하사근기능항진이 없는 V형 외사시와 기본형 일치외사시의 수술 결과 비교
The Clinical Characteristics of V-Pattern Exotropia Without Inferior Oblique Muscle Overaction
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목적: 하사근기능항진이 없는 V형 외사시와 기본형 일치외사시의 수술 후 결과를 비교하고자 하였다. 대상과 방법: 하사근기능항진없이 V형 외사시로 외사시 수술과 V형 수평근전위술을 받은 V형 외사시군 15명과 기본형 일치외사시로수술 받은 일치외사시군 36명을 조사하였다. 수술 전 시력, 약시치료 유무, 이상두위, 입체시, 사시각, 수술 후 복시 지속기간을 조사하였다. 수술 후 정위 또는 10△ 이내의 사시각을 보이는 경우를 수술성공으로 정하였다. 결과: 80초보다 좋은 입체시를 갖는 경우가 V형 외사시군 11명(73.3%)으로 일치외사시군 12명(33.3%) 보다 더 많았다(p=0.01). 속발내사시는 V형 외사시군 1명만 술 후 1년까지 지속되었으며, 외사시의 재발은 수술 후 1년째 V형 외사시군 2명(13.3%), 일치외사시군 4명(11.1%)이었다. 최종 수술 성공률은 V형 외사시군 13명(86.7%), 일치외사시군 21명(58.3%)으로 V형 외사시군이 더 높았다(p=0.04). 결론: 하사근기능항진이 없는 V형 외사시에서 외사시 수술과 함께 V형 수평근전위술을 시행한 경우 기본형 일치외사시에 비하여 외사시의 재발률이 낮음을 알 수 있었다.
Abstract
Purpose: To compare the surgical outcome between V-pattern intermittent exotropia without inferior oblique overaction and comitant intermittent exotropia. Methods: The authors of the present study investigated 15 patients (V-pattern group) who had standard horizontal surgery with half-tendon width vertical transposition and 36 patients (Comitant group) with unilateral rectus muscle recession/resection. Preoperative visual acuity, presence of amblyopia, abnormal head posture, stereoacuity, amount of exotropia,and duration of postoperative diplopia were recorded. Surgical success was defined as final alignment of orthophoria or less than 10 PD orthophoria. Results: The frequency of good stereoacuity with 80 sec of stereoacuity or more was higher in the V-pattern group (73.3%)than in the Comitant group (33.3%) (Fisher’s exact test, p = 0.01). One case of V-pattern showed consecutive esotropia for 1 year postoperatively. Exotropia recurred in 2 patients in the V-pattern group (13.3%), and in 4 patients in the Comitant group (11.1%) 1 year postoperatively. Surgical success rates were statistically significant higher in the V-pattern group (86.7%) as compared to the Comitant group (58.3%) on final follow-up (Fisher’s exact test, p = 0.04). Conclusions: V-pattern exotropia patients without inferior oblique overaction who had standard horizontal surgery with half-tendon width vertical transposition showed a lower recurrence rate of exotropia than patients with comitant intermittent exotropia.
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