수술 전 부분 가림 치료로 형태가 변화한 간헐외사시 환자의 수술 결과
The Surgical Outcome of Intermittent Exotropia with Type Conversion Subsequent to Preoperative Part-Time Occlusion Therapy
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목적: 수술 전 부분 가림 치료를 통해 바뀐 간헐외사시의 형태가 수술 결과에 어떤 영향을 미치는지 알아보고자 하였다. 대상과 방법: 총 140명의 간헐외사시 환자를 대상으로 초진 시 사시각을 바탕으로 간헐외사시의 형태를 조사한 뒤, 부분 가림 치료를시행 후 형태 변화 여부를 판정하였고, 형태 변화에 따른 수술 결과를 후향적으로 비교하였다. 결과: 초진 시 간헐외사시의 형태는 기본형 112명, 눈모음부족형 18명, 거짓눈벌림과다형 10명이었으며, 초진 시 평균 사시각은 원거리에서 25.42 ± 6.05PD, 근거리에서 26.19 ± 8.20이었다. 기본형과 눈모음부족형에서 가림 치료 후 근거리 사시각이 유의하게 감소하였다(p=0.045, p=0.03). 기본형에서 거짓눈벌림과다형으로, 눈모음부족형에서 기본형으로 변한 27명에서 수술 성공률이 89%로 그렇지 않은 113명에서의 성공률 69%보다 유의하게 높았다(p=0.033). 결론: 간헐외사시에서 수술 전 가림 치료로 근거리 사시각이 감소됨으로써 외사시 형태가 기본형, 눈모음부족형에서 각각 거짓눈벌림과다형, 기본형으로 변화된 경우가 그렇지 않은 경우보다 높은 수술 성공률을 얻는 것으로 나타났다.
Abstract
Purpose: To evaluate the effects of converted intermittent exotropia type with part-time occlusion therapy on final postoperative outcomes. Methods: The present study included 140 consecutive intermittent exotropia patients. On the patient’s first visit, the type of intermittent exotropia was determined according to the deviation angle. After preoperative part-time occlusion therapy, the type of intermittent exotropia was reevaluated. The surgical success rates of each group was compared retrospectively according to the converted type. Results: At the first visit, the basic type was the most prevalent (n = 112), followed by convergence insufficiency type (n =18) and pseudo-divergence excess type (n = 10). Mean deviation angle on the first visit was 25.42 ± 6.05 PD at distance and 26.19 ± 8.20 PD at near. There were significant changes in near deviation angle after part-time occlusion in patients with the basic and convergence insufficiency types (p = 0.045, 0.03, respectively). Twenty-seven patients who had converted from basic type to pseudo-divergence excess type and from convergence insufficiency type to basic type showed better surgical success rate (89%) than other patients (69%) (p = 0.033). Conclusions: Part-time occlusion therapy converts the type of intermittent exotropia by reducing near deviation angle and is related to a better surgical success rate.
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