조절내사시 환아의 장기적 양안시성
Long‐Term Binocularity in Accommodative Esotropia
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초록
목적: 조절내사시 환아에서 장기적인 양안시성과 관련된 요소들을 알아보고자 하였다. 대상과 방법: 안경교정(이중초점안경 포함)만으로 근거리와 원거리 사시각이 8 프리즘디옵터 이하로 조절되고, 5년 이상 추적관찰이가능했던 조절내사시 환아 49명을 대상으로 하였다. 최종 입체시가 50초각 또는 그보다 좋고 중심융합이 있으며 망막중심오목억제가없는 환아를 두눈망막중심오목용합군, 그 외의 경우를 주변융합군으로 분류하고 두 군의 임상 요소를 비교 분석하였다. 결과: 두눈망막중심오목용합군 15명, 주변융합군 34명이었고, 추적관찰 기간은 평균 88.9 ± 25.4개월이었다. 두눈망막중심오목용합군은 주변융합군에 비해 발병 연령이 높고(p＜0.01), 사시에 노출된 기간이 짧았으며(p＜0.01), 초진 시(p＜0.01) 및 첫 안경교정 후(p ＜0.02) 간헐사시가 많았고, 첫 안경교정 후(p＜0.01) 및 최종 진료 시(p＜0.01) 원거리 사시각이 작았고, 약시가 적었다(p＜0.01). 결론: 장기적으로 우수한 양안시를 얻기 위해서는 조절내사시가 간헐적이고, 약시가 발생하기 전에 적절한 안경교정을 해 주어야 하며, 안경교정 후 작은 사시각을 유지하는 것이 중요할 것으로 생각된다.
Abstract
Purpose: To find clinical factors related to the long-term outcome of binocularity in accommodative esotropia. Methods: Forty-nine patients with accommodative esotropia who were followed over 5 years after successful optical alignment within 8 prism diopters of orthophoria at near and distance with glasses including bifocals were included. The patients who had stereo acuity better than 50 seconds/arc and central fusion without suppression scotoma at the final visit were divided into the bifoveal fusion group and the others were divided into the peripheral fusion group. Clinical factors were analyzed between the two groups (Chi-square test, student t-test). Results: Of the 49 patients, 15 patients were included in the bifoveal fusion group and 34 patients were included in peripheral fusion group. Mean follow-up was 88.9 ± 25.4 months. Clinical factors that were significantly related to the bifoveal fusion group were older age of onset, shorter duration of misalignment, intermittent esotropia at the initial visit and after initial optical correction, smaller residual deviations at distance after initial optical correction and at the final visit, and lesser amblyopia. Conclusions: To obtain better levels of long-term binocularity, optical correction should be done as early as possible, before the presence of constant eye misalignment or amblyopia, and the residual esodeviations after optical correction should be kept as small as possible.
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