%로 일정해지는 양상을 보였다. 정위군과 재발군을 비교한 결과, 외사시 수술을 시행한 나이가 10세 이하인 경우가 재발군에서 많았으며(14.0% vs. 41.7% p=0.044), 외사시 수술 후 경과관찰 기간이 유의하게길었고(3.9년 vs. 8.6년, p=0.014) 재발하기까지 기간은 평균 16.9개월이었다. 수술 후 1주일째의 사시각이 정위군은 평균 0.5프리즘디옵터(prism diopters, PD)의 내편위, 재발군에서는 평균 4.5PD의 외편위로 유의한 차이를 보였다(p=0.047). 결론: 내사시 수술 후 속발외사시가 일찍 발생하여 어린 나이에 수술이 필요하였던 경우와 속발외사시 수술 후 1주일째 외편위가 있을때 속발외사시의 재발이 더 많은 것으로 나타났으며 속발외사시의 재발이 아주 늦게 발생하는 경우도 있으므로 장기적인 경과관찰이 필요하다.
Abstract
Purpose: In this study we evaluated the prognostic factors by comparing the clinical manifestation of consecutive exotropia after consecutive exotropia surgery. Methods: We performed a retrospective study of 65 patients who had surgery due to consecutive exotropia after esotropia surgery in Yeungnam University Medical Center between July 1988 and December 2013. The type of esotropia, age at diagnosis of esotropia, type of esotropia surgery, age at esotropia surgery, type of consecutive exotropia surgery, age at consecutive exotropia surgery, presence of adduction limitation, presence of amblyopia, and preoperative and postoperative angles of strabismus were analyzed. Results: The mean follow-up time after consecutive exotropia surgery was 5.1 ± 5.2 years and 50 of 65 patients showed successful surgical outcomes at the last follow-up. Cumulative success rate of consecutive exotropia remained stable postoperatively in 68.2% of patients after 7.7 years. When comparing the success group and the recurrent group, the age at consecutive exotropia surgery was significantly younger and mean follow-up time was significantly longer in the recurrent group. The mean interval between consecutive exotropia surgery and recurrence of exotropia was 16.9 months in the recurrent group. The mean angle of strabismus at postoperative 1 week was significantly different between the 2 groups; 0.5 prism diopters (PD) esodeviation in the success group and 4.5 PD exodeviation in recurrent group. Conclusions: Recurrence of consecutive exotropia frequently developed with younger age at consecutive exotropia surgery and exodeviation at postoperative 1 week. Recurrent consecutive exotropia should be observed for an extended period, thus requiring periodic long-term postoperative follow-ups.
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