근거리‐원거리 사시각 불일치를 보인 외사시에서 양안 외직근 근경사후전술의 효과
The Effect of Bilateral Slanted Lateral Rectus Recession in Exotropia with Near-Far Disparity
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목적: 원거리보다 근거리 사시각이 큰 외사시에서 양안 외직근 근경사후전술의 효과를 알아보았다. 대상과 방법: 31명의 환자를 후향적으로 분석하였다. 17명은 근부착부의 위쪽은 원거리 사시각, 아래쪽은 근거리 사시각을 기준으로근경사후전술을 시행하였고, 14명은 위, 아래를 동일하게 후전하였다. 술 전, 후 1주일, 1개월, 3개월, 6개월의 사시각을 비교하여 근경사 후전술의 효과를 알아보았다. 결과: 술 후 6개월에 근거리 사시각은 근경사후전술 시행군에서 33.82PD에서 7.29PD로, 동일량 후전군은 33.67PD에서 11.13PD로 감소하였으며, 원거리 사시각은 25.59PD에서 2.59PD로, 23.67PD에서 4.00PD로 감소하였다. 근-원거리 사시각 차이는 근경사후전술의경우 10.29PD에서 4.71PD로, 동일하게 후전한 경우 9.67PD에서 7.93PD로 근경사후전술 시행군에서 유의하게 감소량이 많았다(p=0.002). 수술 성공률은 근경사후전술군에서 35%, 동일량후전군은 7%로 근경사후전술군이 유의하게 높은 성공률을 보였다(p ＜0.05). 결론: 근경사후전술은 사시각을 줄여줄 뿐만 아니라 근-원거리 사시각 차이를 기존의 후전술보다 감소시키므로 원거리보다 근거리사시각이 큰 경우 사용할 수 있는 효과적인 술식이다.
Abstract
Purpose: To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exodeviation with larger deviation angle at near than far fixation. Methods: A retrospective chart review was conducted of 31 patients. Seventeen patients underwent slanted LR recession,the upper fiber of the LR was recessed according to the distance deviation angle and the lower fiber was recessed according to the near deviation. Fourteen patients underwent classic recession. To evaluate the effect of slant LR recession,postoperative ocular alignment between them was checked at 1 week, 1 month, 3 months and 6 months after operation. Results: At the postoperative 6 months, bilateral slanted LR recession reduced the mean exodeviation at near from 33.82PD to 7.29 PD, and same amount recession group reduced 33.67 PD to 11.13 PD. The far deviation change was from 25.59 PD to 2.59 PD, 23.67 PD to 4.00 PD in each group. The change of near-distance difference was from 10.29 PD to 4.71 PD in slanted recession group, and 9.67 PD to 7.93 PD in same amount recession group, showed that slanted recession group reduced angle more significantly (p = 0.002). Success rate was 35% in bilateral slanted LR recession group,7% in classic recession group, showed that slanted recession group had significantly high success rate (p < 0.05). Conclusions: Bilateral slanted LR recession effectively reduces near and distance exodeviation angle, and reduces near-distance incomitance more superior to classic bilateral LR recession technique.
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