고도원시 또는 정시를 가진 간헐외사시 환자의 수술 후 결과 비교
Surgical Outcomes of Patients with Intermittent Exotropia Exhibiting High Hyperopia and Emmetropia
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목적: 고도원시를 가진 간헐외사시 환자와 정시인 환자의 수술 전후 임상양상과 수술 결과를 비교하고자 하였다. 대상과 방법: 1999년 4월부터 2018년 1월까지 간헐외사시로 사시교정술을 받고 1년 이상 경과 관찰이 가능했던 환자의 의무기록을 후향적으로 분석하였다. 고도원시군과 정시군의 수술 결과를 비교하기 위해 수술 전 구면렌즈대응치가 +4.00디옵터(diopters, D) 이상의 고도원시를 가진 간헐외사시 환자들을 1군, 굴절 이상이 -0.50D to +0.50D 이내의 환자들을 2군으로 분류하였다. 두 군의 임상양상과 수술 결과를 비교 분석하였다. 결과: 전체 74명의 환자 중 1군은 24명이었고, 2군이 50명이었다. 1군에서 평균 원시 도수는 높은 눈이 +5.00D (+4.00 to +8.00D), 낮은 눈은 +2.81D (+0.00 to +7.25D)였다. 1군에서 수술 후 1년 동안의 평균 원시의 감소량은 원시 도수가 높은 눈이 +1.24D, 낮은 눈이 +0.90D로 수술 전에 비해 두 눈 모두 의미 있는 원시 감소를 보였다(p<0.001, p<0.001). 수술 후 1일째 측정한 사시각은 1군은 원거리 -1.25프리즘디옵터(prism diopters, PD), 근거리 0.21PD, 2군은 원거리 -4.62PD, 근거리 -2.16PD로 원거리와 근거리 모두에서 1군이 2군보다 내편위각이 작았으며 수술 후 1년째 외사시각과 수술 성공률은 두 군 간 유의한 차이는 없었다. 결론: +4.00D 이상의 고도원시를 동반한 간헐외사시 환자의 수술 후 1년째 수술 성공률은 정시인 경우와 의미 있는 차이가 없었다.
Abstract
Purpose: We analyzed the clinical factors and surgical outcomes of patients with intermittent exotropia exhibiting high hyperopia and emmetropia. Methods: Patients with intermittent exotropia who underwent strabismus surgery and were followed-up for at least one year between April 1999 and January 2018 were retrospectively reviewed. The patients were divided into two groups according to their preoperative spherical equivalent refractive error (SERE): a high hyperopia group (≥+4.00 diopters [D], group 1) and an emmetropia group (+0.50 to -0.50 D, group 2). The surgical outcomes of the groups were compared. Results: We enrolled 74 patients, of whom 24 and 50 were included in groups 1 and 2, respectively. In group 1, the mean SERE was +5.00 D (+4.00 to +8.00 D) in the more affected eye and +2.81 D (+0.00 to +7.25 D) in the better eye. In group 1, the changes in SERE at one year after surgery were as follows: +1.24 D in the worse eye and +0.90 D in the better eye (both, p < 0.001). The mean exodeviation at one day postoperatively for distance and near were -1.25 prism diopters (PD) and 0.21 PD, respectively, in group 1, and -4.62 PD and -2.16 PD in group 2. Thus, group 1 exhibited less exodeviation in terms of both distance and near than did group 2 on day one postoperatively. However, no significant group difference was evident at one year postoperatively. Conclusions: The surgical outcomes of intermittent exotropia patients with high hyperopia did not differ from those of patients with emmetropia.
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