약시치료로 시력이 호전된 한 눈 굴절부등약시 환아의 입체시 평가
Stereoacuity after Successful Occlusion Therapy in Children with Anisometropic Amblyopia
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목적: 약시치료 후 시력이 회복된 한 눈 굴절부등약시 환아의 입체시검사 결과를 정상 소아와 비교하고 입체시검사 결과에 영향을 주는 요인에 대해 분석해보고자 하였다. 대상과 방법: 한 눈 굴절부등약시로 진단받고 안경 및 가림치료로 시력이 회복된 후 입체시가 시행된 약시 환아(약시군) 37명과 정상 소아 34명의 의무기록을 후향적으로 조사하였다. 약시군과 정상군의 임상 특성을 살펴보고, 각 군 간의 입체시(워트4등검사, 랑II검사, 티트무스검사, 티엔오검사)검사 결과를 비교 분석하였다. 또한 약시군의 입체시검사 결과에 영향을 주는 인자들을 분석하였다. 결과: 입체시 시행 시 나이, 성별, 평균 구면렌즈대응치, 정상안 logMAR 시력은 두 군 사이에 유의한 차이가 없었으나, 약시군의 최종약시안 logMAR 시력(0.04 ± 0.04)은 정상군(0.01 ± 0.02)에 비해 유의하게 나빴다(p=0.001). 약시군에서 정상 입체시를 보인 환자는 정상군에 비해 랑II검사, 티트무스검사, 티엔오검사 모두에서 유의하게 적었다. 랑II검사에서는 고도약시인 경우, 티트무스검사의 경우 최종 약시안의 시력이 나쁠수록 유의하게 입체시 저하를 보였다. 결론: 약시 환아는 안경착용 및 가림치료로 시력이 회복되었더라도 정상 소아에 비해 입체시가 낮았다. 약시 환아에서 치료 전 약시 정도와 치료 후 약시안의 시력은 입체시검사 결과에 영향을 주는 인자로, 좋은 입체시 획득을 위해서 고도약시의 환아 치료 시 더 주의를 기울이고 약시안의 최종 시력을 조금 더 좋게 회복하는 것이 도움이 될 것이다.
Abstract
Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity. Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group. Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test. Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.
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