위눈꺼풀뒤당김 환자에서 눈꺼풀올림근 후전술의 치료 효과
Surgical Outcome of Levator Recession for Correction of Upper Eyelid Retraction
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목적: 위눈꺼풀뒤당김 환자에게 국소마취하 눈꺼풀올림근후전술 시행 후 수술의 효과에 대해 분석한다. 대상과 방법: 12명 12안의 의무기록을 후향적으로 조사하였다. 술 후 위눈꺼풀의 높이, 대칭성을 기준으로 좋음, 양호, 불량으로 미관상결과를 평가하였다. 술 전과 술 후의 MRD1 (mm), 위눈꺼풀 비대칭, 눈꺼풀내림지연, 토끼눈, 안구 건조증 증상에 대해 비교하고, 재수술률도 알아보았다. 결과: 위눈꺼풀뒤당김의 발생 원인은 갑상샘눈병증 9안(75.0%), 안와거짓종양 2안(16.7%), 눈꺼풀처짐 술 후 과교정 1안(8.3%)이었다. 평균 27.7 ± 24.0개월(5-60개월)의 관찰 동안 11명(91.7%)에서 술 후 미용적 만족도가 좋음 또는 양호했다. MRD1은 술 전 6.3 ± 1.5mm, 술 후 3.2 ± 0.9 mm로 술 전에 비해 평균 3.1 ± 1.3 mm 감소하였고, 위눈꺼풀 비대칭, 토끼눈, 눈꺼풀내림지연도 유의하게 호전되었다(p＜0.001). 3안(25%)에서 과교정으로 인해 눈꺼풀올림근 전진술을 시행하였고, 11안(91.7%)에서 안구건조증상이 호전되었다. 결론: 위눈꺼풀뒤당김 환자에서 눈꺼풀올림근후전술은 미용적 만족도가 높고 술 후 2년 이상 안정적인 결과를 보이는 수술방법이다.
Abstract
Purpose: To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction. Methods: Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated. Results: Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean ± standard deviation of 27.7 ± 24.0months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 ± 1.3 mm from 6.3 ± 1.5 mm preoperatively to 3.2 ± 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry,lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession. Conclusions: Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.
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