양안시 기능이 좋은 간헐외사시의 수술결과
The Surgical Outcome of Intermittent Exotropia with Good Binocular Function
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목적: 수술 전 양안시 기능이 좋은 간헐외사시 환자의 수술 성공률과 수술 후 양안시 기능을 알아보고자 하였다. 대상과 방법: 티트무스로 측정한 입체시력이 40초이고, 워트4등검사에서 융합이 가능하였던 간헐외사시 환자 중 수술 후 1년 이상 관찰된 38명을 대상으로 하였다. 수술 연령, 사시각, 시력, 근거리 입체시력 및 융합력을 조사하였다. 수술 후 각 시기에서 편위각이 10프리즘디옵터(PD) 이내인 경우를 수술에 성공한 것으로 정하였다. 결과: 수술 시 연령은 7.9세, 수술 전 원거리 사시각 25.5PD, 근거리 사시각 27.5PD, 수술 후 관찰기간 평균 22.9개월이었다. 수술성공률은 6개월째 81.6%, 1년째 68.4%, 최종 내원시 60.5%였다. 수술 후 입체시가 40초이고 융합이 가능한 환자는 44.7%, 입체시가100초보다 불량한 경우는 5.3%, 근거리 융합만 가능한 경우는 39.5%, 입체시가 200초보다 불량해지거나 융합력이 없어진 경우는18.4%였다. 결론: 수술 전 양안시기능이 좋은 간헐외사시에서도 가장 흔한 수술 실패 요인은 외사시의 재발임을 알 수 있었다. 또한 수술 전 양안시기능이 좋은 간헐외사시에서 수술 후 양안시 기능이 저하될 수 있으므로, 수술 후 양안시 유지에 주의하여야 함을 시사한다.
Abstract
Purpose: We investigated the success rate of surgery and binocular function after surgery in intermittent exotropia with good preoperative binocular function. Methods: Thirty-eight intermittent exotropia patients who had good stereopsis of 40 seconds according to the Titmus test,showed fusion by Worth-4-dot test preoperatively, and had at least 1 year of postoperative follow-up were included in the present study. The age at operation, angle of exodeviation, visual acuity, stereopsis with Titmus test and fusional status with Worth-4-dot test after surgery were analyzed. A surgical success was defined as postoperative angle of deviation less than 10 prism diopter (PD). Results: The patient mean age at the time of the operation was 7.9 years. The mean preoperative angle of exodeviation was 25.5 PD at far distance and 27.5 PD at near distance. The mean follow-up time was 22.9 months. The success rate of surgery was 81.6% at 6 months, 68.4% at 1 year and 60.5% on the last visit. Seventeen patients (44.7%) had stereopsis of 40 seconds and showed fusion at far and near distance after surgery. The stereopsis was worse than 100 seconds in 2patients (5.3%), and fusion was maintained at only near distance in 15 patients (39.5%). In 7 patients (18.4%), the stereopsis decreased to 200 seconds or worse, or there was no fusion after surgery. Conclusions: The recurrence of exodeviation was a major cause of the surgical failure in the intermittent exotropia with good preoperative binocular function. Moreover, binocular function may decrease postoperatively in intermittent exotropia with good preoperative binocular function, so careful follow-up may be required to maintain this function.
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