4세 이상의 부분조절내사시에서 수술방법에 따른 결과 비교
Comparison of Outcomes According to Surgical Method in Partially Accommodative Esotropia in Patients Over 4 Years of Age
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목적: 4세 이상의 부분조절내사시에서 수술법에 따른 술 후 안구위치와 양안시기능을 알아보고자 하였다. 대상과 방법: 부분조절내사시 환아 중 조절마비굴절검사 후 원시값 전량교정 안경착용 후에 남아있는 비조절부분 사시각의 최대량을수술하는 기존수술군과 원시값을 완전교정하기 전과 후의 원거리 사시각의 평균값을 수술하는 증량수술군으로 나누어 술 후 사시각과입체시 변화를 술 후 24개월 이상 추적관찰한 66명의 결과를 비교분석하였다. 또한 기존수술군은 원시값 교정정도에 따라 원시완전교정군과 최대교정시력이 나오도록 원시값을 줄여서 교정한 원시감량교정군으로 나누어 비교하였다. 결과: 최종관찰 시 10프리즘디옵터 미만의 안구편위를 보인 정위군은 기존수술군에서 유의하게 많았으며, 기존수술군의 두 군 중 술후의 입체시는 원시감량교정군이 유의하게 좋았다. 또한 증량수술군에서는 술 후 과교정을 보인 환자의 75%에서 술 후 입체시가 악화되는 경향이 있었다. 결론: 4세 이상의 부분조절내사시를 수술할 때는 수술 결정시 술 후 안구위치뿐 아니라 입체시까지 고려한다면 최대시력이 나오도록원시값을 줄여서 처방한 안경을 착용한 후에, 기존수술법을 시행하는 것이 비교적 안전할 것으로 생각한다.
Abstract
Purpose: To compare postoperative outcomes according to surgical method in partially accommodative esotropia in patients over 4 years of age. Methods: We compared motor and sensory outcomes between conventional and augmented surgery in 66 patients. The postoperative follow-up period was at least 24 months. The formula for the amount of the rectus muscle recession was based on the distant angle deviation after hyperopic correction in the conventional group and the average amounts of the distant angle deviation with and without full correction of hyperopia in the augmented group. In addition, the conventional group was divided into 2 sub-groups to compare surgical outcomes. The A group consisted of patients who underwent surgery with the amount of surgical correction based on distant angle deviation after full hyperopic correction. The B group consisted of patients under the same condition after reduced hyperopic correction to achieve best corrected visual acuity (BCVA). Results: Among the patients who had an ocular alignment less than 10 PD, orthophoria was significantly higher in the conventional group than in the augmented group on the last follow-up. When comparing the 2 conventional sub-groups, the postoperative stereoacuity was better in group B than in group A. Among patients with a postoperative overcorrected alignment of more than 10 PD who underwent augmented surgery, 75% showed decreased postoperative stereoacuity compared to preoperative stereoacuity. Conclusions: In partially accommodative esotropia in patients over 4 years of age, conventional surgery compared to augmented surgery after reduced hyperopic correction is better in order to achieve BCVA for postoperative stereoacuity as well as ocular alignment.
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