혈관성 및 특발성 후천마비사시의 회복 기간에 영향을 미치는 임상인자 분석
Clinical Factors Affecting Recovery Periods of Vascular and Idiopathic Acquired Paralytic Strabismus
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목적: 혈관성, 특발성 후천마비사시의 회복에 영향을 미치는 인자에 대하여 분석하였다. 대상과 방법: 혈관성 및 특발성 후천마비사시로 진단된 환자들의 의무기록을 후향적 분석하였다. 혈관성 원인은 고혈압, 당뇨, 고지혈증, 심혈관질환으로 정의하였다. 방문 시 정면주시 사시각, 안구운동제한 정도를 측정하였다. 회복은 복시가 없고 안구운동제한이 관찰되지 않는 것으로 정의하였다. 최종 방문일을 기준으로 회복 유무와 회복 기간에 영향을 미치는 인자들을 분석하였다. 결과: 혈관성 마비 환자는 87명(3번: 21명, 4번: 28명, 6번: 38명), 특발성 마비 환자는 58명(4번: 20명, 6번: 24명, 3번: 14명)이었다. 회복은 혈관성 마비에서 53명(60.9%), 특발성 마비에서 37명(63.8%)으로 유의한 차이를 보이지 않았고(p=0.15), 혈관성 마비의 회복 기간은 130.1 ± 145.1일로 특발성 마비의 92.6 ± 76.6일보다 길었다(p=0.02). 두 군에서 연령이 회복 기간과 유의한 상관성을 보였다(모두 p<0.05). 혈관성 마비의 회복 기간은 3번 107.4 ± 74.8일, 4번 97.2 ± 51.9일, 6번 159.3 ± 194.1일로 6번뇌신경마비의 회복 기간이 유의하게 길었다(p=0.03). 혈관성 6번뇌신경마비에서 고혈압이 회복 기간과 양의 상관관계를 보였다(OR=2.54, p=0.01). 결론: 혈관성 마비 환자의 복시 회복 기간이 특발성 마비 환자에 비해 길었으며 회복은 유의한 차이를 보이지 않았다. 혈관성 6번뇌신경마비에서 고혈압의 유무가 회복 기간과 유의한 상관관계를 보였다.
Abstract
Purpose: Clinical factors affecting the recovery period in patients with vascular or idiopathic paralytic strabismus were evaluated. Methods: This study involved a retrospective review of medical records of patients diagnosed with vascular and idiopathic acquired paralytic strabismus. Vascular paralysis was defined in cases of hypertension, diabetes mellitus, or cardiovascular disease. The angle of deviation and limitation of extraocular movement were evaluated at each visit. Recovery was defined as the absence of diplopia and complete resolution of limitation of extraocular movement. Factors affecting recovery success and recovery period were analyzed. Results: We retrospectively reviewed data of 145 patients consisting of 87 with vascular paralytic strabismus (cranial nerve [CN] III: 21, CN IV: 28, CN VI: 38) and 58 with idiopathic paralytic strabismus (CN IV: 20, CN VI: 24, CN III: 14). The recovery rate did not significantly differ between vascular (60.9%) and idiopathic (63.8%) groups (p = 0.15). The recovery period was longer in the vascular group (130.1 ± 145.1 days) than in the idiopathic group (92.6 ± 76.6) (p = 0.02). Age at onset was significantly associated with the recovery period in both vascular and idiopathic groups. In the vascular group, the recovery periods were 107.4 ± 74.8 days in CN III palsy, 97.2 ± 51.9 days in CN IV palsy, and 159.3 ± 194.1 days in CN VI palsy. The recovery period was significantly longer in patients with CN VI palsy (p = 0.03). Hypertension was significantly influencing the recovery period in patients with vascular CN VI palsy (odds ratio = 2.54, p = 0.01). Conclusions: The recovery period was longer in patients with vascular paralytic strabismus than in patients with idiopathic paralytic strabismus. Recovery rates were not significantly different between groups. In patients with vascular CN VI palsy, a history of hypertension was significantly associated with the recovery period.
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