스마트폰을 이용한 정량적 견인회선검사
Quantitative Forced Cyclorotation Testing Using a Smartphone
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목적: 한눈상사근마비 환자에서 스마트폰 애플리케이션을 이용하여 정량적 견인회선검사를 시행하고, 그 유용성을 알아보고자 하였다. 대상과 방법: 상사근마비수술을 받은 29명을 대상으로 수술 전 각막윤부에 기준점을 표시한 후 안구를 최대로 외회선, 내회선하여 촬영한 사진을 이용하여 검사자 2명이 2가지 스마트폰 애플리케이션으로 최대회선 범위를 측정하였다. 한눈상사근마비만 있는 군과 한눈상사근마비에 간헐외사시가 동반된 군으로 나누어 측정값을 비교하고, 수술 나이, 상사시각, 안저사진의 회선량과의 관련성을 알아보았다. 결과: 서로 다른 스마트폰 애플리케이션으로 두 검사자가 측정한 값의 급내상관계수는 0.989였다. 전체 마비안 최대외회선 범위는 46.1 ± 9.9°, 비마비안은 41.7 ± 7.6°로 마비안의 외회선 범위가 의미 있게 컸다(p=0.040). 전체 최대내회선 범위는 두 눈 차이가 없었다. 한눈상사근마비만 있는 18명의 마비안 최대외회선 범위는 47.0 ± 9.5°, 비마비안은 39.4 ± 6.3°로, 마비안이 의미 있게 더 외회선될 수 있었으나(p=0.010), 간헐외사시가 동반된 11명의 마비안은 44.5 ± 10.9°, 비마비안은 45.5 ± 8.3°로 의미 있는 두 눈 차이가 없었다. 최대내회선 범위는 두 군 간, 두 눈 간 의미 있는 차이가 없었다. 마비안의 최대외회선 범위는 수술 나이, 상사시각, 안저 외회선량과 의미 있는 상관관계가 없었다. 결론: 스마트폰을 이용하여 수동적인 안구회선 범위를 객관적으로 평가할 수 있었고, 한눈상사근마비만 있는 경우 최대외회선 범위의 두 눈 차이를 측정할 수 있었다.
Abstract
Purpose: To evaluate the utility of a quantitative forced cyclorotation test using a smartphone in patients with unilateral superior oblique palsy. Methods: Twenty-nine patients who underwent muscle surgery for superior oblique palsy were included. With patients under anesthesia prior to surgery, the 12 and 6 o’clock positions of the limbus were marked, the globe was maximally excyclorotated and incyclorotated, and photographs of the globe were taken in each position. The maximum angle of rotation was read by two masked observers using two different smartphone applications. Maximum excyclorotation and incyclorotation were compared between patients with superior oblique palsy alone and patients with both superior oblique palsy and intermittent exotropia; associations were evaluated regarding age at surgery, angle of hypertropia, and cyclotorsion on fundus photographs. Results: The intraclass correlation coefficient between the two readers was 0.989. The maximum excyclorotation of affected eyes was significantly greater than that of the fellow eyes (46.1 ± 9.9° vs. 41.7 ± 7.6°; p = 0.040). Maximum incyclorotation did not differ between the two eyes. The maximum excyclorotation of affected eyes of 18 patients with unilateral superior oblique palsy alone was significantly greater than that of the fellow eyes (47.0 ± 9.5° vs. 39.4 ± 6.3°; p = 0.010). The maximum excyclorotation of affected eyes of 11 patients with both superior oblique palsy and intermittent exotropia was similar to that of the fellow eyes (44.5 ± 10.9° vs. 45.5 ± 8.3°). Maximum incyclorotation did not differ according to group or eye. Maximum excyclorotation did not differ according to age at surgery, angle of hypertropia, or cyclotorsion on fundus photographs. Conclusions: New forced cyclorotation tests using a smartphone quantitatively assess the passive range of cyclorotation, and detect bilateral differences, particularly in patients with unilateral superior oblique palsy alone.
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