영아내사시에서 술 후 장기관찰상 양호한 양안시를 기대하려면?
What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?
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목적: 영아내사시로 수술 받은 환자에서 장기관찰상 양호한 양안시를 획득하기 위한 술 전 및 술 후 관련 인자에 대해 알아보고자 하였다. 대상과 방법: 2000년 1월부터 2010년 12월까지 영아내사시로 진단받고 최소 3년 이상 추적관찰이 가능했던 40명을 대상으로 발병 및수술 시 나이, 술 전 사시각, 굴절이상, 약시, 하사근기능항진, 해리수직편위, 잠복안진 유무, 술 후 1주째 및 2년째 사시각, 성공률과재수술률, 술 후 입체시를 살펴보았다. 일차 술 후 3년째 400초각 이하의 입체시를 보일 때 양호군, 400초각을 넘는 경우 불량군으로분류하여 분석하였다. 결과: 전체 영아내사시 환자 40명 중 양호군은 47.5%, 불량군은 52.5%였다. 발병시 나이, 수술시 나이, 술 전 사시각, 굴절이상, 약시,하사근기능항진, 해리수직편위, 잠복안진의 동반 유무, 술 후 1주째 사시각에서는 두 군 간 통계학적으로 유의한 차이가 없었다. 만2세 이전에 수술한 27명 중 59.3%, 만 2세 이후에 수술한 13명 중 23.1%에서 술 후 3년째 양호한 입체시를 보였다(p=0.046). 술 후2년째 안위에서 10PD 내의 정위를 보인 경우가 양호군 68.4%, 불량군 38.1%였으며(p=0.039), 일차 술 후 3년 내 재수술 받은 경우는양호군 0.0%, 불량군 38.1%로 유의한 차이를 보였다(p=0.004). 결론: 영아내사시로 진단받고 만 2세 이전에 일차 수술을 시행 받은 환자에서 재수술 없이, 술 후 2년간 10PD 이내의 안구위치를 유지할 때 장기적으로 양호한 양안시를 획득했다.
Abstract
Purpose: To analyze pre- and post-operative factors associated with favorable long-term sensory outcome after surgicalcorrection for infantile esotropia. Methods: This study retrospectively examined 40 patients with infantile esotropia who underwent surgery from January2000 to December 2010. Clinical characteristics analyzed included age at onset, age at surgery, mean preoperative deviation,amblyopia on initial visit, other associated strabismus (Inferior oblique overaction (IOOA), dissociated vertical deviation(DVD), latent nystagmus), initial and subsequent postoperative motor alignment at 1-week and 2-year follow-up, recurrencerate, and stereopsis. Long-term sensory outcome was categorized as favorable (≤400 arcsec) or unfavorable(>400 arcsec). Results: The mean follow-up period was 92.53 ± 46.46 months. There were 19 patients (47.5%) in the favorable group and21 (52.5%) in the unfavorable group. There were no statistically significant differences between the groups with respect toage at onset or surgery, presence of amblyopia, and prevalence of IOOA and DVD, latent nystagmus, or initial postoperativealignment at 1-week. There was a tendency towards worse binocularity with larger preoperative angles of esodeviation,but it was not significant. Binocularity was significantly higher among those who had surgery at age ≤24 monthsthan at age >24 months. Orthotropic alignment within ±10 PD at 2-year follow-up was 68.4% in the favorable group and38.1% in the unfavorable group. Reoperation was performed on 8 patients (38.1%) in the unfavorable group and no patients(0.0%) in the favorable group. Conclusions: Surgical correction of infantile esotropia within the first 2 years of life and maintenance of orthotropic alignmentwithin ±10 PD without additional surgery with a minimum follow-up of 2 years may be associated with favorablelong-term sensory outcome in infantile esotropia.
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