간헐외사시 수술의 장기적인 결과
Long-Term Outcome of Surgery for Intermittent Exotropia
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목적: 간헐외사시에서 수술의 장기적 결과 및 효율성과 안전성을 알아보고자 하였다. 대상과 방법: 간헐외사시 술후 5년 이상 추적관찰이 가능했던 78명을 대상으로 하였다. 술후 최종방문시의 원거리사시각이 ≤10PD이면안정군, ＞10PD이면 재발군으로 분류하였다. 재발군은 다시 원거리사시각이 ＜20PD이면서 원거리편위조절정도가 양호이면 임상적성공군, 그 이외에는 실패군으로 나누어 재발률, 성공률, 임상양상을 분석하였다. 결과: 외사시 재발률은 51명(65.3%), 안정군과 임상적 성공군을 합한 수술 성공률은 57명(73%)이었다. 93.6%가 술전에 비해 외사시각이 감소했고 술후 원거리편위조절정도는 66.7%가 유지, 30.8%가 개선, 2.6%만이 악화되었다. 근거리 입체시는 5.1%가 악화, 나머지는유지 또는 개선되었다. 수술시 연령은 재발군에서 안정군에 비해 유의하게 어렸고(p=0.004) 술전 원거리융합조절정도가 불량하였다(p=0.021). 술후 1, 3, 6개월의 외사시각이 재발군에서 안정군에 비해 컸다(p＜0.005). 결론: 높은 재발률에도 불구하고 간헐외사시 수술의 임상적 성공률, 사시각 감소와 감각기능의 유지 및 개선에 대한 장기 효율성과안전성은 높은 것으로 나타났다.
Abstract
Purpose: To evaluate long-term outcomes of surgery for intermittent exotropia. Methods: The authors evaluated 78 patients who underwent surgery for intermittent exotropia and were available for a follow-up over a 5-year period. According to distant exodeviation and fusion control at the last visit, the patients were classified into either the stable group (distant exodeviation ≤10 PD) or the recurrent group (distant exodeviation >10 PD). The recurrent group was reclassified into the clinical success group (distant exodeviation >10 PD, <20 PD with good fusion control)or the clinical failure group (distant exodeviation ≥20 PD or distant exodeviation >10 PD, <20 PD with poor fusion control). We analyzed recurrence rate, success rate, and clinical outcome. Results: Recurrence rate was 65.3% (n = 51), and the surgical success rate calculated as the rate of stable group and clinical success group was 73% (n = 57). The postoperative angle of exodeviation was more decreased than the preoperative angle in 93.6% of patients. When comparing postoperative with preoperative sensory function, only 2.6% of patients demonstrated worse distant fusion control grades, 66.7% of patients remained the same, 30.8% improved, and 5.1% of patients demonstrated poorer near stereopsis. The rest of patients had better or equal fusion control and stereoacuity. Age at surgery in the recurrent group was less than in the stable group (p = 0.004) and the recurrent group had worse preoperative distant fusion control (p = 0.021). Exodeviation angle of the recurrent group at postoperative 1 month, 3 months and 6 months was greater than that of the stable group (p < 0.005). Conclusions: Despite a high recurrence rate, surgery for intermittent exotropia showed a high clinical success rate and good long-term efficacy and safety in both deviation angle and sensory function.
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