갑상샘눈병증환자에서 내벽 안와감압술의 임상효과
The Clinical Result of Medial Orbital Decompression in Patients with Thyroid-associated Orbitopathy
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목적: 갑상샘눈병증환자에서 내벽 단독 안와감압술을 시행한 후 임상효과를 알아보고자 하였다. 대상과 방법: 갑상샘눈병증을 진단받은 환자들 중 2014년 1월부터 2017년 1월까지 미용적인 목적으로 내벽 안와감압술을 시행 후 1년 이상 추적 관찰이 가능한 28명(43안)을 대상으로 후향적 분석을 시행하였다. 의무기록상의 수술 전, 수술 3개월 후, 1년 뒤의 시력, 안압, 안구돌출 정도, 사시, 복시 유무에 대한 변화를 확인하였다. 결과: 내벽 안와감압술을 받은 환자들의 안구돌출 정도의 감소는 수술 3개월 뒤 2.99 ± 0.96 mm, 1년 뒤 3.07 ± 1.24 mm였으며, 각각 통계적으로 유의하였다(p<0.001, p<0.001). 그 중 단안 내벽 안와감압술을 시행 받은 환자는 수술 전 양안의 안구돌출 차이가 3.06 ± 0.78 mm에서 3개월 뒤 0.38 ± 0.44 mm, 1년 뒤 0.50 ± 0.46 mm로 유의하게 감소하였다(p=0.011, p=0.012). 수술 후 안압은 3개월 및 1년 뒤에 유의하게 감소하였다(p<0.001). 수술 후 수평 사시각은 수술 전 평균 0.88 ± 4.85PD 내편위에서 3개월 뒤 5.50 ± 6.74PD 내편위로 변화하여 유의한 내측 편위를 나타났으며(p=0.007), 2명의 환자에서 내사시가 새로 발생하였으나(8.33%) 수술적 치료가 필요한 경우는 없었다. 결론: 내벽 안와감압술은 비대칭적 안구돌출이 있거나 돌출 정도가 심하지 않은 환자에서 심각한 합병증 없이 덜 침습적인 방법으로 구돌출 감소에 좋은 효과를 얻을 수 있다.
Abstract
Purpose: To evaluate the clinical effects of medial orbital decompression in patients with thyroid orbitopathy. Methods: Forty-three orbits of 28 patients who underwent medial orbital decompression for cosmetic purposes between January 2014 to January 2017 were retrospectively reviewed. Changes in visual acuity, intraocular pressure, exophthalmos, strabismus, and diplopia were checked before, 3 months, and 1 year after surgery. Results: The average exophthalmos reduction was -2.99 ± 0.96 mm at postoperative 3 months and -3.07 ± 1.24 mm after 1 year (both, p < 0.001). In patients who underwent unilateral orbital decompression, the mean difference in exophthalmometry between the two eyes was significantly reduced from 3.06 ± 0.78 mm to 0.38 ± 0.44 mm after 3 months, and to 0.50 ± 0.46 mm after 1 year (p = 0.011 and p = 0.012, respectively). After surgery, the final postoperative intraocular pressure decreased significantly at postoperative 3 months and 1 year (both, p < 0.001). The mean preoperative horizontal deviation was 0.88 ± 4.85 prism diopters (PD) and 5.50 ± 6.74 PD at postoperative 3 months, which demonstrated significant esodeviation postoperatively (p = 0.007). Three patients had new onset esotropia (8.33%), but no surgical treatment was needed. Conclusions: Medial orbital decompression is a less invasive and safe surgical procedure for patients with asymmetric or mild thyroid-associated orbitopathy, which can be beneficial for reducing proptosis.
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