큰 각의 외사시에서 수술 결과에 대한 분석
Surgical Outcomes of Large-Angle Exotropia
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목적: 3프리즘디옵터(PD) 이상의 큰 사시각을 보인 외사시 환자에서의 수술 결과 및 영향을 미치는 인자들에 대해 분석하고자 하였다. 대상과 방법: 30PD 이상의 외사시로 수술을 하였던 환자들 중 6개월 이상 추적관찰이 가능하였던 63명의 환자를 후향적으로 분석하였다. 근거리 및 원거리 편위각, 수술 시 나이, 수술 방법, 술 후 1주일, 1개월, 3개월, 6개월의 편위각을 분석하여 수술 성적 및 수술결과에 영향을 미치는 인자를 알아보았다. 결과: 술 전 편위각은 35PD 이상, 40PD 미만인 경우가 38.1%로 가장 많았다. 수술 방법은 양안 외직근 후전술 45명, 단안 외직근후전 및 내직근 절제술 16명, 세 근육 수술이 2명이었다. 정위에서 10PD 이내의 내사시 및 외사시인 경우를 성공으로 정의하였을 때성공률은 술 후 1주일 79.4%, 1개월 77.8%, 3개월 73.0%, 6개월 68.3%였다. 특히 술 전 편위각이 45PD 이상인 경우는 술 후 6개월성공률이 36.4%로 45PD 미만인 경우에 비해 성공률이 유의하게 낮았다. 술 후 1주일에 내사시를 보인 경우 술 후 6개월 성공률이의미 있게 높았으며(86.6%) 나이, 수술 방법은 수술 결과에 영향을 끼치지 않았다. 결론: 큰 각의 외사시 환자에서도 한번의 술식으로 술 후 6개월에 68.3%의 성공률을 얻을 수 있었으며 술 후 1주일에 10PD 이내의내사시를 보이는 것이 가장 이상적이었다. 다만 술 전 편위각이 45PD 이상인 경우 시간이 경과할수록 성공률이 감소하므로 수술 전계획 시 주의가 필요할 것으로 생각한다.
Abstract
Purpose: To examine the surgical results of large-angle exodeviations over 30 prism diopters (PD) and correlation factors influencing surgical outcomes. Methods: The authors retrospectively examined 63 patients with an exodeviation greater than 30 PD. All patients were examined for at least six months after the operation. Near and far deviation angles, age at operation, operation method, and alignment at postoperative one week, one month, three months and six months were analyzed as factors influencing the surgical outcome. Results: The preoperative deviation was 35 to 40 PD (38.1%) in most cases. Forty-five patients underwent bilateral lateral rectus recession, 16 patients underwent unilateral medial rectus resection and lateral rectus recession, and two patients underwent surgery on three different muscles. Success was defined as sustained alignment from esotropia 10 PD to exotropia 10 PD. The success rate was 79.4% at the first week, 77.8% at one month, 73.0% at three months, and 68.3% at six months postoperatively. In particular, the success rate was significantly lower at six months postoperatively in the group with exotropia greater than 45 PD (36.4%). The patients with esotropia on the first postoperative week showed a significantly high success rate (86.6%); however, neither the age at operation nor the operation method affected the surgical results. Conclusions: Large-angle exodeviations can be successfully approached with a single operation, with a success rate of 68.3% at six months postoperatively. Esotropia of less than 10 PD at the first postoperative week shows the most ideal surgical results. For patients having exodeviations greater than 45 PD, the success rate will decrease over time. Therefore,surgeons should carefully plan for large-angle exodeviation surgery.
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